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MALAYSIAN JOURNAL OF

ISSN: 1675-0306

Official Publication of the

MALAYSIAN PUBLIC

PUBLIC HEALTHMEDICINE


0306 Volume 13 (Supplement

Official Publication of the

MALAYSIAN PUBLIC HEALTH PHYSICIANS’ ASSOCIATION

PUBLIC HEALTHMEDICINE


(Supplement 1) 2013

HEALTH PHYSICIANS’ ASSOCIATION

PUBLIC HEALTH

OfficialJournal ofMalaysianPublic Health Physicians’Association

MJPHM

EDITORIAL BOARD

Chief EditorProf. Dato’ Dr. Syed Mohamed Aljunid

(United Nations University – International Institute for Global Health)

Deputy Chief EditorAssoc. Prof. Dr. Sharifa Ezat Wan Puteh

(Universiti Kebangsaan Malaysia)

Members:

Assoc. Prof. Sharifah Zainiyah Syed Yahya University Putra MalaysiaDr. Lokman Hakim Sulaiman Ministry of Health MalaysiaAssoc. Prof. Dr. Retneswari Masilamani University MalayaAssoc. Prof. Dr. Mohamed Rusli Abdullah University Sains MalaysiaAssoc. Prof. Dr. Saperi Sulong University Kebangsaan MalaysiaAssoc. Prof. Dr. Maznah Dahlui University MalayaDr. Roslan Johari Ministry of Health Malaysia Dr. Othman Warijo Dr. Norfazilah Ahmad

Ministry of Health Malaysia University Kebangsaan Malaysia

Dr. Amrizal Muhd Nur United Nations University–International Institute for Global Health (UNU-IIGH)

Chief EditorMalaysian Journal of Public Health Medicine (MJPHM)

United Nations University-International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala LumpurMalaysia

ISSN:1675–0306The Malaysian Journal of Public Health Medicine is published twice a year

Copyright reserved @ 2001Malaysian Public Health Physicians’ Association

Secretariat Address:The Secretariat

United Nations University-International Institute for Global Health (UNU-IIGH)Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala LumpurMalaysia

Tel: 03-91715394 Faks: 03-91715402 Email: [email protected]

Malaysian Journal of Public Health Medicine, Vol. 13 (Suppl 1) 20133rd International Public Health Conference & 20th National Public Health Colloquium

Riverside Majestic Hotel, Kuching, Sarawak, Malaysia (28-29 August 2013)

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MJPHMOfficial Journal of MalaysianPublic Health Physicians’Association

3rd INTERNATIONAL PUBLIC HEALTH CONFERENCE & 20th NATIONAL PUBLIC HEALTH COLLOQUIUM

“New Insights into Non Communicable Disease Prevention: The Next Step”

28 – 29 AUGUST 2013RIVERSIDE MAJESTIC HOTEL

KUCHING, SARAWAK

Organiser:

Department of Community HealthFaculty of Medicine

Universiti Kebangsaan Malaysia Medical Centre

Co-Organiser:

United Nations University -International Institute for Global Health (UNU-IIGH)

Sarawak State Health Department

Sarawak Nursing Professional Association (SNPA)

In Collaboration with: Supported by:Universiti Malaysia Sarawak (UNIMAS)

Sarawak Convention Bureau



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SCIENTIFIC & PROCEEDING COMMITTEE 2013

AdviserProfessor Dr. Mohd Rizal Haji Abd Manaf

Chairperson of Scientific CommitteeAssociate Professor Dr. Aniza Ismail

Chairperson of Abstract Book / Proceeding CommitteeAssociate Professor Dr. Zaleha Md Isa

Members of Scientific CommitteeProfessor Dr. Noor Hassim Ismail

Professor Dr. Khadijah ShamsuddinAssociate Professor Dr. Mohd Hasni Jaafar

Associate Professor Dr. Khalib LatipAssociate Professor Dr. Rosnah Sutan

Dr. Nazaruddin SafianDr. Hanizah Mohd YusoffDr. Ahmad Taufik Jamil

Dr. Halim IsmailAzman Ariff

Mohammad Fuad Mohamad AffaderAssociate Professor Ho Siew Eng (Nursing Department UKMMC)

Professor Dr. Mohd Raili Suhaili (UNIMAS)Dr. Hashimah Basri (Sarawak State Health Department)

Samasu Johari (Sarawak State Health Department)

Members of Abstract Book / Proceeding CommitteeAssociate Professor Dr. Sharifa Ezat Wan Puteh

Noorasmaa Husna Mohd HasniRahimah Raoh



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CONTENT PAGES

SCIENTIFIC PAPER PRESENTATION - EPIDEMIOLOGY / STATISTICS

PRO-A1 THE MALAYSIAN VERSION OF SUSCEPTIBILITY TO PEER PRESSURE SCALE: EXAMINING ITS CONSTRUCT VALIDITY AMONG STUDENTS IN INSTITUTIONS OF HIGHER LEARNINGShazimah A. Samad, Noran N. Hairi, Maslinor Ismail

1

PRO-A2 THE NEEDS OF ADULT FAMILY MEMBERS OF THE ICU PATIENTS AS PERCEIVED BY ADULT FAMILY MEMBERS AND INTENSIVE CARE NURSES Sofee Mohamed Akhlak

2

PRO-A3 SINGLE NUCLEOTIDE POLYMORPHISM GENOTYPING OF SALMONELLA ENTERICA SEROVAR TYPHI ISOLATES IN KELANTAN MALAYSIA USING PYROSEQUENCING ASSIGNED HAPLOTYPESJa’afar N. Ja’afar, Kathryn E.Holt, Vanessa Wong, Subhash J. Bhore, Prabha Balaram, Asma Ismail, Kia Kien Phua

3

PRO-A4 AN OUTBREAK OF LEGIONELLOSIS AT A BUSINESS CENTRE IN KUALA LUMPURRohani I, Normah S, Nurul Hafizah MY, Ummi Kalthum S, Balachandran S, Monica

4

PRO-A5 THE ASSOCIATION BETWEEN BODY MASS INDEX, WAIST CIRCUMFERENCE, AND HYPERTENSION IN ELDERLY PEOPLE AT CIMAHI, INDONESIASri Quintina Indriyana, Salli Fitriyanti, Anastasia Yani Triningtyas

5

PRO-A6 WHAT IMPROVES QUALITY OF LIFE- VIEWS FROM POST-STROKE SURVIVORS IN KANO, NIGERIAAshiru M. Hamza, Al-Sadat S. Nabilla, Siew Y. Loh

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PRO-A7 PSYCHOMETRIC PROPERTIES OF THE MALAYSIAN VERSION OF REASONS SCALE FOR MEDICATION ADHERENCE: RELIABILITY AND FACTORIAL VALIDATIONAMONG HYPERTENSIVE PATIENTS IN PRIMARY HEALTH CARE SETTINGShima R, Farizah Hairi, Hazreen A. Majid

7

SCIENTIFIC PAPER PRESENTATION - FAMILY HEALTH / NUTRITION / SOCIAL WORK

PRO-B1 WOMEN’S SEXUAL AND REPRODUCTIVE HEALTH CARE IN RURAL AREAS OF SOUTH AUSTRALIAWendy Abigail & Cara Flynn

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PRO-B2 SELF EFFICACY, DIABETES ATTITUDE AND SOCIAL SUPPORT ARE RELATED TO DIABETES SELF-MANAGEMENT PRACTICE AMONG ELDERLY DIABETES PATIENTS Salmiah B, K Shamsuddin, Rahmah MA

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PRO-B3 VITAMIN D INTAKE AND BONE MINERAL DENSITY STATUS OF GOVERNMENT EMPLOYEES IN PADANG CITY, INDONESIA: CROSS SECTIONAL STUDYAzrimaidaliza

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PRO-B4 THE ASSOCIATION BETWEEN BODY MASS INDEX AND QUALITY OF LIFE AMONG ADULTS IN SELANGORMohd Rizal A.M, Aniza I, Ahmad Fareed A.R

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PRO-B5 THE QUALITY OF LIFE OF CLEFT LIP AND/OR PALATE CHILDREN AGE LESS THAN 5 YEARS OLD: PARENTS’ PERCEPTIONKhairol N. Ahmad & Jennifer G. Doss

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PRO-B6 NUTRITION AND EXERCISE AMONG ELDERLY: KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) STUDY AMONG CHINESE COMMUNITY IN SIBU, SARAWAKAnnaletchumy L, Annie Wong SM, Kavitha Subramaniam

13

PRO-B7 TOOTH WEAR AND EROSIVE TOOTH WEAR AMONG 16-YEAR-OLD MALAYSIAN ADOLESCENTSNoorhazayti Ab. Halim, Rashidah Esa, Chew Hooi Pin

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PRO-B8 HOUSEWIVES IN SEPANG SELANGOR – FAT OR FITSabariah AH & Manan NA

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SCIENTIFIC PAPER PRESENTATION - OCCUPATIONAL HEALTH / ENVIRONMENTAL HEALTH

PRO-C1 EFFECTIVENESS OF INTERVENTION PROGRAMME IN IMPROVING KNOWLEDGE, ATTITUDE AND PRACTICE AMONG SMOKERS IN MUKIM PERINGAT, KELANTAN Aziah Daud & Group A CFCS 2012/2013

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PRO-C2 THE IMPACT OF BODY MASS INDEX ON SICKNESS ABSENCE AMONG HEALTHCARE WORKERS IN KUALA SELANGOR IN 2012Azizah Wahab, Rozita Hod, Hanizah M Yusoff, Halim Ismail, Azmawati M Nawi, Norfazilah Ahmad, Zaharah Zainuddin

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PRO-C3 OCCUPATIONAL DEPRESSION AMONG EMPLOYEES OF ESFAHAN STEEL COMPANY, IRAN: PREVALENCE AND ASSOCIATED FACTORSMasoud Lotfizadeh & Noor Hassim Ismail

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PRO-C4 PUBLICATION OF SIMPLIFIED VERSION OF CANCER MATERIAL Nosidawati Abdul Gani, Latiffah Abdul Latiff, Othman Omar, Mazanah Muhammad

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PRO-C5 PREVALENCE OF METABOLIC SYNDROME AND COMBAT RELATED AND PSYCHOLOGICAL RISK FACTORS AMONG MILITARY PERSONNEL AGED 30-55 YEARS IN SRI LANKA LIGHT INFANTRY REGIMENT OF SRI LANKAN ARMYChathurani M Wickramaarachchi, Pushpa Fonseka, Nimalka K Ariyaratne

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PRO-C6 PREVALENCE OF OBSTRUCTIVE SLEEP APNOEA AMONG COMMERCIAL TRUCK DRIVERSWahida Ameer Batcha, Ilhamah Othman, Mohamad Suffian Ahmad, Norlen Mohamed

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PRO-C7 MUSCULOSKELETAL PROBLEMS AMONG AGRICULTURAL WORKERS IN FELDA SUNGAI KELAMAH, GEMAS, NEGERI SEMBILANMohd Dzulkhairi Mohd Rani, Zairina A Rahman, Mohd Yunus Abdullah, Nooriah Mohamed Salleh

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PRO-C8 VALIDATING EFFORT OF AN OCCUPATIONAL BACK PAIN QUESTIONNAIRE WITH STANDARDS FROM A SOCIAL SECURITY ORGANIZATION BASED IN A DEVELOPING COUNTRY Jenn Z Tam, Sharifa E W Puteh, Noor H Ismail

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PRO-C9 RELIGIOSITY, COPING AND POST TRAUMATIC STRESS DISORDER AMONG EARTHQUAKE SURVIVORSRafidah Bahari & Norlaili Abdul Aziz

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PRO-C10 URTI OUTBREAK AT SCHOOL X, CHERAS, KUALA LUMPURHaliza AM, Asyraf Z, Rohani I

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PRO-C11 A PILOT STUDY EXAMINING ANEMIA AND OBESITY AMONG WOMEN WORKERSalli Fitriyanti, Anastasia Yani Triningtyas, Sri Quintina Indriyana

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SCIENTIFIC PAPER PRESENTATION - HEALTH MANAGEMENT / HEALTH PROMOTION

PRO-D1 KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS ORGAN DONATION AMONG THE STUDENTS OF UNIVERSITI SAINS ISLAM MALAYSIA (USIM)Nazefah Abdul Hamid, Mohd. Dzulkhairi Mohd. Rani, Marlini Muhamad, Mohd. Hairulhisyam Ngatiman, Rosliza Ghazali, Mustafa ‘Afifi Ab. Halim, Nooriah Mohamed Salleh

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PRO-D2 THE IMPACT OF MIGRAINE ON QUALITY OF LIFE (QOL) IN FEMALESMunvar Miya Shaik, Norul Badriah Hassan, Huay Lin Tan, Shalini Bhaskar, Siew Hua Gan

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PRO-D3 THE EFFECTIVENESS OF DIETARY COUNSELLING BY DIETICIAN ON KNOWLEDGE, ATTITUDE AND PRACTICE AND QUALITY OF LIFE OF DIABETIC PATIENTS IN KLINIK KESIHATAN BANDAR KUANTANEzzaity N Anuar, Noraishah M Nor, Nor Azlina A Rahman

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PRO-D4 PERCEPTION OF END USERS ON I-KELAHIRAN IN SABAH HEALTH DEPARTMENTDhesi Baha Raja Selva Raja & Cheah Whye Lian

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PRO-D5 CIVIL SERVANTS VALUATION OF PRIMARY CARIES PREVENTION PACKAGE, A CASE STUDYAH Nurul & M Asma’

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PRO-D6 THE ACHIEVEMENT OF UNIVERSAL HEALTH COVERAGE POLICY IN CITY OF PADANG, INDONESIA: A DESCRIPTIVE ANALYSISAde Suzana, Syed Aljunid, Amrizal M Nur

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PRO-D7 ILLNESS PERCEPTION AMONG HYPERTENSIVE PATIENTS ATTENDING POLYCLINICS IN KUCHING, SARAWAKHaironi Yusoff & Rasidah Abd Wahap

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PRO-D8 INJURIES AT HOME AND RISK REDUCTION PRACTICES Mohd Idris O, Eliana M, Nabilah H, Roslinah A, Melvyn CYC

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SCIENTIFIC PAPERS PRESENTATION

EPIDEMIOLOGY / STATISTICS

PRO-A1

The Malaysian Version of Susceptibility to Peer Pressure Scale: Examining Its Construct Validity among Students in Institutions of Higher Learning

Shazimah A. Samad1,2,3, Noran N. Hairi1,2, Maslinor Ismail1

1. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia2. Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Malaysia3. Ministry of Health, Malaysia

Introduction: Adolescence is a transitional stage predisposing adolescents to detach themselves from their family. As a result, they would depend on their peers for support and relationship. This heightened peer interaction may give rise to undesired consequences. An instrument to measure this peer pressure, the susceptibility to Peer Pressure Scale was developed and validated among adolescents in Singapore. The present study aimed at examining the reliability and construct validity of the susceptibility to Peer Pressure Scale.

Materials and Methods: A cross-sectional study involving 515 students in three tertiary level institutions was conducted between December 2012 and February 2013. The scale consisted of 35 hypothetical scenarios utilizing a 4-point Likert-type scale. Both forward and backward translations were performed prior to pilot test. The scale’s reliability was determined by Cronbach’s α and Kappa statistics, while its construct validity was assessed using exploratory and confirmatory factor analyses.

Results: The findings supported a two-factor structure instead of the original four-factor structure. The two factors explained 45.1% of the total variance. Cronbach’s α for the two factors were .91 and .89, respectively. Majority of the items reached moderate to substantial agreement in test-retest analysis (.4 to .61). Multi-group analyses demonstrated stability across gender.

Conclusion: The Malay version of the susceptibility to Peer Pressure Scale displayed good psychometric properties. This 18-item scale is a valid and reliable instrument in the evaluation of the susceptibility to peer pressure. However, future studies to assess its stability across the different ethnic groups are warranted.

Acknowledgement: We would like to thank the author of the scale for the permission to utilize and modify the scale. The cooperation of the Students’ Affairs of the tertiary level institutions and the respondents are greatly appreciated.

Keywords: adolescents, confirmatory factor analysis, construct validity, exploratory factor analysis, susceptibility to peer pressure



2

PRO-A2

The Needs of Adult Family Members of the ICU Patients as Perceived by Adult Family Members and Intensive Care Nurses

Sofee Mohamed Akhlak

Department of Nursing, Universiti Teknologi MARA, Puncak Alam, Malaysia

Introduction: The admission of a critically ill patient into intensive care is universally accepted as a crisis for both patients and their families. Family members of critically ill people may experience emotional turmoil and therefore have many needs throughout the course of the relative’s illness. It has been identified that nurses are best placed to meet families’ needs. The aim of the study was to explore the needs of adult family members of the Intensive Care Unit (ICU) patients as perceived by adult family members and intensive care nurses

Materials and Methods: A descriptive study using the Critical Care Family Needs Inventory (CCFNI) questionnaire was employed to measure, rank and compare a series of family needs at ICU unit in Sungai Buloh Hospital. A total of 110 participants (59 family members and 51 ICU nurses) were enrolled in the study.

Results: The 10 most important needs perceived by family members were from the subscale of assurance need, information need, support and proximity need. The 10 most important needs perceived by nurses were assurance need, information need, support and proximity need. T-test results showed a significant difference in the rank order of the need statements listed in the CCFNI amongst family members and nurses (p<0.05).

Conclusion: The results of this study indicated that families had specific and identifiable needs. Providing families of critically ill patients with a clear, simple and updated information about the patients’ and assuring them about the quality of care the patients receive appears to be the priority identified by both family members and nurses.

Keywords: family needs, critical care, family member



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PRO-A3

Single Nucleotide Polymorphism Genotyping of Salmonella Enterica Serovar Typhi Isolates in Kelantan Malaysia Using Pyrosequencing Assigned Haplotypes

Ja’afar N. Ja’afar1, Kathryn E.Holt2, Vanessa Wong3, Subhash J. Bhore4, Prabha Balaram5, Asma Ismail1, Kia Kien Phua1

1. Typhoid and other Enteric Diseases Research Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Malaysia

2. Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Australia3. The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom4. Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Malaysia5. QUEST International University Perak, Malaysia

Introduction: Although the Kelantan state public health authorities have a stringent policy on Typhoid surveillance and reporting of every outbreak, no detailed molecular tracking method is yet available to determine the predominant haplotypes of S. Typhi, if any, circulating in the state. From previous studies, only nine isolates from Malaysia were used in a global study to determine the haplotype of S. Typhi. In the current study, the haplotypes of 271 isolates from the state of Kelantan Malaysia were determined.

Materials and Methods: A single nucleotide polymorphisms (SNP) genotyping platform using pyrosequencing was utilized to investigate 37 known polymorphic variations in 271 individual S. Typhi isolates isolated within an 11-year period. Sequence data on the 37-SNP locations for all the isolates was processed and each isolate was assigned a haplotype by mapping the allele information to an additional 500 individual S. Typhi isolates previously genotyped at 1500 loci using Illumina Golden Gate.

Results: Majority of the isolates (80.4%) belonged to haplotype H50. This suggests the predominance of thishaplotype within the state. Only two isolates assigned H58 and H59 were found. H58 is known to represent isolates that are multi-drug resistant. In contrast, H59 has previously been reported to be geographically restricted to Indonesia.

Conclusion: The predominance of haplotype H50 shows the limited genetic diversity of S. Typhi in the state of Kelantan for almost three decades as far back as 1986. However, the finding of haplotypes H58 and H59 in the state is an early warning sign of emergence of the multiple drug resistant strain and diversification of S. Typhigenotypes from its neighbouring country, Indonesia. Therefore, active screening of foreigners working as food-handlers is imperative to curtail any possible emergence of new S. Typhi strains in the country.

Acknowledgement: We would like to acknowledge the support of Universiti Sains Malaysia by funding the project [grant numbers 1001/CIPPM/844078, 1001/PSKBP/86300111].

Keywords: Salmonella Typhi, haplotype, SNP, pyrosequencing, epidemiology



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PRO-A4

An Outbreak of Legionellosis at a Business Centre in Kuala Lumpur

Rohani I, Normah S, Nurul Hafizah MY, Ummi Kalthum S, Balachandran S, Monica

Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur, Malaysia

Introduction: Legionnaires’ disease was first described by Fraser et al following an outbreak of pneumonia among the participants of the American Legion Convention in Philadelphia in 1976. The disease was caused by Legionella pneumophila, commonly found in aquatic environment and the term “Legionellosis” was used to describe these infections that range from mild (Pontiac fever) to severe form ( Legionnaires’ disease). The business centre is located at the central of Federal Territory of Kuala Lumpur. The block involved, Block A, located in the middle of four office blocks. The air conditioning system for the building is centralized using cross flow cooling system and the cooling tower is located at the roof top of Block B, adjacent to Block A. Notification was received on 12th April 2013 on two cases admitted at different private hospital with similar respiratory symptoms and one of them had passed away seven days prior to notification. Both of them work in the same department in Block A.

Materials and Methods: It is a cohort study involving all employees at Block A. This study includes the epidemiological, environmental and laboratory studies. The objectives of these studies were to verify the outbreak and describe it epidemiologically, to identify the etiology and source of the pathogen and to take preventive and control measures to contain the outbreak.

Results: A total of 1, 365 workers from the same block were examined and 382 (attack rate: 27.9%) were found to have symptoms based on case definition. Blood samples taken from 188 of cases revealed that 70 of them were found positive for IgM Legionella (37.2%). There was no significant findings on the department or level involved.Water and swab samples from the cooling tower at the same block showed positive for Legionella pneumophilaSerogroup 1 and 2.

Discussion: The outbreak caused by Legionella pneumophila Serogroup 1 originated from the cooling tower. Improper maintenance of the cooling towers can lead to accumulation of pathogen and spread to the environment. The largest outbreak of confirmed cases Legionella (449) attributed to cooling towers was reported in City Hospital, Spain in year 2003 and study on building complexes cooling towers in Kuala Lumpur in 1992, showed Legionella viable count ranging from 100 to 2000 CFUml.

Conclusion: There was a Legionellosis outbreak among 382 workers at a business centre in Kuala Lumpur starting from 21st March 2013. The organism causing the outbreak was Legionella pneumophila Serogroup 1 which was found in the cooling tower. The maintenance company was instructed to manually clean the cooling tower immediately.

Keywords: Legionellosis, Legionella pneumophila Serogroup, cooling tower



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PRO-A5

The Association between Body Mass Index, Waist Circumference, and Hypertension in Elderly People at Cimahi, Indonesia

Sri Quintina Indriyana1, Salli Fitriyanti2, Anastasia Yani Triningtyas3

1. Public Health Department, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia2. Medical Nutrition Department, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia

Introduction: Only few studies allow direct comparison of the association between BMI, waist circumference and hypertension in Asian elderly populations. The aim of this study was to allow direct comparison of the associationbetween BMI, waist circumference, and hypertension.

Materials and Methods: As many as 330 participants were recruited, taken by simple random sampling. The definition of hypertension was based on JNC VII, and waist circumference and BMI measurements were based on the World Health Organization standards for Asian ethnicities. Logistic regression model was used to test predictors of hypertension.

Results: Majority of participants (mean age 61.2 y (SD 9.6 y)) are female (79.1%) with hypertension (32.6%), high risk waist circumference (78.2%), and obesity (53.7%). This study showed that waist circumference had significant relationship to hypertension risk (p<0.01, odds ratio (OR) 3.004).

Discussion: This study showed that waist circumference was a significant factor associated with hypertension. Waist circumference (WC) is used as a surrogate marker of abdominal fat mass. BMI and WC are strongly correlated with total-body adipose tissue mass, but WC is a better predictor of intra-abdominal adipose tissue than is BMI.Recent findings also indicate that WC is a stronger marker of health risk than is BMI. A population sample of Chinese adults indicates that BMI and WC are independently associated with CVD risk factors. Another findingindicates that BMI coupled with WC did not predict an increase in obesity related health risk better than did WC alone. Future studies are required to determine whether WC alone can be used as an indicator of hypertension.

Conclusion: Study showed that waist circumference had direct association with hypertension in Asian elderly ethnicities.

Keywords: hypertension risk, waist circumference, body mass index



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PRO-A6

What Improves Quality of Life- Views from Post-stroke Survivors in Kano, Nigeria

Ashiru M. Hamza1, Al-Sadat S. Nabilla1, Siew Y. Loh2

1. Center for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia

2. Department of Rehabilitation Medicine, Faculty of Medicine Building, University of Malaya, Malaysia

Introduction: The residual physical consequences after stroke are not necessarily associated with Quality of Life (QOL) as some survivors are able to adapt to their disabilities while others are devastated even by a minor sequelae.

Materials and Methods: Using qualitative interviews with 15 informants, this study explore the complexity of factors influencing the quality of life of post-stroke survivors. Thematic analysis via constant comparative method and aided by N-Vivo 9 software was used for the qualitative analysis.

Results: The 19 sub themes emerged from the in-depth interview. These themes influencing stroke survivor’s quality of life were regrouped into 7 themes. Of these, 4 themes have further related issues whilst 3 were independent issues: adaptive and coping strategies, the impact of the extent of disability (effects of activities of daily living on functioning, effect on self and identity, effect on religious activities, effect on occupation and return to work), social relationship and support system (social and instrumental supports, communication, autonomy, social role adjustments, sexual relationship), resources (medical services and rehabilitation, spiritual and resources, educational skills and experiences), anxiety and distress due to financial resources, perceived change in body image, fear of uncertainties, increased forgetfulness, pains and stigma.

Conclusion: The finding of this study supports that priorities should be focused on socio-cultural activities considered most essential to an individual’s identity; drawing on existing resources including health services and rehabilitation, social relationship and support system to address individual’s identity.

Acknowledgement: The authors would like to thank the University of Malaya Postgraduate Research Grant for supporting us with the funds to conduct this study (project number: PS034-2012A). We are also grateful to staff and the volunteered stroke patients of the Aminu Kano Teaching Hospital and Murtala Mohammad Specialist Hospital, Nigeria for their active involvement in the translation process.

Keywords: stroke, stroke survivors, quality of life, qualitative study



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PRO-A7

Psychometric Properties of the Malaysian Version of Reasons Scale for Medication Adherence: Reliability and Factorial Validation among Hypertensive Patients in Primary Health Care Setting

Shima R1,2, Farizah Hairi1, Hazreen A. Majid1

1. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia2. Ministry of Health, Malaysia

Introduction: This article describes the reliability and constructs validity of a modified Malay version of the Reasons Scale for Medication Adherence (RSMA).

Materials and Methods: In this cross-sectional study, the 15-items RSMA was administered among 665 hypertensive patients who attended four government primary health clinics under the Hulu Langat and Klang districts in Selangor, Malaysia, between early December 2012 until end of March 2013. The construct validity was examined through two phases. In phase I, translation of the English version, content validity via expert panels, face validity via small preliminary test among hypertensive patients and exploratory factor analysis (EFA) were carried out. In phase II, calculation of internal consistency reliabilities and confirmatory factor analysis (CFA) were done. Results:The EFA verified the existing five factors. CFA extracted four items. The final model with four factor structure provided good evidence of convergent and discriminant validity. Composite reliability (CR) for all the remaining domains was at least 0.7 and factorial invariance was present across gender and ethnicity. Cronbach’s α coefficient was above 0.7 indicating a good internal consistency of the items in the construct. The results suggest that the modified RSMA has good internal consistency and construct validity.

Conclusion: This study demonstrated that the modified Malaysian version of the RSMA suitable to be used to improve the delivery of clinical services by understanding the reasons for non-adherence to antihypertensive medications by the patients. However, the comprehensiveness of other factors need further exploration.

Acknowledgement: We would like to thank the Director General of Health of Malaysia for granting us the permission to publish this study. Our thanks to Professor Karuthan Chinna for his valuable input and guidance on the statistical aspects of the research, and to the District Health Officer of Hulu Langat, Dr. Hanif Bin Zailani for his assistance.

Keywords: adherence, hypertension, scale, validation, exploratory factor analysis, confirmatory factor analysis



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FAMILY HEALTH / NUTRITION / SOCIAL WORK

PRO-B1

Women’s Sexual and Reproductive Health Care in Rural Areas of South Australia

Wendy Abigail & Cara Flynn

School of Nursing and Midwifery, Flinders University, Adelaide, Australia

Introduction: Quality sexual and reproductive health care for women is fundamental to good family planning health. To understand the issues rural and remote women in Australia face, a 10 year period (2003-2013) literature review was conducted.

Materials and Methods: Articles included were Australian primary research reports which discussed rural women’s access to sexual and reproductive health. Articles excluded were discussion or opinion pieces, non-Australian studies, non-English language publications and articles prior to 2002. There were 11 articles identified as most relevant. Thematic analysis of the articles was conducted.

Results: The majority of the articles were nationally based (n=6). Research methodologies used were both qualitative articles (n=6) and qualitative studies (n=5).The specific sexual and reproductive health areas reported on included: poor access to services, adolescent health issues, levels of sexual and reproductive health knowledge, and fertility issues. Most of the articles called for increased public awareness through policy development and advocacy work to help these disadvantaged women.

Discussion: Australia is a very large country with significant rural and remote regions. Women residing in these areas are disadvantaged with inequitable sexual and reproductive health service provision and care. Improved outcomes are required for Australia to meet the Millennium Development Goal 5 ‘Improve maternal health’.

Conclusion: Understanding the issues for women in rural areas is important for service provision, policy development and funding. This information has implications for areas where poor access to sexual and reproductive health exists.

Acknowledgement: This research was funded by an Establishment Grant from Flinders University, Adelaide Australia. The authors have both contributed equally to the literature review presented.

Keywords: women’s sexual and reproductive health care, rural areas, South Australia



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PRO-B2

Self Efficacy, Diabetes Attitude and Social Support are related to Diabetes Self-Management Practice among Elderly Diabetes Patients

Salmiah B, K Shamsuddin, Rahmah MA

Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Malaysia

Introduction: Diabetes is a chronic disease that requires routine and complex self care. For elderly with diabetes, diabetes self-management (DSM) behaviour is necessary to prevent diabetes complications and to improve their quality of life. There are several factors which influence the elderly in performing diabetes self management. The study examined the relationship between respondents' demographic and clinical characteristics, self efficacy, diabetes knowledge and attitudes, and social support with diabetes self-management (DSM) in elderly, diabetic patients in primary health care clinics, Selangor.

Materials and Methods: This is a cross sectional study using questionnaire adapted from the Summary of Diabetes Self Care Activities (SDSCA), Diabetes Self Management Self Efficacy (DSMSE), Diabetes Care Profile (DCP), Diabetes Attitude Scale-3 (DAS-3) and Michigan Diabetes Knowledge (MDKT) instruments for data collection among elderly diabetics on follow-up in primary health care clinics in Selangor.

Results: Preliminary analysis of 389 respondents showed significant linear relationship between respondents’ self efficacy level and DSM ability (p<0.001), social support received (p=0.008), as well as respondents’ diabetes attitude (p<0.001) and DSM ability. Analysis also showed a significant difference in DSM scores of patients treated with combination of insulin and oral hypoglycemia agents (OHA) from patients treated with OHA only (p= 0.001). Patients treated with combination of OHA and insulin on average has a score of 2.8 lower compared to patients treated with OHA only. However, there is no significant difference in DSM scores between patients treated with insulin only with patients treated with OHA only (p=0.113). Other variables did not show significant relationshipswith diabetes self-management.

Conclusion: The factors related to diabetes self-management in this study are self efficacy, attitude, received social support and types of treatment of diabetes. As self efficacy, diabetes attitude and social support levelincreases, diabetes self-management gets better. In term of treatment, patients treated with only OHA had better self management ability compared to those treated with combination OHA and insulin. These findings might help us in developing an individual tailored intervention in this unique group of people.

Acknowledgement: We would like to thank Ministry of Health Malaysia, Selangor State Health Department, health staffs and respondents who were involved in this study. This study was supported by a research grant from the Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (FF-324-2012).

Keywords: diabetes mellitus, self-management, treatment, self efficacy, attitude



10

PRO-B3

Vitamin D Intake and Bone Mineral Density Status of Government Employees in Padang City, Indonesia: Cross Sectional Study

Azrimaidaliza

Public Health Faculty, Andalas University, Indonesia

Introduction: The prevalence of osteoporosis is prone to increase in Indonesia. Current data on the relationship of vitamin D intake with bone mineral density as diagnostic of osteoporosis among employees in Indonesia are scarce. The aim of this study is to assess vitamin D intake and its relationship with bone mineral density status of government employees.

Materials and Methods: A total of 103 employees at national education department in Padang city participated in this study. Nutrient intake was determined using a semi-quantitative food frequency questionnaire and compared to nutritional recommended for adequacy. Physical activity was measured by Baecke’s questionnaire and bone mineral density was measured by bone mineral densitometry. Multivariate logistic regressions by using SPSS program version 15 were used to analyze the main factors that have relationship with bone mineral density status.

Results: Subjects consist of 56.3% female and 43.7% male employees with age range 40-59 years. The result showed that 60.2% workers had osteoporosis risk with low bone mineral density. A higher prevalence of low bone mineral density was among female workers (62.1%). Overall, subjects have adequate vitamin D intake from food (average 10 µg/days). Physical activity of subjects was 40.8% as inactive category. There was no significant relationship between physical activity and bone mineral density status on multivariate analysis. Vitamin D intake was a dominant factor on bone mineral density status (OR=0.85, 95% CI: 0.746-0.972, PV=0.017) after adjusted foreducation status.

Discussion: In this cross sectional study, we found that vitamin D was the main factor associated with bone mineral density status. Overall, calcium did not appear to be associated with bone mineral density. Adequate vitamin D is important in the prevention of bone loss. Skin exposure to sunlight helped synthesis of vitamin D. Skin exposure to sunlight everyday and exercise once a week before activity at work also contributed to bone mineral density.

Conclusion: An adequacy of vitamin D intake had contribution to prevent osteoporosis by improving bone mineral density status of government employees in Padang city, Indonesia.

Acknowledgement: We thank the National Education Ministry for grants, National Education Department of West Sumatera Province and Fonterra Brands Indonesia for cooperation in collecting data of food intake and bone mineral density.

Keywords: vitamins D, bone mineral density, government employees, cross sectional study



11

PRO-B4

The Association between Body Mass Index and Quality of Life among Adults in Selangor

Mohd Rizal A.M, Aniza I, Ahmad Fareed A.R


Introduction: The global and local prevalence of obesity have been on the rise and becoming an important public health concern. Obese and overweight conditions are often associated with significant risk of health impairments and disease burden. There is also an increasing evidence of the association between body mass index and quality of life. This study aims to identify the quality of life among obese and overweight and its associated factors.

Materials and Methods: A comparative cross sectional study was conducted among obese, overweight and normal adults in Selangor health clinics with 1, 200 respondents involved. The data was obtained through self-administered questionnaires namely the Short Form 36 (SF-36) and the validated Malay version of the Impact of Weight on Quality of Life-LITE (MVIWQOL-LITE).

Results: The mean score of PCS (SF-36) was significantly lower in obese (42.97±7.85) as compared to overweight (46.03±7.82) and normal (49.23±6.65) (F=70.22, p<0.001). However, the mean score of MCS (SF-36) did not differ significantly among obese (46.85±8.63), overweight (47.77±8.66) and normal (47.69±8.12) (F=1.45, p=0.235). The total mean score of MVIWQOL-LITE showed a significant difference for obese, overweight and normal individuals with scores of 69.99±17.54, 81.27±16.24 and 88.64±14.22 respectively (F=136.76, p<0.001). Physical functions and health perceptions scores were found to be lowest among obese and overweight. Multivariate linear regression analysis showed that body mass index, gender, marital status, education level, physical activities and presence of chronic illnesses significantly influenced quality of life (p<0.05).

Discussion: Quality of life is lowest among obese as compared to overweight and normal individuals. The physical and social domain significantly impairs quality of life among obese and overweight while the mental domain did not show any significant difference among the three groups. Increasing body mass index, being female, married, having lower education level, not performing regular physical activities and having chronic illnesses reduce quality of life.

Conclusion: The findings in this study should mandate for more specific interventions and appropriate strategies to improve the quality of life among obese and overweight. Provision of obesity specific policies and health services need to be expedited. Individual and community participation in obesity prevention must be improved as well.

Acknowledgement: The authors would like to acknowledge the UKM Medical Research and Ethical Committee for funding and approving this research (Project code: FF-266-2011). The research is also supported by the UKM Young Researchers Grant (Project code: UKM-GGPM-TKP-065-2010). Special thanks to the Director General of Health Malaysia and all personnels who have helped to facilitate this study.

Keywords: body mass index, obesity, overweight, health related quality of life



12

PRO-B5

The Quality of Life of Cleft Lip and/or Palate Children Age Less Than 5 Years Old: Parents’ Perception

Khairol N. Ahmad & Jennifer G. Doss

Department of Community and Clinical Preventive Dentistry, Faculty of Dentistry, University of Malaya, Malaysia

Introduction: Cleft lip and/or palate (CLP) are among the most common congenital malformations that involve a person’s face. It remains undisputed that CLP present variety of difficulties for those affected. Many studies elsewhere have examined the impact of CLP, however locally, there are only very few studies to date that have explored this area.Thus, it is the aim of this present study to provide some baseline data on the impact of this oral impairment on the quality of life (QOL) of children from birth up to 5 years of age in Malaysia. The objective is to assess parents’ perceived impacts of CLP on their child’s QOL and to assess these impacts by family’s socio-demographic characteristics, socio-economic status and child’s clinical details.

Materials and Methods: A cross-sectional study was carried out using ‘face-to-face’ interviews with the PedsQLTM

Questionnaire module. A convenient sample of 131 parents having CLP children (age from after birth to less than 5 years old) were recruited from Cleft Lip and Palate Association of Malaysia (CLAPAM) and monthly combined cleft lip/ palate clinics at two university teaching hospitals. Kruskal Wallis and Mann-Whitney U statistical tests were used to assess associations. Significance level was set at α = 0.05.

Results: QOL for children aged 1-12 and 13-24 months old was highest in cognitive, psychosocial and physical functioning dimensions and lowest in emotional functioning and physical symptoms. Overall QOL was significantly highest among the older children (25-59 months old) and those of post-treatment status. Children of lower income families (<MYR3000) had better psychosocial health. Infants up to 12 months old having only cleft lip had significantly higher QOL and those with Muslim mothers had significantly higher psychosocial health scores.

Conclusions: Parents perceived that their children’s ‘Psychosocial Health’ was more affected than ‘Physical Health’ in all age categories except for the 1-12 months old category. Overall, the child’s age and treatment status plus household income influenced the child’s QOL while mothers’ religion and type of cleft influenced the QOL of their child’s first year of life.

Acknowledgement: The authors wish to thank parents who willingly shared their time to participate in this study. The QOL study described in this paper was carried out using the PedsQLTM, developed by Professor Dr. James W. Varni. The financial support for this study was provided by the University Malaya Postgraduate Research Fund, Grant: PPPC/C1-2012/DPGA/01.

Keywords: Cleft lip, cleft palate, quality of life, parent’s perception, PedsQLTM



13

PRO-B6

Nutrition and Exercise among Elderly: Knowledge, Attitude and Practice (KAP) Study among Chinese Community in Sibu, Sarawak

Annaletchumy L, Annie Wong SM, Kavitha Subramaniam

Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar, Malaysia

Introduction: Elderly population is on the rise globally and locally with increasing life expectancy. The lack of knowledge on nutrition and exercise among the elderly has been widely reported. However, there is paucity in studies that explored on knowledge towards nutrition intake and exercise in our local community-dwelling elderly people. The objective is to explore the knowledge, attitudes and practices (KAP) toward nutrition and exercise among elderly.

Materials and Methods: A descriptive cross sectional survey was conducted from October to December 2012 at Sibu, Sarawak, Malaysia. A self-designed questionnaire was employed to assess the elderly knowledge, attitude and practice toward nutrition and exercise. Elderly people were selected purposively, a total of 150 respondents have participated in this survey and the response rate was 75%. The data were tested for statistical significance using Chi-square test by using Epi Info statistical software with significance taken as p< 0.05.

Results: Overall, 74% (n=111) of the elderly had good nutrition knowledge. A total of 89.3% (n=134) of respondents had positive attitude towards nutrition. Most of the elderly often consume fruits, juice, vegetables, meat, fish and eggs and they seldom consume dairy products, fried food, sweetened food and snacks. Respondents also showed good knowledge towards exercise 94%, (n=141) and good exercise attitudes, 76.7% (n=115). Majority of the respondents exercise once per day and they spent more than twenty minutes on exercise. There were significant association between educational status, p=0.003 and nutrition knowledge and health condition and knowledge on balanced diet, p=0.005.

Discussion: Despite many studies reported poor practices and attitudes towards exercise, Sibu Chinese elderly has significantly good KAP towards exercise. Hong Kong Chinese also had good knowledge and attitudes towards exercise.

Conclusion: Chinese elderly of Sibu have good nutrition and exercise knowledge. However, more nutrition and exercise education programmes should be conducted to improve and sustain elderly nutrition and health status.

Acknowledgement: We would like to thank all the study participants and Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) for the support and facilitation.

Keywords: nutrition, exercises, Chinese community, elderly population, Sibu



14

PRO-B7

Tooth Wear and Erosive Tooth Wear among 16-Year-Old Malaysian Adolescents

Noorhazayti Ab. Halim1, Rashidah Esa1, Chew Hooi Pin2

1. Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Malaysia

2. Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Malaysia

Introduction: General tooth wear (GTW) (indiscriminate of aetiology) and more specifically erosive wear (ETW) are relatively new emerging public health problems globally. Study about their prevalence has not been sufficiently explored in Malaysia. This study aimed to determine the prevalence and severity of GTW and ETW among 16-year-old adolescents in Kuantan, Malaysia.

Materials and Methods: A cross sectional study was carried out using multistage cluster sampling technique. The study group consisted of 16-year-old adolescents attending secondary schools in Kuantan. A total of 598 adolescents (228 males and 370 females) with a total of 16,521 teeth were examined from 5 different schools. The prevalence and severity of GTW and ETW were recorded using the Smith and Knight’s Tooth Wear Index (TWI) and the Basic Erosive Wear Examination (BEWE) index respectively.

Results: The prevalence of GTW was 99.8% (597 subjects) at a subject level and 62.9% (10,400 teeth) at a tooth level. The most frequently affected surfaces were the incisal or occlusal surfaces (99.9%). As for the severity of GTW, most of the affected tooth surfaces (99.8%) exhibited surface loss limited to enamel only (TWI Score 1). The prevalence of ETW however was 45% (269 subjects) at a subject level and 2.7% (451 teeth) at a tooth level. The most frequently affected surfaces were again the incisal or occlusal surfaces (98.2%). Severity results of ETW showed that most of the affected tooth surfaces (98.9%) exhibited a BEWE score of 2 which meant distinct hard tissue loss ≤ 50% of the surface area.

Conclusions: GTW and ETW among 16-year-old adolescents in Kuantan are highly prevalent and similar to some results published in western countries. The results of this study indicate that the local adolescents should be provided with oral health information regarding GTW and ESW. Similar studies should also be carried out in other cities in Malaysia.

Acknowledgement: The authors wish to thank all Principals, teachers, school administrators and students of secondary schools in Kuantan for giving their full cooperation in this study. The study was supported by grants from University of Malaya, Malaysia. Grant: PPPC/C1-2012/DPGA/06

Keywords: tooth wear, erosive tooth wear, adolescents, epidemiology



15

PRO-B8

Housewives in Sepang Selangor – Fat or Fit

Sabariah AH & Manan NA

Faculty of Medicine, Cyberjaya University College of Medical Sciences, Selangor, Malaysia

Introduction: Obesity increases the risk of many diseases and it is showing increasing trend among adult females and in rural area. This study investigates the differences and compares weight status among housewives in rural and urban area of Sepang, Selangor.

Materials and Methods: A cross-sectional study was conducted in a village and housing estate area in Sepang, Selangor with sample of 196 in Kg Ulu Teris and 174 in Taman Mawar. A simple random sample of female adults age 18 years and above were selected. Data were collected by an interviewed questionnaire, physical measurements and blood collection.

Results: Overall, 69% of housewives in rural and 72% in urban areas were at least overweight. The rural-urban difference in waist circumference was greatest with 62% in urban had obesity, whereas 100% in rural was normal. Urban housewives (86%) were more likely than rural housewives (76%) not having appropriate exercise. The reasons for not exercising were no time, lazy and lack of facilities.

Conclusion: Though the data may not represent a larger population, it is crucial for this group of subjects to have their weight reduced by methods such as dietary control and physical exercise. Health education should also be targeted on this aspect.

Acknowledgements: This study was supported by the Cyberjaya University College of Medical Sciences under the Community Medicine Programme. The authors thank the support and help from Assoc Prof Dr Muhammad Najib Mohamad Alwi. We also acknowledge all Class 2010 students in the Department of Community Medicine, CUCMS for helping in the data collection.

Keywords: overweight, obesity, housewives, rural, urban



16

OCCUPATIONAL HEALTH / ENVIRONMENTAL HEALTH

PRO-C1

Effectiveness of Intervention Programme in Improving Knowledge, Attitude and Practice among Smokers in Mukim Peringat, Kelantan

Aziah Daud & Group A CFCS 2012/2013

Department of Community Medicine, School of Medical Sciences, University of Science Malaysia Health Campus, Malaysia

Introduction: Cigarette smoking is a major health concern in most societies because the diseases and deaths that result from it are in fact preventable. It is estimated that tobacco-related deaths will be the most important cause of deaths in developing countries by 2020. Therefore, the aim of this study is to determine the changes in knowledge, attitude and practice following intervention programme among smokers in Mukim Peringat, Kelantan.

Materials and Methods: The intervention programme was focused mainly on smoking and it was divided into two different phases. The first phase was centred on community-tailored activities with the intention to educate the respondents in regard to cease smoking habit among them using the slogan “Puasa Rokok Sihat Sokmo”. The second phase was more specific towards sustaining our efforts to tackle smoking in the village for a long term by developing special programme. Our study population was 168 smokers (active and passive) in Mukim Peringat. The inclusion criteria was subjects who were 15 years old and above at the time the study was conducted and subjects who were mentally and physically insufficient was the exclusion criteria. The data were obtained using the interviewer guided validated questionnaire on knowledge, attitude and practice about smoking by Universiti Sains Malaysia researchers group and data were analysed using SPSS version 20.0.

Results: Our results showed that there was significant increment between the pre-intervention and post intervention survey evaluations for knowledge, attitude and practice on smoking. Mean knowledge score was significantly different (p<0.001, 95% CI) with the mean (SD) knowledge score post-intervention [35.52 (5.36)] was higher than pre-intervention [29.12 (7.12)], in which there was a 22.0% increment. For the mean (SD) attitude score post-intervention was higher [26.44 (5.43)] than pre-intervention [24.44 (5.35)] with an 8.2% increment and lastly for the practice part, there was an increase in mean Fagerstrom score (nicotine dependence level) among smokers after intervention.

Conclusion: Our intervention programme has provided the smokers of Mukim Peringat, Kelantan with good foundations on knowledge, attitude and practice on smoking.

Acknowledgement: In a nutshell, our community case study is a success under the full cooperation between members of PBL 1 and PBL 8, and finally support and hospitality from all the villagers from Mukim Peringat. Not forgotten, our heartfelt appreciation to the Dean, School of Medical Sciences, Prof Ahmad Sukari Halim for his support and financial help.

Keywords: effectiveness, intervention programme, knowledge, attitude, practice, smokers



17

PRO-C2

The Impact of Body Mass Index on Sickness Absence among Healthcare Workers in Kuala Selangor in 2012

Azizah Wahab1, Rozita Hod1, Hanizah M Yusoff1, Halim Ismail1, Azmawati M Nawi1, Norfazilah Ahmad1, Zaharah Zainuddin2

1. Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Malaysia2. Occupational Health and Safety Unit, Selangor State Health Department, Malaysia

Introduction: Prevalence of obesity among healthcare workers is higher as compared to the general population and the complex nature of the occupational hazards at the health centres may increase the incidence of sickness absence among healthcare workers. Therefore, the aim of this study is to determine the relationship between body mass index (BMI) and sickness absence among healthcare workers.

Materials and Methods: Retrospective record review study was conducted among healthcare workers aged of 40 years old and above in public health centres in Kuala Selangor. A simple random sampling of 174 healthcare workers was selected from a list containing the names of all 203 healthcare workers age 40 years old and above. Data of annual health checks and sickness absence from January to December 2012, were recorded and analysed. All statistical analyses were performed by using Statistical Package for Social Sciences (SPSS), version 20. This study was approved by the Research and Ethics Committee, Medical Faculty Universiti Kebangsaan Malaysia (UKM)(FF-2013-315) and as well as National Medical Research Registry, Ministry of Health (NMRR-13-389-14931).

Results: Out of 173 respondents, 101 (58.3%) took sick leave in the past year with 306 spells and 932 sick-off days. The prevalence of pre-obese and obese was 34.1% and 46.2% respectively and higher BMI was significantly associated with sickness absence (p<0.001). There was a fair positive linear relationship between BMI and duration of sick leave (rs=0.3). Regular fix daytime working hour was also significantly associated with sickness absence (p=0.003).

Discussion: These study findings confirmed those of previous studies that have shown significant associations of obesity with sickness absence in both sexes. Healthcare workers with high BMI prone to have various health problems such as musculoskeletal disease, cardiovascular disease and cancer which could decrease physical functioning and interfere them in providing good quality of health services.This study also consistent with Ala-Mursula et al. (2005) that found shift workers have significantly lower rates of sickness absence than day workers10

because they have higher control over working schedule than workers with fix daytime working hour. As found by Ishizaki et al. (2006), increased job control and supervisor or co-worker support were significantly associated with lower levels of sickness absence in men. The limitation of this study is the lack of information on other potential confounders such as perceived workload, job autonomy and decision latitude.

Conclusion: Obesity and regular fix daytime working hour are the risk factors of sickness absence. Therefore, promoting healthy weight maintenance particularly at workplace and full implementation of flexible daytime working hours are essential to ensure an optimum occupational functioning and minimizing the costs associated with sickness absence among healthcare workers.

Acknowledgement: The researchers would like to thank the Dean of Medical Faculty UKM for giving permission to conduct this study. We also would like to thank the Director of Selangor State Health Department for giving permission to use the data from the department.

Keywords: body mass index, sickness absence, healthcare worker, obesity



18

PRO-C3

Occupational Depression among Employees of Esfahan Steel Company, Iran: Prevalence and Associated Factors

Masoud Lotfizadeh1 & Noor Hassim Ismail2

1. Department of Community Health, Shahrekord University of Medical Sciences, Shahrekord, Iran2. Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Malaysia

Introduction: Recently, depression has become one of the most serious community health challenges in the world especially in developing countries and there has been a great deal of public attention on it. Depression is described by changes in state of mind, self-attitude, aware performance, sleep, decreases quality of life, change in appetite, and level of energy. Depression is a common but serious illness, and most humans who practice it need handling to get well. However, this is one of the premier studies about occupational depression among industrial employees in Iran.

Materials and Methods: The aim of the present study is to investigate the prevalence and associated factors of depression among Esfahan Steel Company Employees, Iran. A sample of 400 males between the ages of 20 and 58, from the operational divisions of an Iranian steel company took part in the current study. The participants who provide data in this study were all the full time employees in Esfahan steel company (ESCO), IRAN and the design used in this study is cross-sectional carried out in 2008. The depression, anxiety, and stress scale (DASS) were selected for this research. The questionnaires were filled out through interviews and all the questionnaires were anonymous, informed written consents were taken from the participants and the manager of ESCO as well. The collected data were analyzed by using SPSS version 18.

Results: The prevalence of depression was 70.8%. Analyses did not exhibit significant relationship between depression and age, marital status, experience, literacy and shift work. Conversely, high significant relationship was found between income, work position, family related problems, work environment, job position and depression. Multivariate logistic regression showed that financial problems were the most common reasons for depression among the employees and the main contributors to depression were work environment, task type, financial problems and the income below 500 US $ (p<0.05).

Discussion: Based on the results of the study, about three quarters of the ESCO employees suffer from symptoms of depression compared with other industrialized countries, Iranian employees appeared to have much higher prevalence of depression.

Conclusion: It is clear that the role of the economic problems is more striking than other factors. Consequently, we recommend policy makers to pay more attention to economic problems to get the best response in term of depression reduction among Iranian workers. However, more research is needed to evaluate all the aspects of mental health among Iranian employees.

Acknowledgement: This study was supported by School of Medicine, National University of Malaysia (UKMMC) and the Shahrekord University of Medical Sciences, Iran. Special thanks are due to the management of the Esfahan Steel Company and all others who assisted the researchers in this study.

Keywords: depression, Iran, male, employees



19

PRO-C4

Publication of Simplified Version of Cancer Material

Nosidawati Abdul Gani1, Latiffah Abdul Latiff1,4, Othman Omar2, Mazanah Muhammad3

1. Cancer Resource & Education Center (CaRE), Universiti Putra Malaysia, Malaysia2. Malaysian Foundation for Innovation, Cyberjaya, Malaysia 3. Faculty of Educational Studies, Universiti Putra Malaysia, Malaysia4. Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia

Introduction: Information is important for cancer patients and their caregivers. This information ought to be tailored based on the culture and literacy of the patients. This paper deliberates on the publication of educational materials appropriate for Malaysians cancer patients. A survey in 2005 on the booklets prepared by Universiti Putra Malaysia (UPM)-Cornell Collaboration Cancer Education & Research (CaEd) project showed that there is a needto have a more simplified version of this education material (Othman et al. 2008). Thus, CaEd project initiated the development of simplified versions of education materials in 8 titles.

Material and Methods: The CaEd project booklets were adapted and translated from the education material of the American Cancer Society. A questionnaire was used to assess the feedback on the appropriateness of the booklets. The custom design instrument consisted of 40 likert scale questions. The instrument consisted of 5 sections including content, design, visual, overall, and demography. The booklets were distributed randomly between 48 cancer survivors and their caregivers. Descriptive statistics were used to analyse the data.

Results: The results showed that the majority of readers (98%) clearly understood the content, 100% liked the cover, color, font size, and size of the booklet and 100% found the booklet informative and useful. The feedback also pointed out the need for further improvement of visuals, adding glossary for difficult words and booklet development into other major languages in Malaysia.

Discussion: Although the booklet was found acceptable to cancer survivors in terms of content and appearance, amendments should be done to the booklet especially in terms of the visuals based on the reader’s feedback. It is important to meet the needs of readers in order to bridge the gap in health communication.

Conclusion: The participation of target audience will reflect better to them to make informed decisions. Both patients and health professional involvement are required to produce effective educational material (Kavin et al.2011).

Keywords: cancer survivor, patient education, health communication, education material assessment, Malaysia



20

PRO-C5

Prevalence of Metabolic Syndrome and Combat Related and Psychological Risk Factors among Military Personnel Aged 30-55 Years in Sri Lanka Light Infantry Regiment of Sri Lankan Army

Chathurani M Wickramaarachchi1, Pushpa Fonseka2, Nimalka K Ariyaratne3

1. Postgraduate Institute of Medicine, University of Colombo, Sri Lanka2. Faculty of Medicine, University of Sri Jayawardhanapura, Sri Lanka3. Military Hospital, Colombo 05, Sri Lanka

Introduction: Economic, nutritional and demographic transition hand in hand had led to a change from traditional communicable disease burden to more modernized non communicable disease (NCD) modality. Thus, this epidemiological transition has a great impact on lives of mankind leading to more life style related diseases (Popkin 2002). NCD is accountable to majority of global disease burden. Globally in 2000, 59% of deaths were due to NCD (WHO 2001). Four fifths of deaths from NCD occur in lower and middle income countries (WHO 2005).Mortality rates due to NCD are higher in Sri Lanka in comparison to developed countries. In 2008, NCDs were estimated to account for 66.8% of deaths among males and 51.1% of deaths among female in Sri Lanka (WHO 2011). Metabolic Syndrome is an important indicator of NCDs which is a constellation of obesity, hyperglycemia, decreased High Density Lipoprotein (HDL-c), increased Triglyceride (TG) and high blood pressure (Magliano et al. 2006). Metabolic Syndrome is an emerging concern of public health importance. Its positive association with coronary vascular diseases, stroke and diabetes is evident. Substantial evidence indicates that psychological factors are independent risk factors for chronic physical illnesses (Sundaram et al. 2007; Todaro et al. 2003). The objective of this study is to the determine prevalence of Metabolic Syndrome and combat related and psychological risk factors among military personnel aged 30-55 years in Sri Lanka Light Infantry regiment of Sri Lankan Army.

Materials and methods: A population-based cross sectional study was conducted in 2012 to obtain details on Metabolic Syndrome and its associates. A case control study was done in the subsequent step in order to determine combat related and psychological risk factors. Metabolic Syndrome was defined according to American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition (Grundy et al 2005). Data were collected using a pre-tested interviewer administered questionnaire on demographic and life style factors. A total of 673 subjects (response rate 98.7%) aged 30-55 years (mean 35.0±3.9) were screened with a physical examination and blood tests. Arterial blood pressure, weight, height, body mass index and waist circumference were measured by standard methods. Fasting Blood Sugar and Lipid profile consisting of HDL and Triglyceride were obtained from military data system.

Results: The sample predominantly consisted of Sinhalese 97%; Buddhists 87.4% and educated up to G.C.E. Ordinary level 74.6%. The results revealed the crude prevalence of Metabolic Syndrome as 22.9% [95% CI=22.86-22.93]. Reduced HDL (100%), hypertension (83.1%) and elevated FBS (52.6%) were most common abnormalities among the participants. Age, religion, type of force in the Army, family history of dyslipidemia and diabetes mellitus were significant socio-demographic determinants of Metabolic Syndrome. Alcohol consumption in life time and less frequent alcohol consumption were significantly associated with Metabolic Syndrome. In addition, among current smokers who have started smoking at a younger age of less than 15 years and less frequent smoking were significantly associated with Metabolic Syndrome. In the case control study among selected combat related factors, years of military service in operational areas [OR=0.059 (95% CI=0.724-0.79)], presence of battle casualty [OR=44.8 (95% CI=25.5-78.6)], severe type battle casualty [OR=94.5 (95% CI=18.45-48.45)] and absent without obtaining leave [OR=21.343, CI=6.166-73.882] were key determinant risk factors signifying risk of Metabolic Syndrome with active combat. Among the selected psychological risk factors for Metabolic Syndrome, Depression[OR=0.059 (95% CI=0.724-0.791)], PTSD [OR=65.39 (95%CI=36.47-117.09)], Distress [OR=17.423 (95%CI=11.27-26.94)] and Pessimism [OR=0.049 (95%CI=0.026-0.091)] were found to be significant factors of Metabolic Syndrome.Binary logistic regression analysis was performed using the dichotomous variable MS (0=absent, 1=present). The independent co-variants were: depression, distress and severe type of battle casualty.



21

Conclusion:Prevalence of Metabolic Syndrome is comparatively high in this population. Depression, distress and severe battle casualty were reported as risk factors for Metabolic Syndrome.

Acknowledgements: Director Army Medical Services, Consultant Pathologist, Consultant Psychiatrist from SriLankan Army.

Keywords: metabolic syndrome, psychological risk factors, military personnel, Sri Lankan Army



22

PRO-C6

Prevalence of Obstructive Sleep Apnoea among Commercial Truck Drivers

Wahida Ameer Batcha, Ilhamah Othman, Mohamad Suffian Ahmad, Norlen Mohamed

Vehicle Safety and Biomechanics Research Centre, Malaysian Institute of Road Safety Research, Malaysia

Introduction: Obstructive Sleep Apnoea (OSA) has been recognised as one of significant risk factors of road traffic accident. In Malaysia, the prevalence of OSA among commercial truck driver is not known. Therefore, this study was aimed to identify the prevalence of OSA among commercial truck drivers.

Materials and Methods: A cross sectional study was conducted over a three-month period in 2012. The population of this study was commercial truck drivers travelling within Peninsular Malaysia. Respondents were commercial truck drivers selected from a fleet company operated in Klang Valley. A validated Berlin questionnaire was used as screening tools to identify commercial truck drivers who were at risk of developing OSA.

Results: A total of 130 commercial truck drivers participated in this study and were screened using Berlin questionnaire. All respondents were male, age ranged from 22 to 70 years with an average of 38.9 (±10.7) years old. Screening of OSA based on Berlin questionnaire revealed that about 14.6% of drivers were categorised as having high risk of OSA while 85.4% were having low risk of OSA. Comparison of individual variables between high and low risk of OSA found that the (mean ± SD and p value) for BMI (30.6 ± 3.8, p<0.001) and neck circumference (40.9 ± 2.4, p<0.001) were significantly higher among those with high risk of OSA than the low risk group. This finding is consistent with other studies that had proven a clearly established relation of BMI and OSA. Besides BMI, drivers with high risk of OSA also recorded larger neck circumference. Downey et al. (2009) stated that a neck circumference of 40 cm or greater had a sensitivity of 61 per cent and specificity of 93 per cent for having OSA.

Conclusion: The prevalence of OSA among the commercial truck drivers as reported by our study is alarming. The findings also indicate that BMI and neck circumference could be positive predictors to screen drivers with OSA. Therefore, early detection and treatment of OSA among commercial truck drivers are important preventive measures in reducing the risk of road traffic accidents.

Keywords: Obstructive Sleep Apnoea (OSA), commercial truck drivers, road traffic accident



23

PRO-C7

Musculoskeletal Problems among Agricultural Workers in FELDA Sungai Kelamah, Gemas, Negeri Sembilan

Mohd Dzulkhairi Mohd Rani, Zairina A Rahman, Mohd Yunus Abdullah, Nooriah Mohamed Salleh

Community Health Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Ampang, Malaysia

Introduction: Musculoskeletal problems (MSP) include a diversity of complaints and diseases involving the joints, bones, cartilages, ligaments, tendons, tendon sheaths, bursae and muscles. Work-related musculoskeletal problems are an inevitable consequence of strenous activities in agricultural labor. Thus, to ensure a stable and continuous production of the agriculture especially in the palm oil and rubber estates, MSP should be addressed properly. Hence, the aims of this study are to determine the prevalence of MSP and its association with socio-demographic profile, anthropometric factors, occupational factors and ergonomics, as well as the health seeking behaviours among agricultural workers in FELDA Sungai Kelamah, Gemas, Negeri Sembilan.

Materials and Methods: A cross-sectional study was conducted among adult rubber tappers and palm oil workers from FELDA Sungai Kelamah, Negeri Sembilan, using simple random sampling method. The sample size was calculated using OpenEpi sofware and the minimum sample size determined was 167 with 95% confidence interval. Data for this study were collected from 168 respondents by using pre-tested, self-constructed questionnaire which was modified from established Extended Nordic Musculoskeletal Questionnaire (NMQ-E) through face-to-face interview using validated questionnaire. Data analysis was done using IBM Statistics software version 20.

Results: The prevalence of MSP was 55.4% with the most affected body part was lower back (33.7%), followed by knee (26.2%) and shoulder (25.0%). There was significant association between prevalence of MSP with BMI (p=0.050), working hours (p=0.034), working days per week (p=0.048), and number of trees worked per day (p=0.018). However, there was no significant association between prevalence of MSP with age (p=0.800), working years (p=0.844), working at trees posture (p=0.586), lifting posture (p=0.918), carrying posture (p=0.163) and occupation (p=0.869). Most respondents chose government clinics as their primary choice of treatment (44.6%) and 86.1% of respondents stated that service provided at government health care centre is good.

Discussion: Half of the respondents suffer from MSP with commonest site is the lower back. The prevalence of MSP and the commonest site is in line with a study done in Thailand. In this study, we found that there are significant associations between MSP with occupational factors like working hours, working days and number of trees worked contrary with the findings of Abu Hassan and Hasbullah. The respondents preferred government health clinic and satisfied with their service is similar to the findings of the study done by Aniza I and Suhaila A. The limitation of this study is that the study design used was cross-sectional, so the results could not confirm any causal relationship between risk factors with MSP.

Conclusion: Slightly more than half of agricultural workers in FELDA Sg. Kelamah, Negeri Sembilan sufferfrom MSP with the commonest site was the lower back. The MSP were associated with BMI, working hours per day, working days per week and number of trees worked per day. Majority of them seek treatment from government clinic.

Acknowledgement: USIM Grant: PPP/GS/PSK/STH/30/11212 and Pejabat Kesihatan Daerah Tampin.

Keywords: musculoskeletal problems, agricultural workers, risk factors



24

PRO-C8

Validating Effort of an Occupational Back Pain Questionnaire with Standards from a Social Security Organization Based in a Developing Country

Jenn Z Tam, Sharifa E W Puteh, Noor H Ismail


Introduction: In a country that struggles on safety standards and relying heavily on manual labour, Malaysia is a developing South East Asian country that is strategically located in the centre of the fast booming Asia. With limited appropriate effective commitment, resources and experts; Malaysia has to innovatively transform herself to meet the expectations and standards of the promised national industrialization. The BACKS questionnaire was a proposed Back Apparatus Collaboration between National University of Malaysia Medical Centre (UKMMC) with Malaysian Social Security Organization (SOCSO) to assist in determining occupational chronic back pain. Parameters and measurements to discriminate occupational chronic back pain that were previously identified and confirmed are subjected to concurrent validity testing with existing standards where the questionnaire would be used in the near future.

Materials and Methodology: Chronic back pain was defined as minimal cumulative back pain for more than 2 weeks in the past year, Pain Visual Analog Score above 2 cm and Oswestry Disability Index of above 20%. Pregnant workers, workers with acute back pain due to accidents or fall at work, and those with pathological spine due to infection or cancer were excluded from the study. Based on the SOCSO registry from 2008 to 2010, workers around the country with chronic back pain that were reviewed by the Medical Board were identified via cluster sampling between May to November 2012. Based on the pre- determined scoring, a chronic occupational back pain is suggested when the BACKS score is above 0.573 or percentage above 51.8% using Likert scores.

Results: Based on the SOCSO registry from 2008 to 2010, 428 (56.3%) workers of 760 workers with back pain agreed and met the requirements of our study. The mean age was 39.49 + 9.98 years old while majority were Malay ethnicity (42.3%), males (89.5%), general workers (17.5%), overweight (26.84 + 4.50 kgm-2) and from the semi-urban state of Perak, Peninsular Malaysia (22.4%) whom mainly presented with back strain (70.6%). According to the standards of the Medical Board, the BACKS Tool reported a sensitivity of 62.7%, specificity of 94.5%, positive-predictive value (PPV) of 92.9% and negative- predictive value (NPV) of 69.0% with moderate agreement as Kappa value was 0.56.

Conclusion: The BACKS Tool served as a complementary assessment along with visits to the workplace that has its advantages when one would to conduct a self- administered assessment of their workplace by safety and health officers, organizations with limited funding.

Acknowledgement: We would like to thank Dr Azman Mohammed Aziz Mohammed for his insight and help on this study, Mr Chan Kok Fung for the inspiration, the SOCSO officers and all the respondents of this study who has generously given their time. This work is supported by National University of Malaysia Medical Centre and Social Security Organization, Kuala Lumpur, Malaysia.

Keyword: chronic low back pain, work- relatedness, occupational, validity



25

PRO-C9

Religiosity, Coping and Post Traumatic Stress Disorder among Earthquake Survivors

Rafidah Bahari1 & Norlaili Abdul Aziz2

1. Department of Psychiatry, Cyberjaya University College of Medical Sciences, Malaysia2. Department of Public Health, Cyberjaya University College of Medical Sciences, Malaysia

Introduction: In September 2009, a massive earthquake shook the town of Padang in Indonesia. Following disasters, posttraumatic stress disorder (PTSD) is common, but not inevitable. Why? Could coping style and religiosity play a role? The objectives of this study are to determine the prevalence of PTSD 1 year after the Padang earthquake and examine the association between coping styles and religiosity in PTSD.

Materials and Methods: A cross-sectional study was carried out between August to September 2010. The subjects were all students (n=44) who had been studying in Padang, were present during the earthquake and had since transferred to a Malaysian university. PTSD was assessed using the Revised Impact of Event Scale (IES-R), COPE questionnaire was used to measure coping mechanism and Hatta Religiosity Scale (HRS96) to measure religiosity.

Results: The response rate was 93%. Among the respondents, 53.7% were females, 82.5% were single, 85% were Malay and 85% were Muslims. The prevalence of PTSD after one year was 27.5%. The most common coping mechanisms used were acceptance, positive reinterpretation and growth, as well as turning to religion. It was found that the PTSD group tends to use mental (p=0.003) and behavioural disengagement (p=0.01) as way of coping. No difference was found between those with or without PTSD symptoms in terms of their Islamic knowledge and practices. There is significant correlation between Islamic practices and the use of behavioural disengagement as a coping mechanism (p <0.05), in which PTSD group tend to give up, or withdraw effort from, the attempt to attain the goal with which the stressor is interfering.

Discussion: The high prevalence rate has been consistent with previous studies. However, it is interesting to discover that those with PTSD are more likely to cope by detaching themselves from the stressor, especially those with lower religiousity.

Conclusion: Untreated, symptoms of PTSD persist even after a year. The most common coping mechanisms used were turning to religion, positive reinterpretation and growth and acceptance. Finally, poor Islamic practice seems to correlate with use of maladaptive coping.

Acknowledgement: Cyberjaya University College of Medical Sciences Research Grant funded the study.

Keywords: posttraumatic stress disorder (PTSD), earthquake survivors, coping styles, religiosity



26

PRO-C10

URTI Outbreak at School X, Cheras, Kuala Lumpur

Haliza AM1, Asyraf Z1, Rohani I2

1. Cheras Health Office, Kuala Lumpur Health Department, Malaysia2. CDC Unit, Kuala Lumpur Health Department, Malaysia

Introduction: This study was performed to identify the cause of Upper Respiratory Tract Infection (URTI) in a school and to prevent the outbreak from spreading.

Materials and Method: To evaluate 482 students and staffs of a school staying in three hostels (A, B and C) exposed to URTI outbreak, a questionnaire was used to measure demographic data, symptoms experience and onset date. All the data were interpreted in Microsoft Excel 2013 and Epid Info 7. The clinical samples of throat swab and samples of air and wall scraping from the hostel were used to identify the presence of bacteria, fungus and virus.

Results: About 88 URTI cases were identified by using active case detection method with an attack rate of 18.3%. Five out of 88 cases had throat swab samples taken. The results showed three cases were positive for Haemophilus influenza. Air and wall scraping samples taken by IMR showed presence of fungus such as Aspergillus and Penicillium sp but negative for Haemophilus influenza. Based on analytical study conducted, Hostel A has a significant value (p = 0.04) with relative risk 2.2 times higher to get an URTI infection compared to other hostels. The Engineering Division, MOH found improper installation of the air-conditioning system causing multiple fungi residing on the wall of Hostel A.

Discussion: The cause of the outbreak pointed to Hostel A which was a rented commercial building. The overcrowding of students and improper installation of air-conditioner thus has catalysed the growth of certain fungus which may potentially cause URTI. Failure of the school management to comply with instructions in isolating the students due to financial limitation has caused the increase in the number of cases.

Conclusion: There was an outbreak of URTI in school X involving 88 students with an attack rate of 18.3% where the cases were mainly from Hostel A. Source could be from the improper installation of the air-conditioning systemcausing a leak on the wall of Hostel A, resulting in multiple organisms infestation.

Acknowledgement: Special thanks to the Institute of Medical Research and Engineering Division, Ministry of Health for their expertise.

Keywords: URTI outbreak, fungus, Haemophilus Influenza, Aspergillus sp, Penicillium sp



27

PRO-C11

A Pilot Study Examining Anemia and Obesity among Women Worker

Salli Fitriyanti1, Anastasia Yani Triningtyas2, Sri Quintina Indriyana2

1. Medical Nutrition Department, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia2. Public Health Department, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia

Introduction: The prevalence of anemia in women worker at Indonesia is still high. Anemia in women worker will decrease their productivity. The health practitioner in Indonesia pay less attention to anemia in overweight and obesity, because there is still paradigm that anemia is always associated with underweight. The aim of this pilot study is to know the prevalence of anemia in obesity and overweight women worker at Cimahi, Indonesia.

Materials and Methods: The study was a descriptive design and conducted in Cimahi, West Java Province, Indonesia. All subjects signed informed consent form. Subjects were female workers at 6 garment and textilecompanies in Cimahi, taken by purposive sampling. A total of 257 subjects (mean age 31.5 y) (SD 8.5 y) were able to meet the complete examination. Anemia was defined if hemoglobin (Hb) concentration below 12 g/dL and measured by Tallquist hemoglobin scale. To assess overweight and obesity, we used World Health Organizationstandard body mass index for Asian.

Results: This study showed the prevalence of anemia in women worker was 80.5% (mean Hb 10.8 g/dL (SD 1.3)). The average BMI was 24.2kg/m2, with 17.1% subjects overweight and 37.4% obesity. As much as 81.8% overweightsubjects had anemia (mean Hb 11.1 g/dL (SD 1.2)), while 82.3% of obese subjects also have anemia (mean Hb 10.6 g/dL (SD 1.2)).

Discussion: The prevalence of anemia in this study was high than other research in Indonesia because we used a simple method, the Tallquist method. Anemia in overweight and obesity subjects were higher than in normoweight and underweight subjects because excess fat cells can interrupt iron metabolism in human body, with hepcidin as a key mediator.

Conclusion: The prevalence of anemia in overweight and obesity women worker in Cimahi was high.

Keywords: anemia, obesity, overweight, women worker



28

HEALTH MANAGEMENT / HEALTH PROMOTION

PRO-D1

Knowledge, Attitude and Practice towards Organ Donation among the Students of Universiti Sains Islam Malaysia (USIM)

Nazefah Abdul Hamid1, Mohd. Dzulkhairi Mohd. Rani1, Marlini Muhamad1, Mohd. Hairulhisyam Ngatiman1, Rosliza Ghazali1, Mustafa ‘Afifi Ab. Halim2, Nooriah Mohamed Salleh1

1. Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, Malaysia2. Faculty of Shariah and Law, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Negeri Sembilan, Malaysia

Introduction: Awareness about organ transplantation has increased in the last recent years. In Malaysia, demand for organ and tissue transplantation is high. It is believed that the awareness to donate organs is based on good knowledge, attitude and practice amongst the public members. Enhanced knowledge and involvement in organ donation may be best achieved through educational programmes in the university. Hence, this study aims to determine knowledge, attitude and practice (KAP) and its association and correlation amongst USIM students.

Materials and Methods: A cross-sectional study utilizing systematic random sampling was conducted on 222 USIM students using self-administered and validated questionnaire. Data analysis was carried out using IBM Statistics version 20.

Results: There was no significant correlation between total knowledge and total attitude score (p=0.091, r=0.114), total knowledge and total practice score (p=0.666, r=0.029) but there was a significant correlation between total attitude score and total practice score (p=0.001, r=0.213). There was a significant mean difference in the knowledge scores (p=0.048) between male and female students but not for attitude (p= 0.346) and practice (p=0.594). No correlation was found between total knowledge and total attitude (p=0.091) and knowledge and practice (p= 0.666). However, there was a correlation between attitude and practice score (p=0.001). Comparing the students from Faculty of Medicine and Health Sciences with Faculty of Shariah and Law, there is a significant difference in the mean age (p= 0.038). The total knowledge score for Year 1 and Year 6 students in the Faculty of Medicine and Health Sciences showed a significant difference (p=0.013). The total practice score also showed a significant difference (p=0.011).

Discussion: The majority of the students had the knowledge and positive attitude towards organ donation, however it is not translated into the practice. This finding concurs with the reports that university students in Poland, Turkey, China and Taiwan had the knowledge and positive attitude towards organ donation but did not register as organ donors. Our study showed that there was a significant difference in the total knowledge and practice score for Year 1 and Year 6 students in the Faculty of Medicine and Health Sciences. Researchers in Brazil and Hong Kong also reported similar findings. This observation may be due to the fact that the Year 6 students have been exposed to clinical training compared to first year medical students. However, there was no significantdifference in total attitude of the medical students in Hong Kong.

Conclusion: The attitude towards organ donation is good amongst the students but only 3 students have registered to donate their organs. Hence, it is our responsibility to educate and promote organ donation amongst university students in Malaysia.

Acknowledgement: USIM Greenshoot Grant: PPP/GS/PSK/STH/30/11112, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Negeri Sembilan, Malaysia, 71800.

Keywords: knowledge, attitude, practice, organ donation, student



29

PRO-D2

The Impact of Migraine on Quality of Life (QOL) in Females

Munvar Miya Shaik1, Norul Badriah Hassan2, Huay Lin Tan1, Shalini Bhaskar3, Siew Hua Gan1

1. Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia2. Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia3. Gleneagles Medical Centre, Penang, Malaysia

Introduction: Despite advances in therapy, the prevalence of migraine has remained constant over the years. Health-related quality of life (QOL) is becoming an important outcome measure in the field of migraine. This study was aimed to determine association between migraine and QOL and to compare QOL between migraine and non-migraine controls in females.

Materials and Methods: This hospital-based study was conducted in Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia, between January and May, 2013. Migraine was diagnosed at the Neurology Clinic as per criteria of the International Headache Society. A total of 100 female migraine cases and 100 non-migraine female volunteers completed the World Health Organisation quality of life (WHOQOL-BREF) questionnaire. Multiple logistic regression was used to determine association between migraine and QOL. Independent t-test and analysis of covariance (ANCOVA) were used to compare QOL between migraine and non-migraine controls in females.

Results: The QOL scores has a significant linear association with migraine (p <0.001) and they were decreased by 15% due to migraine headaches. Females with migraine had lower scores (83.43, p < 0.001) on WHOQOL-BREF compared with their non-migraine counterparts (91.90). After adjusting for age, income and years of education, QOL scores were still significantly lowered (84.32, p<0.001) compared with their non-migraine controls (91.87).

Discussion: This is the first study to assess the impact of migraine on QOL in females. In this study, total QOL scores, physical and psychological domain scores were significantly lower. This study agrees with the previous studies results and they also reported low QOL scores among migraineurs. Further, they reported significantly lower physical and emotional domains. Liptom et al. reported the linear association between migraine and disability and QOL. In this study also, QOL has linear association with migraine.

Conclusions: QOL score has linear association with migraine and females with migraine have significantly lower QOL compared with non-migraine controls. Further studies are needed to determine the triggers for low QOL scores among the migraine subjects.

Acknowledgements: This study was funded by the Universiti Sains Malaysia Research University (RU) Grant (Grant no. 1001/PPSP/815094). The first author was supported by the Graduate Assistance Scheme, School of Medical Science, Universiti Sains Malaysia. We would like to thank all the staff at the Neurology Clinic, HUSM, Kelantan, Malaysia, for their help with sample collections.

Keywords: quality of life (QOL), migraine, female



30

PRO-D3

The Effectiveness of Dietary Counselling by Dietician on Knowledge, Attitude and Practice and Quality of Life of Diabetic Patients in Klinik Kesihatan Bandar Kuantan

Ezzaity N Anuar1, Noraishah M Nor1, Nor Azlina A Rahman2

1. Department of Nutrition Sciences, International Islamic University Malaysia, Kuantan, Malaysia2. Department of Biomedical Science, International Islamic University Malaysia, Kuantan, Malaysia

Introduction: Dietary counselling is very important for diabetic patients because diabetic control is very much related to the patients’ dietary intake and this can affect their knowledge, attitude and practice (KAP) and quality of life (QoL). Behavioral modification for diet and physical activity through individual counseling has been proven to be able to prevent the development of diabetes mellitus. The objective is to assess the effect of dietary counselling by dietician on KAP and QoL of diabetic patients in Klinik Kesihatan Bandar Kuantan.

Materials and Methods: This quasi-experimental study assessed diabetic patients’ KAP and QoL, pre- and at least four weeks post-intervention, using an interview-guided, Likert scale designed questionnaire. Randomization could not be done because medical officers decided on the referral of patients to dietician for dietary counselling, who were recruited for the intervention group. Convenience sampling was used to select patients for the control group. Only patients with no previous counselling by dietician were recruited for both groups. Patients in the intervention group were given counselling sessions by dietician but not for the patients in the control group. Due to time limitation, the counselling can only be given at least two sessions per patient in the intervention group. The counselling given included the information on diabetes itself, dietary intake and exercise for diabetic patients.

Results: A total of 70 diabetic patients were recruited but only 63 of them completed this study (31 in intervention and 32 in control group). Based on the results of RM Anova, more improvement on the total score of KAP and QoL were seen in intervention as compared to control group, however the differences were not statistically significant (p-value of 0.880, 0.179, 0.555, 0.139, respectively).

Discussion: As opposed to this study, a study whereby two-years structured counselling by physician were given to type 2 diabetic patients did show significant improvement in energy expenditure, body mass index and HbA1c of the patients. Another study found the common barriers in providing counseling for physical activity in diabetic patients include inadequate training, little reimbursement, insufficient time and perceived lack of effectiveness among the healthcare providers. In view of that, they suggested to include counseling skills as part of continuing medical education for healthcare providers.Conclusion: Even though not statically significant, dietary counselling did show more improvement on diabetic patients’ KAP and QoL as compared to the control group.

Acknowledgement: The authors would like to acknowledge IIUM Research Endowment Grant (Type A) EDW A 11-038-0829, the Ministry of Health Malaysia, namely the Institute for Health Behavioural Research, Medical Research Ethics Committee, Medical Officer of Health in Kuantan District Health Office, the staff in Klinik Kesihatan Bandar Kuantan, all participants and the dietician, Noor Aishah Mohd Nasir.

Keywords: diabetes mellitus, dietary counselling, dietician, knowledge, attitude and practice (KAP), quality of life (QoL)



31

PRO-D4

Perception of End Users on I-Kelahiran in Sabah Health Department

Dhesi Baha Raja Selva Raja & Cheah Whye Lian

Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia

Introduction: I-Kelahiran (Inovasi Kelahiran) is a health informatics system that manages birth data. It was developed and implemented in June 2012 in Sabah to intervene birthing discrepancy, delayed reporting of high risk pregnancy and immunization coverage. Since its implementation, there has not been any formal evaluation on the acceptance of the system, particularly among the nurses who are the end user of this system. This study aims to assess the perception and acceptance of I-Kelahiran among the nurses in Sabah Health Department.

Materials and Methods: It was a cross-sectional web-based study, conducted on February 2013 among nurses actively working with I-Kelahiran in 21 hospitals and 292 health clinics. A 12-items questionnaire based on “perceived usefulness” and “perceived ease of use”, adapted from technology acceptance model (TAM) was used for data collection. Data was analysed using SPSS version 21.

Results: A total of 800 nurses participated in this study, with a mean age of 33.62 years (SD=8.060) and majority of them are community and staff nurses. About 63% of them are from primary health clinics and only 6.3% do not have any experience with computer. Mean score for both perceived usefulness 6.11 (SD=1.058) and perceived ease of use 6.14 (SD=0.952) were found to be high. Significant associations were found between perceived usefulness (p=0.001) and perceived ease of use (p=0.008) towards place of work. Significant higher score in perceived ease of use (p=0.033) and perceived usefulness (p=0.047) were found among nurses who have degree and higher qualification than those who have diploma.

Conclusion: Though the study indicates that overall perceived usefulness and perceived ease of use were high, future study is needed to understand why higher qualification and place of work play an important role in determining technology acceptance behavior.

Acknowledgement: We acknowledge the help rendered by Universiti Malaysia Sarawak and Ministry of Health, Malaysia.

Keywords: reporting, pregnancy, health informatics system, delivery information system



32

PRO-D5

Civil Servants Valuation of Primary Caries Prevention Package, A Case Study

AH Nurul & M Asma’

Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, University of Malaya, Malaysia

Introduction: Oral health needs among adults in Malaysia remain high. Among the oral diseases, caries prevalence is high (90.3% in 2000) and the caries severity increased with age. The complexities of treatment incur substantial cost. This paper attempts to measure the monetary value that people relate to primary caries prevention programme in Malaysia. The objectives were to determine the willingness to pay (WTP) value for primary caries prevention package and describe the factors influencing people’s preferences.

Materials and Methods: A cross-sectional survey was conducted among civil servants working in six divisions under the Melaka State Health Department. The survey was conducted in the following manner: a) Face to face interview for hypothetical question using the Stated Preference technique (Contingent valuation method) to measure willingness to Pay (WTP) b) Self-administered questionnaire to capture staff’s details. All data were analyzed using Statistical Package for the Social Science (SPSS) version 16.0. The test of significance was Mann-Whitney and Kruskal-Wallis.

Results: A total of 188 civil servants participated. WTP for primary prevention was 40MYR (13USD).This amount was just a little more than one-third of the total floor price(105MYR) proposed by Malaysian Dental (MDA); which covered the price of consultation [25MYR (8USD)] and fluoride therapy [80MYR (26USD) and above].Higher WTP value was observed among: female, Professional & Managerial group, those with no dependent family members, those with degree & higher qualifications, those in higher income group, those who able to own proxy assets, those who owned a medical insurance with dental benefits, those frequently did routine dental check-up and those preferred private dental facilities.

Conclusions: The civil servants in this study valued the caries prevention, however they are not ready to pay the actual consumption cost.

Acknowledgement: This research was approved by Medical Ethics Committee, Dental Faculty [DF C01112/00729P)]; and funded under Postgraduate Research Fund, University of Malaya (PPPC/C1-2012/DGPA/08). We would like to express our deepest appreciation to the Director of Health and staffs in Melaka State Health Department, who have made time embark in this study.

Keywords: willingness to pay (WTP), contingent valuation method, caries, preventive package



33

PRO-D6

The Achievement of Universal Health Coverage Policy in City of Padang, Indonesia: A Descriptive Analysis

Ade Suzana1, Syed Aljunid2,3, Amrizal M Nur2

1. Faculty of Public Health, Andalas University, Padang, Indonesia2. United Nations University-International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia3. International Centre for Casemix and Clinical Coding, UKM Medical Centre, Malaysia

Introduction: The long-term treatment for NCDs forced people to expend expensive costs which may push the poor to forgo the health treatment needed. To reduce the inequality of health service utilization and protecting the poor from catastrophic health expenses, Indonesian government is aiming to achieve universal health coverage (UHC) on 2019 through social health insurance. This study is aimed to find the proportion of the uninsured in City of Padang, Indonesia and their characteristics.

Materials and Methods: A household survey was conducted with 961 samples of households in 9 sub-districts out of 11 sub-districts in Padang during February to April 2012. The sampling unit was households, derived by using multistage sampling from 9 smallest administrative structure of Padang City called RT in each sub-district. All households in the selected RT were sampled. Descriptive statistics was used to figure the proportion of the population who are not covered and covered by health assurance scheme whilst analytic statistics found the characteristics of the population.

Results: The percentage of households that were protected by health insurance was 50.3%, with more than 50% of them were covered by subsidized scheme for the poor. Lower educated and non-wage-earner head of households were significant factors that differentiate the insured and uninsured. Among those with low educated head of households, 52.5% were uninsured compared with 45.5% among households with higher educated head. Most of households with non-formal worker head were uninsured (61.4%) compared with only 38.5% among formal worker head of household. The difference of the income level of the household was not significant.

Conclusion: The universal health coverage policy in Indonesia especially in the city of Padang has successfully extended the portion of insured population and provide them guarantee to the access and financial protection on health care. However, this study suggests that there is low health insurance coverage among low educated and non-formal workers families which was also characterized by unfixed income. The government will face a big challenge if the policy of voluntary health insurance will be implemented to minimize the uninsured population.

Keywords: universal health coverage, social health insurance, Indonesia



34

PRO-D7

Illness Perception among Hypertensive Patients Attending polyclinics in Kuching, Sarawak

Haironi Yusoff1 & Rasidah Abd Wahap2

1. Department of Community Medicine & Public Health, Faculty of Medicine & Health Sciences, Universiti Malaysia Sarawak, Malaysia

2. Medical Education Department, Faculty of Medicine & Health Sciences, Universiti Malaysia Sarawak, Malaysia

Introduction: The prevalence of hypertension is increasing worldwide and knowledge on patient’s perception may have an impact in compliance to treatment.

Materials and Methods: In order to assess the perception of illness among hypertensive patients, a cross-sectional study was conducted among those attending the three main polyclinics in Kuching. A total of 150 hypertensive patients were randomly selected. A revised version of the Illness Perception Questionnaire (IPQ-R) was used. The IPQ-R measures perception based on timeline, emotional control, consequences, personal control, treatment,cyclical nature of hypertension and identity. Only 100 patients completed and returned the questionnaires.

Results: There were 59 females and 41 males. Of those, 30 were Malays, 42 Chinese and 28 comprised of other ethnic groups (Iban, Bidayuh, Melanau). The mean age was 58.3 (±10.03) years, and the mean duration of hypertension was 10.2 (±7.33) years. Most of the patients (97%) were on medication, with 43% on combined anti-hypertensives. Positive personal control was noted to be higher among females (2 = 4.98, df = 1, p = 0.026), and was also higher among housewives (2 = 14.02, df = 3, p = 0.003). The housewives were also shown to be better able to identify their symptoms of hypertension (2 = 8.48, df = 3, p = 0.037). For treatment, more males had a negative notion that they will be able to control their hypertension (2 = 5.25, df = 1, p = 0.022). In comparing the ethnic groups, the Malays were less likely to perceive the chronicity of their disease (2 = 8.33, df = 2, p = 0.016).

Discussion: A total of 34% of the respondents were able to associate their symptoms with hypertension. This is consistent with another study which showed that 34.6% of subjects were aware of their hypertension (Rampal et al. 2007). Beliefs in well-being and subjective identification of symptoms have been shown to affect compliance and adherence to medication (Jolles et al. 2013). Furthermore, 47% of the respondents had positive personal control of their hypertension, and this was noted to be higher among females, particularly the housewives. Beliefs in personal ability to control illness have been shown to be a good predictive factor for compliance to medication (Ross et al. 2004).

Conclusion: Results of this study may have implications on the compliance of hypertensive patients to treatment and coping strategies in managing their illness.

Acknowledgment: Acknowledgment to Universiti Malaysia Sarawak for the short research grant scheme and Sarawak State Health Department.

Keywords: hypertension, illness perception, Revised Illness Perception Questionnaire (IPQ-R)



35

PRO-D8

Injuries at Home and Risk Reduction Practices

Mohd Idris O1, Eliana M1, Nabilah H1, Roslinah A2, Melvyn CYC1

1. Institute for Health Management, Ministry of Health Malaysia, Malaysia2. Institute for Health System Research, Ministry of Health Malaysia, Malaysia

Introduction: Accidents are unfortunate events that occurred as a result of the interaction between the agent (hazard), the host (man) and the environment (physical and psychosocial). Nevertheless injuries at home do occur especially among the children and elderly. The purpose of this study is to determine the incidence rate of injuries at home and to assess the magnitude of risk reduction practices in the population.

Materials and Methods: This study is part of National Health and Morbidity Survey (NHMS) III. This is a cross sectional study (April- August 2006) which involved urban and rural areas (sampling frame updated from 2004 version).Data collection were conducted simultaneously in 5 regions in Peninsular, 2 in Sabah and 4 in Sarawak. Face to face validated interviews were used. Training of research team was conducted for 2 weeks to develop communication skills, teamwork and familiarity with the questionnaires. Data analysis was done using SPSS and STATA.

Results: The response rate was 98.4% (55,774/56,710) and the overall incidence rate of home injury was 6.49% (3,742/55,593) [Cl: 6.2 – 6.8]. The highest incidence of injury was among the age group of 0-4 (11.8%) and the lowest was between 45-54 years (3.7%). The incidence then increased among those in the age group of 65 years and above (6.0%). Other Bumiputras recorded the highest incidence rate (10.7%) followed by Indians (6.9%). The injury rate was significantly higher among those in the rural (7.4%) and the main cause of injuries was due to fall (63.4%) followed by cut (19.9%), fire (4.3%) and strucked by object (3.9%). The injuries were most commonly occurred in the garden (28.0%) followed by kitchen (24.9%), living room (14.7%), bathroom (7.5%) and stairs (7.2%). About 16.7% resulted in inability to go to school, work or play and about 4.9% required hospital admission for at least one night.

Discussion: There is an increase from 2.5% to 6.5% in the incidence rate of home injuries as compared to NHMS II. It was noted that exposure to both First Aid and Cardiopulmonary Resuscitation increased significantly with level of education, highest among age group 18-24, had higher personal and household income.

Conclusion: In this NHMS III study, home injuries was the highest number of injuries reported compared to road,workplace and school injuries. Therefore, it is recommended that mainstream media (television and newspapers) promote education on home injuries prevention to the households.

Acknowledgement: This study was funded by the Ministry of Health Malaysia (grant number: MRG-IKU-2006-01), and conducted by the Institute for Public Health (IPH) under the National Institute of Health (NIH). Mohd Idris O was the first author and did the data analysis while Dr Roslinah Ali acted as the co-author. Eliana M and Nabilah Hwere the co-authors and designed the layout for the results section. Melvyn CYC was also acted as the co-author.

Keywords: home injuries, incidence rate, risk reduction practices

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