Theses (MSc. Public Health)

Background: University students of the current generation face a plethora of stressors including family, academics, finances and social. Research indicates that academic stressors can affect eating habits in various ways. Students tend to eat an unbalanced meal or have diets consisting of too much starch, sugar and fat. Unbalanced nutrition due to stress can contribute to the development of diseases and impact their cognitive abilities. The prevalence of obesity has been on a rise in Malaysia and the prevalence of overweight and obesity had increased by 80 percent and 70 percent respectively in just under two decades. Objective: This study aims to determine the association of academic stressors and eating behaviours among students in a private university in Kuala Lumpur, Malaysia. Methodology: A cross-sectional quantitative research study was conducted among 183 pre-university students. Students were emailed an online questionnaire after systematic random sampling. The academic stressors of the subjects were assessed using the Academic Stress Questionnaire comprising of four categories of stressors: personal, relating to other people, environmental and scholarly. The Three Eating Factor Questionnaire Revised-18 Items was used to determine the eating behaviours of students which was categorised into: cognitive restraint, uncontrolled eating and emotional eating. Results: The results of this study were significant as there is an evidence of association between academic stressors and eating habits. The increase in academic stressors increases Cognitive Restraint, Uncontrolled Eating, and Emotional Eating. The results of the Pearson Correlation test reveal the mean of academic stressor to be 3.48 and mean of eating behaviour to be 2.23. R- value and p- value are 0.455 and 0.000 respectively. There is a positive correlation and statistically significant difference between both variables. Conclusion: The findings of this study illustrate the need for university initiatives focusing on academic stressors to combat unhealthy eating habits that hamper the wellbeing of students and may progress to disease. This may include revision of curriculum where there is shift away from exam assessments and more towards coursework. Other strategies could include support groups and awareness workshops. Keywords: Academic Stressors, Eating Behaviour, Students

Background: Work-related stress is a significant issue among nurses globally, impacting their well-being and the quality of healthcare services. This study focuses on assessing the risks of work-related stress among nurses at King Fahad Hospital in Jeddah, Saudi Arabia. King Fahad Hospital was chosen for its status as one of the largest and busiest tertiary care hospitals in the region, representing the high-pressure healthcare environments typical of many Saudi hospitals, which are known to contribute to nurse stress due to heavy patient loads and long working hours. Objective: The primary objectives of this research were to estimate the risks of work-related stress hazards, explore the differences between demographics and workplace characteristics, and identify predictors of work-related stress among the nursing staff at King Fahad Hospital. Methods: A quantitative cross-sectional study was conducted, involving 262 registered nurses from non-critical wards at King Fahad Hospital. Data were collected using the Health and Safety Executive Management Standards Indicator Tool (HSE-IT), which measures potential stress hazards across seven dimensions: demands, control, manager support, peer support, relationships, role, and change. Statistical analyses, including the Mann-Whitney U test and logistic regression, were performed using SPSS to identify significant differences and predictors of work-related stress Results: The study revealed high levels of work-related stress among the nurses, with the highest risk factors being demand (Mean = 3.2, SD = 0.5) and role clarity (Mean = 3.7, SD = 0.8). Logistic regression analysis identified several significant predictors of work-related stress. Male nurses were 3.02 times more likely to experience stress related to job demands compared to female nurses (AOR = 3.02, 95% CI: 1.55–5.87, p = 0.001). Younger nurses (≤30 years) had 2.38 times higher odds of experiencing stress from job demands compared to older nurses (AOR = 2.38, 95% CI: 1.28–4.43, p = 0.006). Additionally, nurses with higher educational attainment (undergraduate or above) were 2.21 times more likely to report stress due to lack of job control compared to those with a diploma (AOR = 2.21, 95% CI: 1.14–4.27, p = 0.019). Nurses working longer hours (48 hours per week) had 3.14 times higher odds of experiencing stress related to peer support (AOR = 3.14, 95% CI: 1.68–5.87, p < 0.05), and shift workers were 5.17 times more likely to experience stress compared to those working fixed hours (AOR = 5.17, 95% CI: 2.14–10.82, p < 0.01). These findings suggest that targeted interventions are needed to support younger nurses, male nurses, and those working longer hours or shifts. Conclusions: The findings highlight the urgent need for targeted interventions to mitigate work-related stress among nurses at King Fahad Hospital. Broader implications extend beyond this hospital, as the challenges faced by nurses in Saudi Arabia are reflective of similar issues in other high-pressure healthcare environments globally. Addressing work-related stress through supportive policies, improved workplace relationships, clear role definitions, and organizational changes is crucial for enhancing nurse well-being and ensuring the delivery of high-quality patient care across the healthcare sector. Keywords: Work-related stress, nurses, healthcare, King Fahad Hospital, Saudi Arabia, HSE Management Standards, risk assessment, demographic predictors, workplace characteristics.

Dyslipidaemia is a highly prevalent and asymptomatic disorder that warrants blood lipid screenings to identify at-risk individuals and to prevent the development of vascular diseases. Various predisposing, enabling and need factors have been described in literature to elucidate the inclination of an individual to perform medical screenings. The objectives of this study were to determine the level of knowledge about dyslipidaemia, to determine the association between the level of knowledge about dyslipidaemia and the frequency of lipid testing, and to determine the personal and healthcare related factors in relation to predisposing, enabling and need factors that are associated with the frequency of lipid testing among adults aged 30 and above, residing in Taman Selatan, Klang, Selangor, Malaysia. Methods: A cross-sectional survey was carried out amongst 314 residents of Taman Selatan from September 2022 to October 2022. Participants were selected via systematic random sampling and were administered a paper-based 42-item bilingual questionnaire, that assessed the predisposing, enabling and need factors, in terms of the respondent’s sociodemographic characteristics, knowledge about dyslipidaemia, belief and attitude towards screening, and healthcare related factors that may influence lipid testing practice, as measured by the lipid testing frequency of Malaysian adults aged 30 and above, residing in Taman Selatan, in the past year. Results: Out of the 314 residents approached, 271 responded to the questionnaire yielding a response rate of 86.31%. The median and interquartile range for total dyslipidaemia knowledge score was found to be 5 and 1 respectively. A medium positive correlation was identified between total dyslipidaemia knowledge score and frequency of blood lipid testing (r=0.447, p<0.001). Four variables, namely total knowledge score (OR=1.385, 95% CI = 1.112, 1.726), respondent’s belief and attitude, in terms of fatalistic attitudes, fear and perception of good health (OR=0.276, 95% CI = 0.132, 0.575), ethnicity, specifically Chinese (OR=0.458, 95% CI = 0.225, 0.933), and lower income group (OR=3.428, 95% CI = 1.379, 8.525) were found to be statistically significantly associated with the frequency of lipid testing. Conclusion: The sample had below average knowledge level about dyslipidaemia. Higher knowledge score and low monthly income were associated with frequent lipid testing. Higher fatalistic attitudes, fearfulness and perception of good health correlated to a decrease in lipid testing frequency. Respondents of Chinese ethnicity were found to be associated with a lower lipid testing frequency. Key words: Dyslipidaemia, knowledge, lipid testing, practice, frequency.

Introduction: Call centers are known to have high-pressure and stressful work environments. This frequently results in physical, mental and social health problems. Nevertheless, only few studies have assessed the well-being status of the call center employees in Malaysia. This study aimed to assess the health-related quality of life (HRQoL) of call center employees in Malaysia and further examine its association with socio-demographic factors, job characteristics, occupational stress and job satisfaction. Methodology: A cross-sectional study was conducted among 116 call center employees in Kuala Lumpur, Malaysia. Stratified random sampling method was carried out and employees that met the selection criteria were invited to participate into the study. The health-related quality of life was the dependent variable while socio-demographic, job characteristics, job satisfaction and occupational stress were the independent variables. Data analysis was performed using SPSS 23. Obtained scores were analyzed with the help of ANOVA and two-tailed independent samples ttest Results: The study population comprised of 65.5% female and 34.5% male. The overall mean SF-36 score was 60.74, lower than the Malaysian general population score (65). Results suggest the socio-demographic factors were not statistically significant associated with the overall HRQoL but statistically significantly associated with at least one of the eight domains of the SF- 36 (p<0.05). There was statistically significant association between job characteristics – call duration, duration of employment and choice to work in a call center- with the overall HRQoL among the employees (p<0.05). The study reveals a positive relation between job satisfaction and HRQoL. Moreover, occupational stress is negatively related with the HRQoL among the call center employees. Conclusion: The study found that the call center employees in Malaysia had a slightly lower HRQoL than the general Malaysian population. While occupational stress and job satisfaction influences the overall HRQoL, the socio-demographic and job characteristics influences at least one of the eight SF-36 domains. Keywords: Health related quality of life, call center, occupational stress, job satisfaction, job characteristics

Objective: The objectives of this study were to investigate the types and purpose of social media use, estimate the prevalence of social media use and determine the association between social media use and psychological effects among university students. Methodology: A cross-sectional study was carried out in International Medical University among 12 Undergraduate programmes for a period of three months in 2018 with 396 respondents. Proportionate random sampling was carried out using the students name list. Data was collected using a self-administered questionnaire with three parts (socio-demographic, types and purpose of social media use and DASS-21). Social media use (dependent variable) was measured by the frequency of site-checks across five social media (Facebook, Instagram, SnapChat, YouTube and Twitter) per week and converted to a global score of 0 to 1050. While respondents with scores higher than 280 were categorized as high social media use. Independent variable this study includes socio-demographics such as gender, age, and course, types and purposes of social media use. Results: Results showed that 50.8% (95% CI: 49.5, 55.7) of respondents were considered to be high social media use. Depression is found to be significantly associated with high social media use (p < 0.05). The most used social media is YouTube (93.9%) followed by Facebook (89.4%). Majority of the respondents (88.4%) used smartphone to access social media, and 88.8% used more than two social media sites among the five. Other results showed that Instagram users reported more body image concerns while/after using the site. Whereas more YouTube users reported feeling motivated while/after using the site. Conclusion: Social media is an indispensable tool for students to communicate and engage with friends and family, search for information, and for self-expression. However, overusing social media might cause undesirable effects on their psychological well-being. Therefore, awareness should be raised among users of social media of these negative effects and public health talks targeted at them should be held. Keywords: Social media, Psychological effects, university students

Objective: The objective of this study was to determine the immunization status and the barriers to childhood immunization among the Rohingya refugees in Klang, Selangor, Malaysia. Methodology: A cross-sectional study was conducted among 150 mothers of Rohingya refugee children aged 6 months to 5 years old residing in Taman Sentosa and Kampung Sungai Pinang during the study period of two weeks in March 2015. Stratified random sampling method was carried out and mothers who met the selection criteria were recruited into the study. A face to face interview was done to determine the immunization status of children and to identify the barriers to immunization. Results: The prevalence of ‘no immunization’ and ‘incomplete immunization’ in this study was 3.3% and 37.9% respectively. In the univariate analysis, variables that were significantly associated with incomplete immunization included: child’s place of birth, child’s documentation status, length of stay of the mother in Malaysia, fathers’ level of education, mothers’ first source of information about childhood immunization, whether or not mothers knew the immunization schedule, inconvenient clinic working hours, unfriendliness of healthcare providers and lack of time. After the multivariate analysis, child’s documentation status, child’s age, length of stay of the mother in Malaysia, and whether or not the mothers knew of any diseases which can be prevented through immunization were independently associated with incomplete immunization. Conclusions: The findings in this study suggested that Rohingya refugee children who do not have the UNHCR card and those less than 24 months of age are more likely to have incomplete immunization. Also, Rohingya refugee mothers who have been living in Malaysia for less than 4 years and mothers who do not know of any diseases which can be prevented through immunization are more likely to have children with incomplete immunization. Key words: Barriers, Vaccination, Immunization, Rohingya refugees, Malaysia.

Background: Drug abuse is a significant social problem and public health concern. A change in philosophy and direction to make drug abuse a medical problem is needed. It should start with positive change of mindset of the healthcare providers. Accurate information must be cascaded to communities to fill the great gap between scientific evidence and perception on drug abuse and addiction. Objectives: To determine the medical student's beliefs, attitudes, and agreement with treatment towards drug abuse. Their beliefs and attitudes may influence their perceptions of individual with drug use disorders, ability to use specific intervention techniques, and likelihood of consenting to treatment strategies. Materials and Methods: This is a cross-sectional study carried out in the International Medical University, using self-administered questionnaire. Samples were selected by simple random sampling using Microsoft Excel. Section A consists of four demographics items. Section B comprised of 12-items of attitude subscales questionnaire, Section C comprised of 7-items of belief subscales questionnaire, and Section D comprised of 5-items on agreement to treatment questionnaire. The independent variable is agreeing to drug abusers deserve treatment. The dependent variable is disease and psychosocial model beliefs. Statistical Analysis: Data was analysed using Statistical Packages for the Social Sciences (SPSS). Demographics data were analysed for frequency, percentage, mean, and standard deviation (SD). PROCESS macro for SPSS was utilised for mediation analysis. Results: 95 medical students participated. Scores for beliefs in disease and psychosocial models, and attitudes towards drug abuse were middling-to-high. Relationship between beliefs and outcome of agreeing to drug abusers deserving treatment was mediated by attitudes towards drug abusers. More exposures in clerking and observing drug abuse cases leads to less negative attitudes towards the abusers Conclusions: Medical students in clinical year of the IMU is not ready to be the change agent to promote drug abuse and addiction as a medical disease. More teaching and learning activities with additional clinical contact hours will help to build positive attitudes among these medical students. Key Words: Substance use disorders, Substance abuse, Drug dependence, Disease model, Psychosocial model

Objective: The main aim of the study is to determine Birth Preparedness and Complication Readiness (BPCR) and its associated factors among pregnant women attending two antenatal clinics in rural and urban settings in Kano, Nigeria. Methodology: A cross-sectional study was conducted among 397 antenatal clients, who visited Aminu Kano Teaching Hospital and Maryam Sani Abacha General Hospital, Gezawa during the study period of six weeks, four days from 15th September to 30th October, 2015. A sampling by convenience was carried out on the patients who met the selection criteria and were recruited into the study. A face to face interview was conducted and questionnaires were filled to detect the prevalence of Birth Preparedness and Complication Readiness and its associated factors. Results: This study established the prevalence of Birth Preparedness and Complication Readiness among the pregnant women in rural and urban areas to be 39.4% and 94.7% respectively. The factors that were statistically significantly associated with Birth Preparedness and Complication Readiness were age, education, gestation age and antenatal clinic visitation, but only education and gestation age were found to be good predictors of Birth Preparedness and Complication Readiness. Other factors had no significant association with Birth Preparedness and Complication Readiness. Knowledge of danger signs was found to be very low in both rural (0.8%) and urban (5.7%) settings. Conclusion: This study established the prevalence of Birth Preparedness and Complication Readiness among the pregnant women in rural and urban areas to be 39.4% and 94.7% respectively. The prevalence of knowledge of danger signs of pregnancy was found to be significantly low in both rural (0.8%) and urban (5.7%) women with the most common danger sign known being vaginal bleeding and the least being prolonged labour beyond 12 hours. Multivariate analysis revealed education level and gestation age as the factors that were significantly associated with Birth Preparedness and Complication Readiness. Those with higher education level were found to be more likely prepared than those with lower education status. Finally, those at 27 to 40 weeks’ gestation age were found to be more likely prepared than those with pregnancy at 16 to 26 weeks’ gestation age.

Introduction: Bullying in school is prevalent in many countries around the world. The impact of bullying gives out negative consequences such as depressive symptoms towards psychological health and development of adolescents. More research in bullying victimization and depressive symptoms among adolescents needed in Malaysia. Objective: To determine the relationship between bullying victimization and depressive symptoms among secondary school students. Methodology: This cross-sectional study was conducted among 355 students from two secondary schools in Simpang Ampat, Penang. The study was conducted for two weeks in March 2015. Stratified simple random sampling was used to select the respondents. Self-administered questionnaire that contains socio-demographic variables, perceived academic performance, Adolescent Peer Relation Instrument scale and Center for Epidemiological Studies Depression Scale for children were used to detect the prevalence and variables that were associated. Results: Significant association was found between bullying victimization and depressive symptoms. Physical, verbal and social bullying victimization were significantly associated. Variables that were significantly associated with bullying victimization were age, father’s education level and perceived academic performance. Gender, perceived academic performance and social bullying victimization were statistically significant with depressive symptoms. Conclusion: The prevalence of bullying victimization was 82.8% and out of this proportion, 54.5% of secondary school students were found to have depressive symptoms. Being a female student, those who perceived below average for their academic performance and socially bullied were the statistically significant variables of depressive symptoms among secondary school students under the multivariate analysis. These significant variables are important for the development of intervention programs to prohibit negative effects towards adolescents. Awareness campaign about the nature of bullying and its effects among secondary school students needed. Keywords : Bullying victimization, depressive symptoms, secondary school students

Background: Shortage and disproportionate distribution of specialists is a major concern for healthcare and public health in Malaysia. The nature of medical specialization pathway in Malaysia is also continuously evolving over the years. The house officers' career specialty preference has implications for the healthcare system particularly in future distribution and availability of specialist manpower in this country. Understanding the junior doctor’s specialty preference and the factors contributing to their choice will be beneficial for specialist workforce provision to cater to the growing population's health need for specialist care. Aims: The objectives of this study were to identify the preferred choice of specialist training among house officers and to determine the factors associated with their choice. This study also aimed to qualitatively identify the young doctor's perception on specialist training opportunities and to explore in depth the motivational factors for their career specialty preference. Methodology: This was a mixed methods study with exploratory sequential design conducted for 6 months from July 2020 to December 2020. Qualitative method involved audio recorded in-depth interviews among seven house officers of a tertiary care hospital to explore their perception on specialist training opportunities in Malaysia and the motivational factors for their career specialty preference. The interview recordings were transcribed with the aid of Microsoft Word 365 dictation tool and thematically analysed with the aid of NVIVO version 1.0 (2020) software. Questionnaire with 33 scale items of motivational factors for career specialty preference was developed based on the qualitative findings, validated, and distributed to randomly selected 262 house officers from the same hospital in the quantitative phase. Exploratory factor analysis was done based on 185 responses from the main quantitative study before proceeding with the hypothesis testing. Quantitative data on socio demographic characteristics, choice of specialist training and motivational factors were analysed using descriptive statistics (proportion, mean and standard deviation). For inferential statistics; bivariate comparison, univariate analysis and multivariate analysis (multinomial logistic regression) were done to determine the factors associated with the choice of specialist training. For quantitative data analysis Statistical Package for the Social Sciences (SPSS) version 26 was utilized. Results: Two major themes identified from qualitative were 1) Perception of specialist training opportunities (with two subthemes; i. Advantages of specialist training and ii. Perceived challenges of specialist training in Malaysia) and 2) Motivational factors for their career specialty choice (with seven subthemes; i. Work schedule, ii. Patient care characteristics, iii. Specialty characteristics iv. Personal factors, v. Past work experience, vi. Training factors, vii. Career prospects). There were 185 respondents for the cross-sectional questionnaire survey. Overall Cronbach's alpha for pre-test, main study and post exploratory factor analysis were 0.82, 0.85 and 0.83. Exploratory factor analysis done on 185 responses from main study retained 26 items out of 33 items in 7 constructs with 64.9% variance. House officers' first choice of specialty were medical based specialties (40.5%), followed by surgical based specialties (31.5%) and primary care or community health related specialties (14.6%) and acute care-related specialties (13.5%). By multivariate analysis, "age", "health professional in family", "work schedule and personal factors", "career prospects" and “specialty characteristics” were the significant factors associated with specialty choice. Conclusions: The factors influencing the specialty choice vary according to the specialties. The information on house officers' specialty preference and the factors associated with their choice that were identified in this study will provide evidence based information to develop policies to encourage more doctors to specialize in specialties with shortage of doctors and to formulate career specialty guidance. Keywords: house officers, choice of specialist training, specialty, junior doctors

Introduction: Air pollution continues to receive a great deal of interest worldwide due to its negative impacts on human health and welfare. Cement industry has been listed as one of the 17 most polluting industries. Many studies have revealed the effects of cement dust on the respiratory system (larynx and lungs), gastro intestinal system (oral cavity and teeth, liver, stomach and colon), urinary system (kidney), cardiovascular system and the lymphatic system (spleen and thymus). Objectives: To determine the health effects on a population living in the proximity a cement factory. Methodology: The study was a cross sectional study with 203 participants. 96 exposed participants living within 5km radius of cement factory were selected and 107 participants living 15km away from the cement factory were selected as control. A modified respiratory symptom questionnaire was used to assess respiratory symptoms experienced by the participants in the two communities and peak expiratory flow rate was also measured for all the selected participants. Results: In this study we found out that the exposed population had higher prevalence of respiratory symptoms with 35.4% shortness of breath, 40% wheeze, 58.3% cough, 36.5% morning phlegm and 2.1% chronic bronchitis compared to unexposed population with 15% shortness of breath, 33.6% wheeze, 27.1% cough, 10.3% morning phlegm and 0.0% chronic bronchitis. These differences were found to be statistically significant except wheeze and chronic bronchitis that were not statistically significant. The exposed population also had higher prevalence of eyes, throat and skin irritation than unexposed population. The differences were statistically significant except for throat irritation. PEFR decreased significantly in exposed population compared to unexposed population. Conclusions: The findings in this study suggested that people living in the proximity of cement factories are more likely to develop respiratory symptoms and other symptoms such as eyes, throat and skin irritations than unexposed population. These may be as a results of dusts produced by the cement plant which is known to cause several health problems in human, vegetation and environment. Key words: Respiratory symptoms, community, industrial pollution, cement dust and peak expiratory flow rate (PEFR).

Objective: The objective of this study was to determine the level and prevalence of Depression, Anxiety, and Stress and compare the depression, anxiety, and stress level among various sub-groups among Bangladeshi Male Migrant Workers during the COVID-19 Pandemic in Malaysia. Lastly to find out if anxiety and stress are significantly associated with depression among the workers. Methodology: A cross-sectional study was carried out amongst 217 Bangladeshi migrant workers who visited the Bangladesh High Commission Passport Service center, Selangor, Malaysia during the study period of two weeks in May 2021. Visitors who fulfilled the selection criteria were enrolled in the research using a systemic random sampling with a replacement method. A face-to-face interview was used to determine the level and prevalence of depression, anxiety, and stress, as well as to compare depression, anxiety, and stress levels and to see if anxiety and stress are significantly associated with depression among the workers. Results: The findings of this study showed that the prevalence of depression, anxiety, and stress were 6.5%,0.9% (mild, moderate); 8.8%, 4.6% (mild, moderate); 0.5%, 0.9% (mild, moderate) respectively. Multivariate analysis found that worry about losing the current job was significantly associated with depression, support from the employer was significantly associated with anxiety and dependent family members, total income per month, and sending wages to family were statistically and significantly associated with stress. Lastly, stress was significantly associated with depression. Conclusions: The prevalence of depression, anxiety, and stress was low, and sub-groups such as fear of losing one's current job, employer support, dependent family members, total monthly income, and sending wages to the family should be given more attention to providing mental health services. It is also necessary to learn more about how to reduce stress in this population because it was correlated with depression. Keywords: Depression, anxiety, stress, COVID-19 pandemic, migrant workers, DASS-21 Scale, Bangladeshi migrant workers, Malaysia.

ntroduction: The objective of this study was to qualitatively describe the content present on e- cigarette manufacturer and retailer websites in Malaysia and to study the e-cigarette use behaviour, motivations, information seeking behaviour and experiences of e-cigarette users in Malaysia. Methodology: This research uses a cross-sectional descriptive study design. 30 e-cigarette manufacturer and retailer websites were analyzed and coded for regulatory and promotional themes. 9 online e-cigarette platforms on Reddit, Facebook and Lowyat forum were identified on which questionnaire was shared with items relating to sociodemographic factors, tobacco- related factors, information seeking behaviour and side effects experienced. Modified FTND questionnaire for vaping was used to assess predictors for e-cigarette use behaviour. Results: The content analysis identified only click through age verification (60%), health related (47%), smoking cessation (37%) and modernity (37%) related advertising strategies to be most common, and promotion (37%) and sales (93%) of nicotine products on the websites. The average FTND score of the respondents was 3.9 and average number of side effects experienced was 4. Health and smoking cessation related reasons were the most common for e-cigarette use and multivariable regression analysis revealed dual use, being a male and use of nicotine e-cigarettes to be significantly associated with increase in FTND score. Conclusion: The content analysis revealed regulatory void, youth accessibility, health- information based advertising, and promotion and sales of nicotine products on the websites. The study of e-cigarette users found low to moderate e-cigarette dependence among respondents and the health and smoking cessation related motivations for use to be most common. The findings revealed current smoking status, sex, and use of nicotine in e-cigarettes to be significant predictors of e-cigarette dependence. The research findings call for regulation of online e-cigarette marketplace in Malaysia and further research of harms and benefits of e- cigarettes. Keywords: Content Analysis, E-cigarette Websites, E-cigarette Use Behaviour,

Introduction: Psychological distress is a major problem of present era discussed extensively in many refugee literatures. It is reported that 84% of Rohingya had been emotionally distressed. In spite of that, individuals who cope effectively with such situations can move from having psychological distress to being well. Limited research work has been carried out on the psychological distress of the Rohingya refugees and how they cope with their distress. Objective: To determine the prevalence, determinants of psychological distress and the coping strategies among the Rohingya Refugees in Klang, Malaysia. Methodology: A cross-sectional study was conducted among 227 Rohingya Refugees in Klang, Malaysia in March 2015. Psychological distress was assessed by using Kessler Psychological Distress Scale (K10). Factors associated with psychological distress were assessed using a 24-item questionnaire grouped into three main themes namely the work related factors, personal and family related factors as well as security and protection related factors. The validated Brief COPE inventory was used to assess coping strategies. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and p-value <0.05 was considered statistically significant. Results: The prevalence of psychological distress among Rohingya refugees in Klang was 70.9%. Determinants of Psychological distress among Rohingya Refugees revealed using the multiple logistic regression analysis include employment status (OR = 2.828, 95% CI=1.291–6.197, p = 0.009), overcrowded living conditions (OR = 0.164, 95% CI=0.068–0.397, p < 0.001), behavioural disengagement coping strategy (OR = 15.759, 95% CI=2.028–122.4, p = 0.008) and acceptance coping strategy (OR = 8.369, 95% CI=2.209–31.706, p = 0.002). (p-value <0.05).The most commonly used coping strategies by the Rohingya refugees to deal with their psychological distress were religion, positive reinterpretation, acceptance, and active coping. Conclusion: This study confirmed the magnitude of psychological distress experienced by Rohingya refugees in Klang Malaysia. In order, to reduce the levels of psychological distress among the Rohingya refugees the multiple factors that affect it should be taken into account. In addition to that, utilization of effective coping strategies among Rohingya refugees might improve their psychological health. These points should be taken into consideration for improving the training professionals who may encounter Rohingya Refugees. Keywords: Psychological Distress, Coping Strategies, Refugees, Distress, Rohingya

Objective: The objective of this study was to identify the correlates of diet quality among adults in a suburban area in Johor, Malaysia. Methodology: A cross sectional study among 300 participants was carried out in a suburban area located in Johor during the study period of two weeks in September 2018. A systematic random sampling without replacement method was conducted and the individuals who met the selection criteria were selected for this study. The Healthy Eating Index for Malaysians (M-HEI) was used to determine the diet quality of adults. The survey instruments to determine sociodemographic, socioeconomic, lifestyle, 24-hour dietary recalls and health status were also conducted amongst the participants. Results: The prevalence of participants who scored M-HEI score of 46 and below with an indication of at risk of poor diet quality is 58.3%. The factors such as lower education level (p=0.047) and consumption of alcohol (p=0.010) were statistically significantly associated with M-HEI scores. No association could be seen from other factors with M-HEI scores. Conclusion: The findings of this study showed that the prevalence of at risk of poor diet quality among the participants residing in a suburban area in Johor, Malaysia was 58.3%. Multivariate analysis revealed that adults with an education level below tertiary level were more likely to be at risk of poor diet quality. Those adults who reported alcohol intake were non-Muslims and found to be at low risk of poor diet quality. Key words: Determinants, diet quality, Healthy Eating Index (HEI), adults, Malaysia

Gestational Diabetes Mellitus (GDM) is a diabetic disorder that increases risk of development of type 2 diabetes mellitus (T2DM) and it occurs during pregnancy and its incidence has been steadily rising all over the world. GDM prevalence in the United States (U.S.) was 4.6% in 2010. In India it increased from 1% to 16% from 1998-2004. A study done in Malaysia showed that GDM is increasing and the prevalence was 18.3% in 2009. GDM is one of the most common complications with short term and long term effects for the fetus and the mother. The objective of the study was to identify the determinants of Gestational Diabetes Mellitus among pregnant women in one of the hospitals in Malaysia. Methodology The sample consists of 112 cases and 112 case-control from 224 participants who delivered at Tuanku Ja’afar Hospital in Seremban. The data were collected from the record book in the labour room. The data were collected from the patients with strict confidentiality. Results The results of the research undertaken shows the proportion of GDM is 12%. Risk factors include age, high risk race group (Indians), maternal history of DM, family history of DM, obesity pre-pregnancy, BMI during delivery, infertility treatment, menstrual history, parity, gravida, previous history of GDM, previous history of caesarean section were all associated with GDM. iii Conclusion: The determinants of GDM identified in this study from the multivariate analysis were age, family history of diabetes and menstrual history. The predicted probability was 80.5%. The findings from this study suggest the need for preventive measures by policy makers and health promoters. Keywords: Gestational diabetes, Determinants, Multivariate, Diabetes mellitus, Pregnancy.

Introduction: Malaria is a major public health problem in Cameroon (West Africa) where 100% of the population is at risk. Malaria in Cameroon is mainly due to infections by Plasmodium falciparum. Some population groups including pregnant women are at considerably higher risk of contracting malaria, and developing severe disease, than others. In Africa, 30 million women living in malaria-endemic areas become pregnant each year. It is known that malaria infection during pregnancy is a significant public health problem in Cameroon with substantial risks for the pregnant woman, her foetus, and the new-born child. The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area and the individual’s level of acquired immunity. Agricultural practices of the population are often associated with malaria. Ecological complexity is both at the heart of agricultural impacts on malaria transmission and also the deepest challenge to successful collaboration between the agricultural and health sectors. Thus, malaria in pregnancy in plantation settings presents an important opportunity for health-related interventions that can simultaneously improve outcomes for both mother and child in Cameroon. Objectives: 1. To identify socio-demographic factors associated with malaria in pregnancy in the plantation community at Niete, Cameroon. 2. To identify the antenatal, housing and environmental factors associated with malaria in pregnancy in this population. 3. To identify the outcomes associated with malaria in pregnancy in this population. Methods: The study design was case-control. The sample size comprised of 120 participants. There were 60 cases and 60 controls. Data was collected from hospital records and also by interview technique as well as observation of investigator. Univariate and Multivariate analysis were conducted for comparison purposes. In this study, a p-value <0.05 was considered as statistically significant. Results: In univariate analysis for determinants of malaria in pregnancy it was revealed that there were significant association between these factors listed below and malaria in pregnancy in the Niete Plantation: Socio- Demographic Factors: Younger Maternal Age, Lower Education, Lower Household Income, Women not being employed and Women Rubber Tappers. Antenatal Factors: Lower Frequency of antenatal attendance Housing Factors: Absence of Fan, No Toilet Facility, Wooden Floor Material, Wooden Wall Material, Wooden Floor Holes, Wooden Wall Holes, Zinc Roof Holes, More than six months older Insecticide Treated Net (ITN), Holes on Currently Using ITN’s, Lower Usage of ITN by Pregnant Women, and Lower Usage of ITN by All Age Groups Environmental Factors: Presence of Bush Around the House Compound, Presence of Mosquito Breeding Sites, Absence of Personal Use of Insecticides or Sprays, Less Than One Kilometre distance of water body from house and ownership of livestock especially pig. Then using Multiple Logistic Regression the confounders were removed and this analysis revealed that the best significant predictors of malaria in pregnancy which were ownership of fan (p = 0.001*, OR = 6.349, 95% CI = 2.679 – 15.045), bush around compound (p = 0.016*, OR = 2.378, 95% CI = 1.175 – 4.812), presence of mosquito breeding site (p = 0.009*, OR = 3.882, 95% CI = 1.407 – 10.712), and use of personal insecticides or sprays (p = 0.027*, OR = 2.229, 1.098 – 4.524). Furthermore, it was observed that women whom had malaria in pregnancy were significantly (P < 0.05) more likely to have babies with medical problems such as low birth weight and neonatal asphyxiation as compared to women who did not have malaria in pregnancy. Conclusion: This study identified the maintenance of a clean environment free of mosquito breeding sites and use personal protections in the form of mosquito repellents as most essential measures for reducing mortality and morbidity rates associated with malaria in pregnancy. Keywords: Predictors, Malaria, Pregnancy, Cameroon, Multiple Logistic Regression

Introduction: Flood is a common form of natural disaster that Malaysia experiences regularly. Post-traumatic stress disorder (PTSD) is a psychological disorder that some victims may experience after natural disasters like flood. Identifying those victims of floods who are more at risk of developing PTSD is beneficial in preventing PTSD and disability. The purpose of this study was to determine the prevalence and determinants of PTSD in 2 communities that were affected by the 2014 floods in Kota Bharu, Kelantan. Methodology: A cross-sectional study was carried out among 154 individuals who were affected by the December 2014 flood in Kota Bharu, Kelantan. Multi-stage sampling was done to select subjects from flood affected areas. Data was collected through self-report measures. PTSD was screened using a psychological assessment tool PCL-C civilian version. The data collected included socio-demographic variables, effects of floods, help received. The Brief COPE inventory was used to determine the coping strategies adopted by the victims. Univariate and multivariate analysis were done to determine the associations, p<0.05 considered statistically significant. Results: Total of 54 (35.1%) subjects were screened positive for PTSD. Four independent factors (experienced lost contact with a close associate, loss of belonging(s)/property, total value of loss more than RM 2000, trapped and waited for rescue) were significantly predictors of PTSD. Conclusion: Mental health services should be distributed to groups at particular risks after flood, to reduce any possible psychological impact such as PTSD. Keywords: Flood, PTSD, cope, Kelantan

Objective: The objective of this study was to determine the relationship between eating behaviours and work-related stress among working-adults residing at Rasah Kemayan, Malaysia. Methodology: A cross sectional study was conducted among 133 working-adults at the residential area of Rasah Kemayan to determine the relationship between eating behaviour and work-related stress and identify the coping strategies used by the respondents when they are stressed. The study was conducted between September to November 2016. Systematic sampling was carried out to select the houses and from each house a working-adults who met the selection criteria was selected for this study. The Eating Behaviour of the subjects was assessed using Three Factor Eating Questionnaire (TFEQ). The Job Content Questionnaire was used to determine the work-related stress among the employees. The Brief Cope Inventory Questionnaire (BCI) survey instruments were used to determine the coping skills of the subjects. Results: The prevalence of work-related stress among the working population in Rasah Kemayan is 25.6%. Factors that were statistically significantly associated with work-related stress are transport mode; shared vehicle (13.5%), self-driven vehicle (12.0%) and emotional eating (21.8%). Other factors had no association with Work-related stress. As for coping, the strategies that were used frequently by the respondents are Behavioural Disengagement, Self-Blame, and Positive Reframing with median of 4. Conclusion: These findings bear potential implications in preventing work-related stress by applying suitable coping strategy to combat of work-related stress which may alter their eating behaviour. There is need for working adults to come up with interventions to manage stress and healthy eating at the work place for better health. Keywords: Work-related stress, eating behaviour, coping skills

Background: Emotional resilience is a phrase that is becoming increasingly prevalent on various spheres of society including universities. Emotional resilience aids undergraduate students in choosing effective coping mechanisms in order to deal with stressful situations. Participation in extracurricular activities has implications on emotional resilience and coping mechanisms. Understanding the relationship between extracurricular activities, emotional resilience and coping mechanisms would contribute to the well-being of students. Objectives: The objectives of this study were to determine the level of emotional resilience, types of coping mechanism undergraduates used and the contribution of emotional resilience towards stress coping mechanisms. This study also investigated the moderating effect of extracurricular activities on the relationship between emotional resilience and coping mechanism. Methodology: A cross sectional study was conducted among 241 randomly selected International Medical University undergraduates who consented to participate in the study. A four-part self-administered questionnaire (demographics, 14-Item Resilience Scale, Brief COPE and extracurricular activities) was used for data collection. To conceptualize the study, the independent variable (emotional resilience) was tested against the dependent variable (coping mechanisms). The moderating variable was extracurricular activity. Sociodemographic factors, level of emotional resilience and types of coping mechanisms were analysed using descriptive statistics (mean, proportion and standard deviation). For inferential statistics, simple linear regression and independent samples t-test were performed on the independent and dependent variables. Moreover, Hayes PROCESS Macro v3.5 was used to analyse the moderating effect of extracurricular activities. Results: Most participants had a medium level of emotional resilience with problem focused coping as the dominant type of coping mechanism use. It was also found that emotional resilience significantly contributed to the coping mechanisms. However, extracurricular activities had no significant moderating effect on the relationship between emotional resilience and coping mechanisms. Conclusion: This study found that most IMU undergraduates were resilient and had effective coping mechanisms. However, it would be important for the institution to include syllabus or programmes to promote resilience and effective coping mechanisms among undergraduates. Keywords: undergraduates, emotional resilience, coping mechanism, extracurricular activities