Introduction: Previous studies have proposed the lower waist circumference (WC) cutoffs be used for defining abdominal obesity in Asian populations. Background: The duration of the protective efficacy of BCG vaccine plays an important role in the establishment of vaccination policies particularly for tuberculosis endemic countries. The effectiveness of revaccination with two or more doses is still a controversial issue. In this systematic review, we qualitatively appraised available epidemiological evidence. Method: A search strategy using both PubMed and Embase databases and manual search was done up to January 2013. The main search terms used include BCG, revaccination, tuberculosis, mortality and adverse reaction. The studies were grouped by designs; randomized-control trials, cohort and case-control studies. Outcomes were categories into primary outcomes (tuberculosis and mortality from tuberculosis) and secondary outcomes (vaccine efficacy, immunity and adverse reaction from BCG revaccination). Results: Nine articles were selected and data on the primary and secondary outcomes were extracted. The review noted no significant difference in the incidence rate ratio (range 0.57-1.74), relative risk [0.39 (0.31-0.49)] and hazard ratio [1.20 (0.77-1.89)] from tuberculosis in the BCG revaccinated group compared to BCG non-revaccinated group. Comparison between the two groups also noted no significant difference in the relative risk of adverse reaction [2.3 (0.67-7.80)] and vaccine efficacy [8 (-77-52)], but a significant increase in immune response in revaccinated group. Conclusion: In summary, our review demonstrated the available evidences do not support BCG revaccination as a strategy to reduce tuberculosis.

Introduction: Changes in dietary habits are known to be associated with changes in health outcomes. This study determined food choices among Malaysian adults using secondary data of the Malaysian Adults Nutrition Survey (MANS) in 2003 and MANS in 2014. Methods: A total of 6,742 and 3,000 adults aged 18 to 59 years participated in MANS 2003 and MANS 2014, respectively. Both studies used a semi-quantitative food frequency questionnaire (FFQ) to assess habitual food in take. Results: Overall, the prevalence of adults consuming rice twice daily were 97.3% and 86.9% in 2003 and 2014, respectively. While the percentage of urban dwellers who consumed rice daily differed significantly between 2003 (96.7%) and 2014 (86.9%), the percentage remained quite similar among rural adults in 2003 (97.8%) and 2014 (96.3%). Other top ten food items consumed daily were sugar (2003, 58.5% vs 2014, 55.9%), marine fish (40.8% vs 29.4%), green leafy vegetables (39.9% vs 43.2%) and sweetened condensed milk (35.2% vs 29.3%). In both surveys, a higher percentage of men consumed rice, sugar and sweetened condensed milk on a daily basis compared to women, a higher proportion of whom daily consumed green leafy vegetables and marine fish. Majority of the adults reported drinking plain water daily. Other beverages taken daily were tea, coffee and chocolate-malt drinks. Conclusion: Rice, sugar and sweetened condensed milk were among the top food items consumed daily in 2003 and 2014. Educational efforts to improve dietary intake of Malaysian adults is recommended.

Objective: Depression is the single largest contributor to the global burden of disease. Depression was found as a common disorder among children lower than 18 years old. The aim of this study is to determine the prevalence and factors associated with depression severity among adolescents in Malaysia. Study design: A cross-sectional study. Methods: In order to achieve the objective of this study, secondary data analysis from Malaysian National School Based Health Survey 2012 was carried out, involving a total of number of 21,764 eligible school adolescents between the ages of 12 to 18 years old. Additionally, complex sample ordinal logistic regression was also employed for analysing and quantifying the odds ratio, in which 95% confidence interval was achieved. Results and Discussion: This study discovered that the prevalence of mild, moderate and severe depression was 16.6%, 12.8% and 3.8% respectively. The result of the multivariable analysis showed that females have 32% more risk in having more severe depression as compared to males. Indians ethnics have 73% higher odds in developing more severe depression as compared to Malays. Those who were smoker and drink alcohol have 30% higher risk in having more severe depression as compared to non-smoker and who do not drink alcohol. Adolescent who ever used drug had 81% higher chance in having more severe depression as compared to those who never used drug. Adolescent who ever had suicidal ideation had 3-time greater chance in having more severe depression as compared to whom don’t. Adolescent who involved in truancy activity had 31% higher chance in having more severe depression as compared to those who didn’t. Adolescent who ever being bullied had 84% higher chance in having more severe depression as compared to those who never been bullied. Adolescent who have parent or guardian never or rarely know what they were doing had 33% greater risk in having more severe depression as compared to who have parent or guardian know what they do. Lastly, adolescent who have parent or guardian never or rarely understand what their problems and worries had 29% greater risk in having more severe depression as compared to who have parent or guardian understand their problems and worries. Conclusion: The submission of this study is that there is need for prevention and intervention programs, which must be designed and targeted towards adolescents who are exposed to various risks identified in this study.

Introduction: Household food insecurity is defined as the inability to provide enough food for a healthy and active lifestyle for all household members. This study aimed to reveal the risk of household food insecurity in Malaysia based on data from Malaysian Adults Nutrition Survey (MANS) 2014. Method: Six question adapted from the ‘Household Food Security Survey Module’ have been asked to 3000 respondents in MANS 2014. An Exploratory Factor Analysis (EFA) has been used to identify the main underlying structure or dimension. Result: All of six question establishing one underlying structure which explained 71.7% of the variance. This single structure was named ‘risk of household food insecurity’. By summing score, regression approach suggested the score 21 and above indicated no risk for household food insecurity whilst the score 20 contrarily. According to this cut-off, 24.8% of Malaysian household was at risk for household food insecurity and 75.2% was secured. The risk found to be household food insecurity and 75.2 was secured. The risk found to be significantly different by location, strata, race and income. Conclusion: Quarter of the Malaysian household was at the risk of household food insecurity. Immediate action by multi-sectoral food insecurity and also reduce the prevalence in the next survey.

The prevalence of overweight and obesity among adolescents is rising rapidly in many countries, including Malaysia. This article aims to present the associations between body mass index–based body weight status, body weight perception, and weight control practices among adolescents in Malaysia. The Malaysia School Based Nutrition Survey 2012, which included a body weight perception questionnaire and anthropometric measurements, was conducted on a representative sample of 40 011 students from Standard 4 until Form 5, with a 90.5% response rate. Comparing actual and perceived body weight status, the findings show that 13.8% of adolescents underestimated their weight, 35.0% overestimated, and 51.2% correctly judged their own weight. Significantly more normal weight girls felt they were overweight, whereas significantly more overweight boys perceived themselves as underweight. The overall appropriateness of weight control practices to body weight was 72.6%. Adolescents attempting to lose or gain weight need to have better understanding toward desirable behavioral changes.

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41–3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02–1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

Introduction: Food labeling regulation has been implemented to enable consumers, including those with chronic diseases to make healthy informed choices before purchasing pre-packaged foods. The purpose of this study is to determine the prevalence of obese adults in Malaysia who practice reading food labels. It explored types of labels read and understanding of the information. Methods: Findings presented in this study were captured from the secondary analysis of National Health and Morbidity Survey’s (NHMS, 2006) food label study which focused only on obese adults (BMI > 30 kg/m2 ) aged 18 and above. This nation-wide cross sectional study was conducted from April to August 2006 using an interview-based questionnaire. Complex data analysis was done using Stata version 12.0. Results: There were 4565 obese respondents with the mean age of 33 ± 9.7 (18 – 60 years old). About 54.7% completed high-school and 9.9% were higher degree holders. Prevalence of obese adults who claimed to read label was 80.5% (95%CI: 79.3, 81.6). Findings showed significant results in reading and understanding labels among all age group categories, Malay, Indian and other Bumiputras, all education categories and married respondents. Expiry date was the highest percentage being read (74.5%), followed by fat content (15.3%), vitamin (11.8%) and carbohydrate (10.9%). Conclusions: The obese population in Malaysia claimed to read and understand the food label but did not focus on specific macronutrients related to their health condition. Findings can be used to implement effective education programmes targeting the relevant groups to instill an awareness to read, understand and use the label information as one of the means in combating obesity.

This case study describes the implementation of a randomized controlled trial of a brief cognitive-behavioral therapy intervention by trained nurses for the management of postnatal depression at primary care clinics in Malaysia. This case study illustrates the detailed methodology of this study, which includes design, randomization, assessment tools, and follow-up schedule. It also discusses challenges faced and how they were overcome.

This study is a secondary data analysis from the National Health Morbidity Survey III, a population-based study conducted in 2006. A total of 7,749 children between 7 and 12 years old were recruited into the study. This study seeks to report the prevalence of overweight (including obesity) children in Malaysia using international cut-off point and identify its associated key social determinants. The results show that the overall prevalence of over weight children in Malaysia was 19.9%. The urban residents, males, Chinese, those who are wealthy, have over weight or educated guardians showed higher prevalence of overweight. In multivariable analysis, higher likelihood of being overweight was observed among those with advancing age (OR=1.15), urban residents (OR=1.16, 95% CI: 1.01-1.36), the Chinese (OR=1.45, 95% CI: 1.19-1.77), boys (OR=1.23, 95% CI: 1.08-1.41), and those who came from higher income family. In conclusion, one out of five of 7-12 year-old-children in Malaysia were overweight. Locality of residence, ethnicity, gender, guardian education, and overweight guardian were likely to be the predictors of this alarming issue. Societal and public health efforts are needed in order to reduce the burden of disease associated with obesity.

Depression among adolescents has been recognized as a major public health issue. The objective of this study was to determine the prevalence and correlates of depression among school-going adolescents in Malaysia. Data from the Malaysia Global School-based Health Survey (GSHS) 2012 were analyzed with additional data from the validated DASS21 (Depression, Anxiety, and Stress) questionnaire. The study revealed that 17.7% of respondents had depressive symptoms. Multivariate analysis further showed that feeling lonely (adjusted odds ratio [aOR] = 2.99; 95% CI = 2.57-3.47), Indian ethnicity (aOR = 2.00; 95% CI = 1.63-2.44), using drugs (aOR = 1.85; 95% CI = 1.21-2.82), and being bullied (aOR = 1.79; 95% CI = 1.60-1.99) were significantly associated with depressive symptoms. Lack of parental supervision, alcohol use, and tobacco use were also significant risk factors. Addressing depressive symptoms among adolescents may have implications for managing their risks of being bullied and substance use. This study also highlights the need to further investigate depressive symptoms among adolescents of Indian ethnicity.

Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with adverse effects. However, NSAIDs are among the most popular pain killers and easily available over the counter. This study aimed to determine the prevalence of NSAIDs use in Malaysian adults and among those with chronic diseases such as arthritis, kidney disease, hypertension, heart disease and asthma. It also examined the factors associated with NSAIDs use. Data from the National Health Morbidity Survey (NHMS) 2011, a nation-wide survey was analysed. A total of 18231 respondents aged 18 years and above responded to this module. Multivariate logistic regression was used to investigate the association between NSAIDs use and associated factors. The overall prevalence of NSAIDs use among Malaysian adults was 14.2% (95%CI 13.3-15.1). Of the respondents, 4.2% (95%CI 3.8-4.7) took NSAIDs once daily. NSAIDs use was highly associated with those who were ever-told to have arthritis (aOR: 3.03; 95%CI 2.60-3.52) and have difficulty of performing daily activities or work (aOR: 2.06; 95%CI 1.86-2.28). Those who were ever-told to have kidney disease (aOR: 2.36; 95%CI 1.74-3.20), ever-told to have asthma (aOR: 1.36; 95%CI 1.17-1.58), ever-told to have heart disease (aOR: 1.34; 95%CI 1.08-1.65), known hypertension (aOR: 1.22; 95%CI 1.08-1.37) also were associated with NSAIDs use.  By socio-demographic profiles, NSAIDs use was positively associated with those who have government benefit scheme or private health insurance (aOR: 1.44; 95%CI 1.31-1.58), higher education level (aOR: 1.35; 95%CI 1.20-1.51), higher household income (aOR: 1.26; 95%CI 1.11-1.44, aOR: 1.12; 95%CI 1.02-1.24), currently working (aOR: 1.25; 95%CI 1.13-1.39) and female (aOR: 1.17; 95%CI 1.07-1.28). NSAIDs use was less likely among those aged 60 years and above (aOR: 0.83; 95% CI 0.72-0.97), Chinese (aOR: 0.41; 95% CI 0.36-0.47) and ‘Others’ ethnicity (aOR: 0.82; 95% CI 0.67-0.99) compared to Malay ethnicity. NSAIDs use is prevalent in Malaysian adults and associated with co-morbidities and higher socio-demographic status, thus appropriate awareness should be promoted and highlighted in the community.

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.

Electronic cigarettes (e-cigarettes) are a new method for the consumption of nicotine. A nationwide survey among 4288 Malaysian adults was conducted in 2016 to measure the prevalence and to describe the population characteristics of e-cigarette users. A complex sampling design was used, and data were collected using a face-to-face questionnaire. The overall prevalence of current, ever, former, and dual users of e-cigarettes in Malaysia were 3.2% (95% confidence interval [CI] = 2.5-4.1), 11.9% (95% CI = 10.5-13.5), 8.6% (95% CI = 7.5-9.8), and 2.3% (95% CI = 1.8-3.1), respectively. The prevalence of all type of e-cigarette use was higher in urban than in rural areas. Current e-cigarette users were likely to be younger, males, and with higher education level. Among current e-cigarette users, 74% (95% CI = 64-82) also smoked conventional cigarettes (dual user). E-cigarette use is prevalent in Malaysia. It is common among younger adults, males, and cigarette smokers.

Objective: This study determined the prevalence of food label reading and understanding among the Malaysian adults, types of labels being read and factors associated with not reading labels. Methods: Malaysian Adult Nutrition Survey 2014 was a cross-sectional and applied a multistage stratified cluster sampling of living quarters. A total of 4044 adults aged 18-59 years were randomly chosen in selected households to represent the Malaysian adult’s population. Data collection was carried out between March to June 2014. Trained data collectors conducted interview using a validated food label questionnaire to obtain information on whether the respondents read labels (every time they bought or received food) and types of information being read. Complex sample analysis was applied to describe the findings. Result: A total of 2992 respondents (1382 men and 1610 women) answered the questionnaire. About 55.0% of the respondents reported never read labels, sometimes read labels was 22.0% and always read labels was 23.0%. Male sex, lower education, being single (not married/divorced/ widow/widower) and normal weight respondents were significantly less likely to read food label, the expiry date was the most common label information. Among those who rea labels, the expiry date was the most common label information being read (91.8%), followed by the precautionary statement (65.9%). Nutrient information being read was carbohydrate and sugar (21.5%), fat (20.0%) and total energy (14.4%). Non-working respondents and primary school attainers were significantly less likely not to understand label information. Conclusion: Only half of Malaysian adults read the label when buying or receiving food. Expiry date was the most frequently read information and the prevalence of reading the nutrient information was low. These findings provide useful evidence for the health authorities to plan for nutrition intervention programs in order to increase the food label usage among the relevant target groups.