Malaysian Journal of Public Health Medicine
Malaysian Journal of Public Health Medicine (MJPHM) is the official Journal of Malaysian Public Health Physicians’ Association. This is an Open-Access and peer-reviewed Journal founded in 2001 with the main objective of providing a platform for publication of scientific articles in the areas of public health medicine. . The Journal is published in two volumes per year. Contributors are welcome to send their articles in all sub-discipline of public health including epidemiology, biostatistics, nutrition, family health, infectious diseases, health services research, gerontology, child health, adolescent health, behavioral medicine, rural health, chronic diseases, health promotion, public health policy and management, health economics, occupational health and environmental health.
Malaysian Public Health Physicians’ Association
SILICA EXPOSURE AND INTERLEUKIN-8 (IL-8) LEVELS OF MARBLE ARTISANS IN TULUNGAGUNG, INDONESIA
Working as a marble artisan exposes individuals to marble dust, which often contains high levels of silica. This study looks at how breathing in marble dust affects marble workers in Tulungagung. It focuses on respiratory problems and higher IL-8 levels in their blood, aiming to understand how much silica in the dust relates to these health issues. This cross-sectional observational study involved 30 artisans, assessing silica dust levels using personal dust samplers and IL-8 levels via ELISA. In Tulungagung, many marble artisans, mostly over 45 years old with over 5 years of experience, work 8 hours daily using cloth masks for protection. The finishing unit had the highest dust exposure, with levels far above safe limits: dust measured 37.1203 mg/m³ (TLV is 10 mg/m³), and silica concentration was 0.1114 mg/L (TLV is 0.0250 mg/L). The study found a clear relationship between using PPE, exposure to silica, reports of shortness of breath, and higher IL-8 levels in the blood (p < 0.05). The study showed that higher silica in marble dust is tied to increased IL-8 levels in the blood of marble artisans in Tulungagung. However, there was no clear link found between breathable dust levels and IL-8 in their blood.
Copyright (c) 2026 Noeroel widajati, Kusuma Scorpia Lestari, Saliza Mohd Elias, Ari Prayogo Pribadi, Hadi Prayitno, Vivien How
THE RISK FACTORS OF LEPROSY INDICENCE IN PIDIE JAYA REGENCY, ACEH, INDONESIA
Leprosy is a contagious infectious disease that still causes high morbidity and mortality rates in the world. Uncontrolled risk factors can increase the transmission and cause permanent damage to nerves and human body tissue. The aim of the study was to determine the risk factors of leprosy. The study used a case control design with 42 respondents consisting of 12 leprosy cases and 24 neighbors of cases who did not have leprosy (1:2). Cases were patients confirmed bacteriologically at the community health center. Multivariate analysis by logistic regression was carried out to determine the most risk factors of the incidence of leprosy, using the P-Value < 0.05 and Odds Ratio (OR). People who had close contact (P-Value= 0.035; OR= 10.8; 95%CI= 1.07-108.62), did not get BCG vaccination (P-Value= 0.023; OR= 5.67; 95%CI= 1.28-25.02), low monthly income (P-Value= 0.031; OR= 9.75; 95%CI= 1.12-85.16), poor water resources (P-Value= 0.036; OR= 8.41; 95%CI= 0.96-73.73), and low level of knowledge (P-Value= 0.009; OR= 6.60; 95%CI= 1.48-29.36) were related to the incidence of leprosy. The most risk factors of the leprosy are did not get BCG vaccination (P-Value= 0.015; OR= 45.81; 95%CI= 2.08-10.96) and low level of knowledge (P-Value= 0.029;OR= 25.64; 95%CI= 1.39-473.13). People who did not receive BCG vaccination and had low knowledge were the main risk factors of leprosy in Pidie Jaya Regency. Close contact with leprosy patients and poor water sources also increased the risk through prolonged exposure and poor hygiene. Strengthening BCG coverage and public education is recommended
Copyright (c) 2026 Farrah Fahdhienie, Frans Yosep Sitepu, Irma Hamisah
The PREVALENCE OF DENGUE IN MALAYSIA, A SYSTEMATIC REVIEW AND META-ANALYSIS
Dengue is a mosquito-borne viral illness and remains a significant public health burden in Malaysia, with the cases rising substantially for the past 3 decades. This meta-analysis estimates the prevalence of dengue in Malaysia by analyzing 31 studies conducted between 1981 and 2020. The prevalence trends were evaluated across time, regional variation, study design, diagnostic methods, and further explored factors contributing to variability in studies. A total of 972 records were retrieved from five electronic databases, with 31 studies meeting the inclusion criteria for qualitative and quantitative synthesis. These studies represented diverse Malaysian states and predominantly involved post-2001 data. The diagnosis methods varied, with ELISA, PCR, and serological tests commonly employed. The meta-analysis included 22,921 cases, revealing a pooled dengue prevalence of 50.22% (95% CI: 38.7–57.8) with high heterogeneity (I² > 99.3%, p < 0.001). Dengue prevalence increased significantly, peaking at 49.7% during 2011–2020. Dengue presents with a wide range of symptoms, of which fever is the most prevalent, accompanied by musculoskeletal symptoms, headache, retroorbital pain, and fatigue. Additional manifestations include vomiting, abdominal pain, diarrhea, rashes, petechiae, and bleeding tendencies, which are associated with severe dengue. The findings emphasize prioritizing high-risk groups alongside urban-focused dengue control strategies. Further research in rural and less populated regions is essential to address the nationwide dengue burden comprehensively.
Copyright (c) 2026 Izzati, Hasyairi, Shafei, Shanghari, Naveed
DEVELOPMENT OF A HEALTH EDUCATION MATERIAL ON CHILD MEDIA HABITS
Early exposure to electronic devices and excessive screen time have shown to be disrupting young children’s emotional regulation, and delay their developmental milestone attainment. Hence, it is vital to ensure that parents are informed on practical ways of cultivating healthy child media habits. This study aimed to develop and validate an education material which would serve as guidance to lead an image-based communication to promote healthy child media habits to parents with children under five-years old. The single-paged education material in the form of a flyer was developed based on guidelines and evidence-based recommendations on usage of screen-based media among young children in Bahasa Melayu - the national language of Malaysia. It was validated using the ‘Patient Education Material Assessment Tool’ (PEMAT) guidelines by seven experts from the related fields, namely Public Health Medicine, Developmental Paediatrics, Family Medicine, Educational Psychology, Social Behavioural Science, and Health Communication. Based on the feedback given by the experts, the flyer underwent three rounds of iterations. Both the components of PEMAT’s scoring were good, with understandability reporting an average score of 89.7% and actionability reporting an average score 88.6%. The health education material named “MEDIA” – an acronym which denotes the five components of healthy child media habit is an excellent tool for health promotion in the field of technology and toddlers. This development of a health communication material tailored to local population in this study has contributed to the efforts of ensuring young children thrive in a safe media environment.
Copyright (c) 2026 Catherine Arumugam, Associate Professor Dr. Nik Daliana, Professor Dr Mas Ayu binti Said, Annie Patricia Lourudusamy
DEVELOPMENT AND CONTENT VALIDATION OF THE AMOHS-Q: ASSESSMENT TOOL FOR ORAL HEALTHCARE UTILISATION AMONG ANTENATAL MOTHERS
Utilisation of oral health care services is still low in Malaysia. A reliable and validated tool is required to assess the factors influencing this low utilisation. This study aimed to develop and validate the content of the Antenatal Mothers’ Oral Healthcare Services Questionnaire (AMOHS-Q). A mixed-methods design was employed. Qualitative data were obtained through seven focus group discussions (FGDs) with antenatal mothers in Selangor, Malaysia. Themes derived from the FGDs, and existing literature informed the development of questionnaire items, guided by AMEE Guide No. 87. Experts assessed the instrument’s relevance and comprehensibility using a four-point Likert scale. Microsoft Excel was used to compute the Content Validity Index (CVI) and Content Validity Ratio (CVR). Following content validation, 66 items across 10 domains were retained from the initial 71, with I-CVI and CVR values ranging from 0.75 to 1.00. The content validation process indicated that the AMOHS-Q was valid for identifying factors that may influence the low utilisation of antenatal mothers in oral health care. Most items were considered relevant, clear, simple, and necessary
Copyright (c) 2026 Suhaila Mat Said, Mohd Zulkarnain Sinor, Basaruddin Ahmad, Noorneza Abdul Rahman
A CROSS-SECTIONAL STUDY OF MEDICAL PRACTITIONERS' KNOWLEDGE AND ATTITUDES ON HYPERBARIC OXYGEN THERAPY FOR CHRONIC WOUNDS IN KELANTAN, MALAYSIA
This study assesses the knowledge and attitude of medical practitioners toward hyperbaric oxygen therapy (HBOT) in the treatment of chronic wounds. HBOT has been increasingly recognised as an adjunctive treatment for chronic, non-healing wounds, yet its adoption in clinical practice remains limited. A cross-sectional study was conducted involving 197 medical practitioners from various clinical departments in a tertiary hospital. A validated self-administered questionnaire was used to assess their knowledge and attitude toward HBOT. Descriptive statistics were used to summarise the data, and logistic regression analyses were performed to identify significant predictors. The results showed that 70.6% of respondents demonstrated good knowledge of HBOT, while 65.0% exhibited a positive attitude toward its use in chronic wound management. The only significant predictor of good knowledge was the duration of medical practice. A positive attitude was strongly associated with three things: seeing a higher volume of wound care patients each month, having prior experience referring patients for HBOT, and having more years in practice. Additionally, practitioners with good knowledge were 6.62 times more likely to have a positive attitude toward HBOT. Although most practitioners were knowledgeable and supportive, gaps remain in practical experience, particularly regarding cost-effectiveness and accessibility. These findings underscore the need for structured continuing medical education, postgraduate training, and clearer referral pathways to enhance the integration of HBOT into chronic wound management.
Copyright (c) 2026 Iqlima Idris, Mohamad Masykurin Mafauzy, Nik Hisamuddin Nik Ab Rahman, Abu Yazid Md Noh, Wan Syahmi Wan Mohamad, Ahmad Rasyidi Mohamad
COMPLETE BLOOD COUNT-BASED PREDICTIVE MODELLING FOR DIABETES MELLITUS AMONG MALAYSIAN WOMEN: IMPLICATIONS FOR PUBLIC HEALTH SCREENING
Diabetes mellitus is a major global public health concern, with a rising prevalence among women. Early prediction using routine clinical data, such as complete blood count (CBC) parameters, provides a cost-effective strategy for identifying individuals at risk. This study compared the effectiveness of classical binary logistic regression and Bayesian binary logistic regression in predicting diabetes mellitus among females using CBC parameters. Data from 537 female patients were analysed, incorporating CBC variables and diabetes status. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, posterior predictive checks, and sensitivity analyses. Bayesian diagnostics, including trace plots and credible intervals (Crls), were used to ensure model reliability. The Bayesian model outperformed the classical approach, demonstrating higher AUC, improved calibration, and more informative uncertainty estimation. Significant predictors included age, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), white blood cell count (WBC), haematocrit (HCT), platelet count, and haemoglobin (Hb). The Bayesian model produced stable posterior estimates and robust convergence, supporting its suitability for small or correlated datasets. These findings highlight the potential of CBC parameters as early indicators of diabetes risk among women and underscore the value of Bayesian modelling in informing gender-sensitive screening strategies and interventions.
Copyright (c) 2026 Agnes Ayang Kenyang, Nurliyana Juhan, Yong Zulina Zubairi, Nornazirah Azizan, Chong Mun Ho , Abu Sayed Md. Al Mamun
ADOPTION OF VIRTUAL CARE IN A MALAYSIAN GOVERNMENT HOSPITAL: A QUALITATIVE STUDY OF HEALTHCARE PROVIDERS’ PERCEPTIONS, BARRIERS, AND FACILITATING CONDITIONS
The COVID-19 pandemic marked a tipping point in the global adoption of virtual care (VC). In Malaysia, VC gained traction notably in primary healthcare, while adoption within hospital settings has yet to fully embrace its potential. This study aims to understand VC adoption in a tertiary government hospital, focusing on healthcare providers’ perceptions, barriers, and facilitating conditions influencing integration. Informed by theoretical frameworks, this qualitative study examined provider characteristics, perceived ease of use (PEOU), perceived usefulness (PU), subjective norms (SN), barriers, and facilitating conditions. Semi-structured interviews with a diverse group of purposively sampled healthcare providers (HCPs) and administrators from outpatient departments were transcribed and analyzed through directed content analysis. Findings indicate that VC adoption and practice varied across departments, often driven by individual- or department-led initiatives. PEOU is shaped by patient digital literacy and infrastructure access, influencing platform and modality selection. PU—encompassing operational efficiency, safety, convenience, and accessibility—emerged as a salient influence on adoption intentions. However, organizational constraints, communication challenges, and particularly limitations in clinical assessment limit these perceived benefits, contributing to concerns regarding effectiveness, quality, and medicolegal risk. SN was shaped by the nature of the work and departmental expectations. Facilitating conditions, including organizational support, infrastructure, policies, and training, were described as supporting factors influencing SN for greater uptake of VC. Providers emphasized the need for comprehensive training covering technical, clinical, and ethical aspects, with a preference for a flexible and interactive approach. This study refines the understanding of VC adoption in a tertiary government hospital by highlighting the interconnected and non-linear relationship between perceptions, barriers, and facilitating conditions in the VC adoption framework. Targeted strategies may promote more comprehensive and sustainable VC implementation, benefiting both patients and HCPs while improving healthcare delivery.
Copyright (c) 2026 Suzana Amin, Carl Abelardo T. Antonio
ORGANISATIONAL AND OPERATIONAL POLICE STRESSORS AND THEIR ASSOCIATED SOCIODEMOGRAPHIC AND WORKPLACE FACTORS
Police work is a high-pressure profession where stressors are categorised into organisational and operational domains, significantly impacting officer well-being. This cross-sectional study aimed to identify the ranking of these stressors and their associated sociodemographic and workplace factors among police officers in Kuala Lumpur. Following a one stage cluster sampling, data were collected using the Organisational and Operational Police Stress Questionnaires. With a response rate of 94.3% analysed was carried out using Independent T-tests, ANOVA, and General Linear Model. Operational stressors (mean 2.79) were ranked slightly higher than organisational stressors (mean 2.73), with fatigue, not enough time to spend with friends and family (operational stressors), and bureaucratic red tape (organisational stressor) emerging as primary concerns. Multivariable analysis revealed that age and years of service were significantly associated with both stressor categories, while marital status and rank were predictors for organisational stressors. Salary commensurability remained a primary predictor (p<0.001), with mean difference (MD) of 0.58, (95% CI: 0.40, 0.75) for organisational stressor and, (p<0.001), with a mean difference (MD) of 0.72 (95% CI: 0.53, 0.90) for operational stressors. The practice of prayer served as a significant protective factor p= 0.02 with MD of -0.46, (95% CI: -0.85, -0.08) for organisational stressors and, (p<0.001), MD of -0.88, (95% CI: -1.29, -0.47) for operational stressors. These findings suggest that the Royal Malaysia Police (RMP) welfare strategies should prioritize financial stability and spiritual support units to effectively mitigate the unique organisational and operational burdens identified.
Copyright (c) 2026 Retneswari Masilamani, Awang Bulgiba
UNCOVERING KEY DRIVERS OF RISING DENGUE CASES IN MALAYSIA: A SYSTEMATIC REVIEW
Dengue fever, a viral disease transmitted by Aedes mosquitoes, continues to escalate as a significant public health threat in Malaysia, leading to a growing burden on the healthcare system and the economy. Despite the increasing incidence, the factors contributing to the rise in dengue infections remain multifaceted and under-explored within the Malaysian context. Addressing these factors is crucial for devising more effective preventive strategies and interventions. This study provides a comprehensive examination of the complex factors driving the surge in dengue cases in Malaysia. By systematically analysing human behaviours, environmental conditions, vector dynamics, and the viral characteristics, the study aims to uncover the underlying determinants and inform targeted public health responses. A systematic review was conducted, incorporating studies published between 2011 and 2024, selected through a rigorous screening process from databases including ScienceDirect and EBSCOhost. The review adhered to the PRISMA guidelines, with quality assessments performed using the Mixed Method Appraisal Tool (MMAT) for the included 20 studies. These studies were analyzed to synthesize evidence on the key drivers for rise of dengue transmission in Malaysia. A total of 20 studies were included in this systematic review and the results were categorized into four core domains: human factors, environmental influences, vector dynamics, and virus characteristics. Human factors such as age, occupation, and socioeconomic conditions were identified as significant determinants, with older adults and those in high-risk occupations exhibiting increased vulnerability to severe dengue. Environmental conditions, particularly rapid urbanization, poor waste management, and dense population clusters, emerged as critical factors fostering mosquito breeding and transmission. The coexistence of Aedes aegypti and Aedes albopictus in both urban and rural settings exacerbated the risk. Virus-related findings revealed that DENV-3 was the dominant serotype linked to higher disease severity, while mixed serotype infections significantly heightened the risk of severe outcomes, underlining the role of viral factors in the progression of the disease. Overall, urbanisation, population density, and socioeconomic disparities were consistently identified as key drivers across the included studies. The rising incidence of dengue infections in Malaysia can no longer be attributed to a single cause but rather to an intricate interaction of human, environmental, vector, and viral factors. This study provides compelling evidence that addressing these determinants through integrated public health strategies, spanning urban planning, vector control, socioeconomic reforms, and education is essential to combat the dengue crisis. By focusing on high-risk groups, urban infrastructure, and timely medical interventions, Malaysia can better mitigate future outbreaks and safeguard its population. These findings highlight important implications for public health policy, particularly the need for integrated, multi-sectoral strategies involving urban planning, vector control, socioeconomic interventions, and community engagement. More specific actions, including strengthening surveillance systems and improving urban waste management, are essential to effectively mitigate future outbreaks.
Copyright (c) 2026 Kalaivani Muniandy, Rahmat Dapari, Alabed Ali A. Alabed, Ririh Yudhastuti, San Suwanmanee
DESIGN AND DEVELOPMENT OF A LEAN-BASED MODEL FOR THE EMERGENCY DEPARTMENT GREEN ZONE OF A PUBLIC UNIVERSITY HOSPITAL IN MALAYSIA
Emergency Departments (EDs) operate under sustained pressure from increasing patient demand, overcrowding, and workflow inefficiencies. Although Lean principles have been widely adopted in healthcare to address these challenges, there remains limited documentation of systematic processes for designing and developing Lean-based intervention models in complex clinical environments. This study aimed to systematically design and develop a Lean-based model for the green zone of a public university hospital Emergency Department using a Design and Development Research (DDR) framework. This study comprised three phases: (i) needs analysis, (ii) model design and development, and (iii) model validation. A multidisciplinary Lean team conducted Value Stream Mapping (VSM) and Gemba to identify workflow inefficiencies and non–value-added activities. Improvement opportunities were prioritised using an effort–impact matrix to ensure feasibility within existing resource constraints. The prioritised components were integrated into a future-state workflow, constituting the Lean-based model, which was subsequently implemented at a pilot level within the department. Future-state VSM analysis projected a reduction in overall process length time from 6.7 hours to 4.5 hours, corresponding to an estimated 29% improvement in patient waiting time. Expert validation demonstrated strong agreement regarding the clarity, feasibility, and operational alignment of model components. This study provides a structured and reproducible pathway for the development and preliminary implementation of Lean-based interventions in Emergency Department setting, contributing methodological guidance for systematic healthcare process redesign in resource-constrained environments.
Copyright (c) 2026 Dina Syazana Ho Imran Ho, Mohd Rizal Abdul Manaf, Azmawati Mohammed Nawi, Rosnah Sutan, Mohd Amran Mohd Daril, Mohamad Ikbar Abdul Wahab, Nur Farah Hafizah Mukhtar, Mohd Helmie Ismail
EFFECT OF MEDICAL NUTRITION THERAPY ON NUTRITIONAL STATUS OF CHRONIC KIDNEY DISEASE UNDER HAEMODIALYSIS ASSESSED BY MIS TOOL: A PRE-POST INTERVENTIONALSTUDY IN TERTIARY HOSPITAL OF NEPAL
Chronic kidney disease (CKD) remains a major global public health challenge, accounting for approximately 1.48 million deaths worldwide in 2023 and ranking as the ninth leading cause of death globally. The global prevalence of CKD is estimated at 9.1%, with advanced disease being less common, as CKD stage 5 affects about 0.07% of the population and 0.041% requiring dialysis.The estimated annual incidence of end-stage kidney disease in Nepal is approximately 2,900 new cases, highlighting the growing need for effective prevention and management strategies. Thisstudy aims to evaluate the prevalence of Protein-Energy Wasting (PEW) using serum albumin, C-reactive protein (CRP) for inflammation, and the Malnutrition Inflammation Score (MIS) both before and after medical nutrition therapy intervention. It also explores the relationship between Malnutrition Inflammation Score, C - reactive protein, and serum albumin in patients undergoing haemodialysis. The study involved 83 chronic haemodialysis patients from Kist Medical College and Teaching Hospital, Imadol, Gwarko, Nepal.Patients were divided into two categories: adequately nourished and malnourished. Initially, only 22% of patients were adequately nourished, while 78% were classified as malnourished. Following dietary counselling, monitoring and evaluation, the proportion of adequately nourished patients on haemodialysis increased significantly to 80%.Paired sample t-test were used to compare pre and post intervention values, and results are interpreted as mean differences with 95% confidence intervals.MIS scores significantly decreased (mean difference=9.76;95%CI:8.4 to 11.2;p<0.001) at twelve months. The study found a strong negative correlation between MIS and albumin levels (r = -0.661, p = 0.01). Furthermore, moderate positive correlation was detected between CRP and MIS in haemodialysis patients (r = 0.454, p = 0.01). This study highlights that dietary counselling and regular monitoring help increase protein intake, enhance serum albumin levels, reduce inflammation, and decrease muscle wasting, leading to improved nutritional status in patients.
Copyright (c) 2026 Rena Shrestha; Uma Koirala; Shamima Abdul Rahman
COMPARATIVE EFFICACY OF ACCEPTANCE AND COMMITMENT THERAPY (ACT) AND DIALECTIC BEHAVIOR THERAPY (DBT) IN REDUCING AGGRESSION IN PAKISTANI YOUNG ADULTS: A QUASI-EXPERIMENTAL STUDY
Aggression is a serious issue with adverse consequences for individuals and society. Aggression among young adults has been an emerging psychological and social problem in Pakistan, which is worsened by socioeconomic stress, family and peer conflicts, poor impulse control, and lack of emotional regulation skills. Acceptance and commitment therapy (ACT) and Dialectical Behavior Therapy (DBT) are mindfulness-based therapies that have demonstrated potential in the management of aggression in the world. Nonetheless, their relative contributions in the Pakistani context remain underexplored. The current paper sought to draw parallels between the performance of ACT and DBT in the minimization of aggression and other associated mental consequences in young adults. A stratified random sampling technique was used to select a sample of 120 young adults, with a quasi-experimental pretest-posttest control group design (Acceptance and Commitment Therapy Experimental Group (ACT EG n = 40), Dialectical Behavior Therapy (DBT EG n = 40), and Control group n = 40). The groups will include males (n=20) and females (n=20). The Buss-Perry Aggression Questionnaire (BPAQ), the Positive Mental Health Scale, the Brief Psychiatric Rating Scale (BPRS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Depression Anxiety Stress Scales 21 (DASS-21) were used to test aggression, psychological symptoms, and functional impairments of the participants. The data was analyzed by using SPSS version 29 and Jamovi version 2.7.5. The results indicated a significant reduction in aggregate and individual aggression in the two intervention groups relative to the control group. The ACT group showed a greater decrease in overall aggression scores between pretest and the posttest (p <.001, Cohen's d=0.88) than the DBT group (p <.001, Cohen's d=0.64). Improvements were also observed in psychiatric symptoms and functional outcomes, with a large effect size observed in the ACT group. In conclusion, both Acceptance and Commitment Therapy and Dialectical Behavior Therapy were effective in reducing aggression among Pakistani young adults, with ACT demonstrating a comparatively more substantial effect. These findings support the use of evidence-based psychological Interventions for aggression management and emphasize the importance of early structured therapeutic approaches for young adult populations.
Copyright (c) 2026 Saima Abbas, Anasuya Jegathevi Jegath
EFFECTIVENESS OF HEALTH EDUCATION ON INFANT AND YOUNG CHILD FEEDING BEHAVIOR TO PREVENT STUNTING IN CHILDREN UNDER 2 YEARS: A SYSTEMATIC REVIEW
Stunting in children under two years remains a critical global health challenge. While health education is a primary strategy, its effectiveness in reducing stunting—as opposed to merely changing behavior—remains debated. This systematic review aimed to evaluate the effectiveness of health education on Infant and Young Child Feeding (IYCF) behaviors and stunting prevention. Following PRISMA 2020 guidelines, a search was conducted in PubMed, Scopus, and ScienceDirect for studies published between 2014 and 2024. Inclusion criteria encompassed Randomized Controlled Trials (RCTs) and non-randomized studies evaluating maternal education. Risk of bias was assessed using Cochrane RoB 2 and JBI tools. Data synthesis was conducted using a narrative approach based on the Synthesis Without Meta-analysis (SWiM) framework. Nine studies met the inclusion criteria (six RCTs, three non-randomized). Narrative synthesis indicated that health education consistently improved Early Initiation of Breastfeeding, Exclusive Breastfeeding, and Dietary Diversity. Interventions combining interpersonal counseling with mass media or utilizing peer counselors demonstrated stronger behavioral impacts. However, the impact on linear growth (HAZ/stunting) was inconsistent. Improvements in nutritional status were more evident when education was integrated with health system strengthening or nutritional supplementation, rather than as a standalone intervention in food-insecure populations. Health education is effective in improving feeding behaviors but has variable capacity to reduce stunting if implemented alone. Behavioral improvements do not necessarily translate into child growth when structural barriers persist. Future policies should integrate education with nutrition-sensitive interventions, such as food security and sanitation, to achieve measurable impacts on child growth.
Copyright (c) 2026 Desy Syswianti, Sri Mulyani , Eti Poncorini Pamungkasari , Betty Saptiwi
THE IMPACT OF INTERMITTENT FASTING ON COGNITIVE FUNCTION AND INFLAMMATORY MARKERS IN MIDDLE-AGED AND OLDER ADULTS: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS
Intermittent fasting (IF) has shown potential health benefits, including improved glucose homeostasis, stress resistance, and reduced inflammation, as well as slowing cognitive decline. However, studies focusing on older adults have been limited and often contradictory. This systematic review and meta-analysis aim to comprehensively examine the impact of IF on cognitive function and inflammatory markers in middle-aged and older adults. The meta-analysis showed that IF significantly enhances cognitive function, as measured by the Mini-Mental State Examination (MMSE). These results suggest that while IF can enhance cognitive function, it is ineffective in reducing inflammatory markers. Nevertheless, an association was found between IF, cognitive function, and inflammation. Recommendations for future work include larger randomized controlled trials to confirm the cognitive benefits of IF and mechanistic studies to clarify its effects on inflammatory markers.
Copyright (c) 2026 Yaasheni Loganathan, Chin Yi Ying, Asheila Meramat
APPLYING MACHINE LEARNING TO ANALYZE TUBERCULOSIS SERVICE STANDARDS IN INDONESIA
Tuberculosis (TB) remains a significant public health challenge in Indonesia, with persistent disparities in service quality. Early identification of substandard TB services is critical to prevent transmission and accelerate elimination efforts. This study developed a machine-learning–based model to classify TB service compliance, identify key predictors, and provide evidence to guide targeted TB control policies. A retrospective design was applied using primary and secondary data from 1,722 TB patients in Semarang City, Indonesia. Three algorithms—Random Forest, K-Nearest Neighbors (KNN), and Boosting—were implemented with 5-fold stratified cross-validation, feature selection via Recursive Feature Elimination (RFE), hyperparameter tuning, and variable importance analysis. Model performance was evaluated based on accuracy, AUC, recall, and F1-score, with particular emphasis on the ability to detect the minority class ("non-compliant services"). The Random Forest model achieved the highest test accuracy (97.7%) with an average AUC of 0.655. However, the high accuracy should be interpreted cautiously, given the highly imbalanced class distribution (96.1% compliant vs 3.9% non-compliant), which limits the model's ability to detect minority cases. The analysis, therefore, emphasized recall and F1-score for the minority class as indicators of the model's practical usefulness for early detection. Five key predictors were identified, with anti-TB drug regimen and age contributing most to model performance. The model shows potential as an early warning tool for substandard TB services and can support risk-based interventions. Integration into national health information systems may strengthen decision-making and accelerate TB elimination.
Copyright (c) 2026 Maria Goretti Catur Yuantari, Yusthin M. Manglapy, Ririn Nurmandhani, Edi Jaya Kusuma, Haikal Haikal, Dani Miarso
BRIDGING KNOWLEDGE AND PRACTICE IN SURGICAL WOUND CARE: A CROSS-SECTIONAL STUDY AMONG NURSES AT A MALAYSIAN TERTIARY HOSPITAL
Surgical wound care is a crucial aspect of postoperative nursing. In other words, this is important for recovery, complications, and patient satisfaction. The purpose of this study was to evaluate the knowledge and practice of nurses in the surgical ward of Sabah Women and Children’s Hospital regarding surgical wound management. A cross- sectional study design was employed from July to December 2024, utilising simple random sampling to select 60 Nurses. A self-developed, validated questionnaire in English was used to collect the data. It consisted of three sections, including demographics, knowledge, and practice. The experts validated the instrument, which showed high internal consistency (Cronbach’s alpha > 0.80). The data was analysed using SPSS version 24. The analysis revealed that most respondents were female (96.7%), with a mean age of 29.4 years and an average of 7.3 years of clinical practice experience. The general average knowledge score achieved was 3.8 (SD = 0.6), based on the highest scores, indicating a strong understanding of theoretical concepts related to infection recognition and wound assessment. Nonetheless, notable gaps in knowledge were identified regarding moist wound healing and the use of topical antiseptics. The practice scores were generally high, with a mean of 4.1 and a standard deviation of 0.5. Most mothers demonstrated a high level of compliance with aseptic technique and hand hygiene. However, the use of separate tools on infected wounds was inconsistent. The results highlighted the need for ongoing clinical training, adherence to established procedures, and the implementation of regular audit mechanisms for surgical wound care. This study provides a basis for identifying and informing institutional policies and targeted nursing education.
Copyright (c) 2026 Johari Daud Makajil ; Nanthini A/P Letchumikandanc, Nurain Hamdan
SOCIODEMOGRAPHIC FACTORS, KNOWLEDGE, AND ATTITUDES AS PREDICTORS OF ORAL HEALTH QUALITY OF LIFE: A CROSS-SECTIONAL STUDY OF INDONESIAN MIGRANT WORKERS IN KUALA LUMPUR
Indonesia has a significant population of migrant workers in Malaysia, many of whom face health challenges. Yet, few studies have addressed the oral health-related quality of life (OHRQoL) of this population. This study aims to investigate the relationship between sociodemographic factors, oral health knowledge, attitudes, behaviors, and OHRQoL among Indonesian migrant workers (IMWs) in Kuala Lumpur. A cross-sectional study was conducted from August to September 2024. Involving 164 IMWs Participants were selected using convenience sampling based on criteria such as working in the domestic sector for at least one year, and being 18 years or older. Data were collected through a questionnaire assessing sociodemographics, oral health knowledge, attitudes, behaviors, and OHRQoL using the OHIP-14 (Oral Health Impact Profile-14). The questionnaire was distributed via Google Forms and in paper-based formats. Statistical analysis included Chi-Square tests and logistic regression to examine associations between variables and OHRQoL. Of the respondents, 57.9% reported low OHIP scores. Older age > (> 47 years), lower educational levels, and a greater number of family dependents were associated with poorer OHRQoL (higher OHIP scores). Conversely, respondents with good oral health knowledge had significantly better OHRQoL (higher OHIP scores), while those experiencing oral health problems reported poorer OHRQoL. The majority of IMWs in this study had low OHRQoL. Key factors influencing this were age, educational level, number of family dependents, oral health knowledge and the presence of oral health problems. Improving oral health knowledge and addressing these factors through targeted interventions could significantly enhance the OHRQoL of this population
Copyright (c) 2026 Yuanita Lely Rachmawati, Dyah Nawang Palupi Pratamawari, Trining Widodorini, Merlya, Tuti Ningseh Mohd Dom
THE EFFECTS OF FORWARD WALKING VERSUS BACKWARD WALKING ON PAIN LEVEL, STATIC AND DYNAMIC BALANCE AMONG COLLEGIATE ATHLETES WITH KNEE INJURIES
Knee injuries are prevalent among collegiate athletes, necessitating effective rehabilitation strategies to restore function and minimize pain. The study aimed to compare the effects of backward and forward walking on pain levels, static, and dynamic balance in collegiate athletes with knee injuries over a 4-week intervention. Twenty-four collegiate athletes with an age of (M=22.43; SD=1.63 years) and at least 2 months of knee injury participated in the study. They were equally divided into forward walking (Group A) and backward walking (Group B) and were required to walk 3 times a week, with each session lasting 10 minutes. The results revealed that within group, both interventions showed significant pain reduction (forward walking: -22.42%; backward walking: -20.04%), and improvements in standing stork test for balance (forward: 12.87%; backward: 14.31%), anterior dynamic balance (forward: 21.32%; backward: 25.71%), posteromedial dynamic balance (forward: 33.86%; backward: 16.51%), and posterolateral dynamic balance (forward: 22.24%; backward: 26.09%) (p < 0.05). However, no significant differences were found between groups (p > 0.05). The results indicate that both interventions are equally effective on improving pain levels and balance among athletes with knee injuries. However, clinicians should consider patient preferences or specific clinical factors when selecting intervention strategies.
Copyright (c) 2026 Nur Amirah Razali, Mohd Huzairi Mohd Sani, Haashwein Moganan, Ebby Waqqash Mohamad Chan
PLS-SEM MEASUREMENT MODEL VALIDATION OF SOCIAL MEDIA NEEDS, PATIENT EMPOWERMENT, AND QUALITY OF LIFE IN CHRONIC PATIENTS
The increasing burden of chronic diseases highlights the need to improve patients’ quality of life through a holistic approach that considers the potential of social media to fulfil their needs and empower them. This study aimed to develop and validate a measurement model integrating social media needs, patient empowerment, and quality of life, tailored to Malaysian primary care. The proposed model comprised seven constructs: affective needs, cognitive needs, diversion needs, personal integrative needs, social integrative needs, patient empowerment, and quality of life domains, including physical health, psychological health, social relationships, and environmental health. Content validation by experts and face validation ensured the adapted instruments were appropriate and clearly understood. Data was collected through purposive sampling of 130 chronic patients from selected clinics in Sibu. Measurement model assessments were conducted using Partial Least Squares Structural Equation Modelling (PLS-SEM) with SmartPLS to validate the constructs, including a higher-order reflective–reflective construct assessed with the disjoint two-stage approach. Results showed that all 50 indicators met convergent and discriminant validity criteria. Indicator loadings exceeded recommended thresholds, average variance extracted values were above 0.5, and composite reliability values were satisfactory. Discriminant validity was confirmed using the Fornell–Larcker criterion, cross-loadings, and the HTMT ratio with a bootstrapping procedure of 10,000 samples. These findings provide evidence that the validated model can reliably assess how social media needs and patient empowerment relate to quality of life among chronic patients in Malaysia. This measurement model offers a strong foundation for future research and practical use in primary care.
Copyright (c) 2026 Loo Tze Yong, Cheah Whye Lian, Helmy Hazmi
RISK FACTORS OF TEENAGE PREGNANCY IN SARAWAK: GROUNDED THEORY APPROACH
Teenage pregnancy remains a significant public health concern in Sarawak, with rates among the highest in Malaysia, affecting the health and well-being of adolescent mothers, their children, and society. Despite its prevalence, locally grounded qualitative evidence on the risk factors specific to Sarawak's multicultural and geographic context remains limited. This study addresses this gap by identifying the risk factors associated with teenage pregnancy in Sarawak, as the foundational phase in developing a culturally contextualised risk assessment tool for teenage pregnancy (TeenRAT). A qualitative grounded theory approach was utilized to explore the experiences of 20 mothers aged between 20 and 35, recruited from rural and urban settings across four divisions in Sarawak: Kuching, Sibu, Miri, and Limbang. They were recruited using a purposive sampling technique. In-depth interviews were conducted from February to October 2022 until data saturation was achieved. Data triangulation was obtained through focus group discussions with relevant stakeholders. Data analysis was guided by Strauss and Corbin's grounded theory coding procedures using NVIVO-12 software. Ten themes and 38 sub-themes emerged as risk factors, with family dynamics and relationships identified as the key factor across themes. The findings provide a locally grounded evidence base for developing TeenRAT, which has the potential to support nurses, school health workers, and community health practitioners in early identification of adolescents at risk of teenage pregnancy in Sarawak.
Copyright (c) 2026 Christina Busak Henry Sum Agong, Rosalia Saimon
EXPLORING SILVER EMPLOYMENT OPPORTUNITIES FOR ECONOMICALLY VULNERABLE OLDER ADULTS IN MALAYSIA: A QUALITATIVE STUDY
Longevity may impose substantial financial burdens, particularly among economically vulnerable older adults. Silver employment represents an important component of active ageing and a potential strategy to address challenges associated with population ageing. This qualitative study aimed to explore potential silver employment opportunities for economically vulnerable older adults in Malaysia. In-depth interviews and focus group discussions (FGDs) were conducted among 21 older adults aged 55 years and above, recruited using convenience and snowball sampling techniques. Data collection continued until thematic saturation was achieved. Interviews and FGDs were guided using a validated semi-structured interview protocol containing predetermined questions and prompts, with flexibility to explore emerging themes. All interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s thematic analysis approach. Four major themes emerged: (i) centralised database/portal/advisory system, (ii) reskilling and upskilling, (iii) paid grandparenting, and (iv) community empowerment and incentive-based employment. The findings highlight the urgent need to strengthen silver employment opportunities for economically disadvantaged older adults through structured and sustainable mechanisms. Effective implementation requires active collaboration among relevant stakeholders, continuous policy support, and greater attention to barriers such as the digital divide among older adults.
Copyright (c) 2026 Halimatus Sakdiah Minhat, Hui Foh Foong
HOMESICKNESS AND DEPRESSION RISK AMONG UNDERGRADUATE HEALTH SCIENCE STUDENTS IN A THAI UNIVERSITY: A CROSS-SECTIONAL STUDY
Homesickness is a common psychological issue among university students living away from home, impacting their mental health and academic performance. Studies have shown a higher risk of depression linked to homesickness. This study investigates the levels of homesickness, the risk of depression, and their relationship among health science students in Thailand. A descriptive cross-sectional study was conducted from October 2023 to March 2024, involving a total of 291 students selected through proportional stratified sampling. Data were gathered using self-administered questionnaires and analyzed employing descriptive statistics and Pearson's correlation coefficient. The results indicated that 78.1% of participants experienced moderate homesickness, 19.2% reported low homesickness, and 2.7% faced severe homesickness. In terms of depression risk, 48.5% reported very low risk and 34.0% reported low risk of depression, 13.0% exhibited a moderate risk, while 4.5% were classified as having a severe risk. A significant positive correlation was observed between total homesickness scores and depression risk (r = 0.357, p < 0.001). Among the various dimensions of homesickness, the loss of self aspect showed the strongest association with depression risk (r = 0.482, p < 0.01), highlighting its critical role in the connection between homesickness and mental health issues. This study emphasizes the high prevalence of moderate homesickness among university students, alongside a majority reporting very low to low depression risk. The significant relationship between homesickness and depression, particularly through the loss of self dimension, suggests the necessity for university mental health programs to implement early screening and targeted interventions to address these intertwined challenges.
Copyright (c) 2026 Jatuporn Ounprasertsuk, Prakasit Wannapaschaiyong, Araya Tipwong
THE DEVELOPMENT AND VALIDATION OF A HEALTH BELIEF MODEL QUESTIONNAIRE FOR MEASURING FACTORS INFLUENCING ADHERENCE DURING PREGNANCY
This study aimed to develop and validate a Health Belief Model (HBM) questionnaire to measure adherence to drug, vitamin, and supplement use in pregnant women. This cross-sectional study was conducted over a duration of one month at one of the advanced type B health facilities in Surabaya, namely the obstetrics and gynecology clinic of Airlangga University Hospital. The respondents were pregnant women who took drugs, vitamins, and/or supplements, using convenience sampling. Reliability was analyzed using Cronbach's alpha, whereas validity was analyzed using the content validity index, Pearson's product-moment correlation, and exploratory factor analysis (EFA). The analysis was conducted using IBM SPSS software (version 26). A total of 135 respondents participated in this study. Construct validation was performed using exploratory factor analysis (EFA). The result of the Kaiser-Meyer-Olkin (KMO) test was 0.806, and Bartlett’s test showed a value of 0.000. We deleted two items because the loading factor value was less than 0.5. The results showed that the Health Belief Model questionnaire had a Cronbach's alpha value > 0.7 and Pearson's correlation above the r-table with a significance of < 0.05. The 25-item questionnaire, based on the Health Belief Model theory, is a valid and reliable instrument for measuring adherence factors for the use of drugs, vitamins, and/or supplements by pregnant women.
Copyright (c) 2026 Fitri Nurussani Aulia, Rista Fauziningtyas, Elida Zairina