Background: Malaria remains a public health problem in Malaysia despite a decline in the number of cases in recent years. Public knowledge of malaria is essential to achieving and maintaining malaria elimination. Therefore, this survey assessed the prevalence of people who had ever heard of malaria, had correct knowledge of malaria transmission, symptoms, risk activities, and prevention measures in the Malaysian population, and identified the associated factors involved. Methods: The data were obtained from the National Health and Morbidity Survey (NHMS) which was conducted from September to October 2020. A cross-sectional survey with five structured questionnaires using the method of computer-assisted telephone interviews (CATI) was used to collect data. The socio-demographic characteristics such as age, gender, ethnicity, nationality, marital status, educational level, and occupation were recorded. Data were analysed using STATA SE Version 16. Associations between variables were tested using chi-square and logistic regression, with the level of statistical significance set at p < 0.05. Results: Out of 3085 respondents who participated in this survey, 2491 had ever heard of malaria with a prevalence of 76.1% (95% CI 70.5, 80.9). The prevalence of correct knowledge of malaria transmission was 53.9% (95% CI 50.2, 57.7), symptoms 24.1% (95% CI 21.2, 27.2), risk activities 34.0% (95% CI 29.3, 39.1) and prevention measures 59.7% (95% CI 55.5, 63.7). Multivariate analysis showed that age, ethnicity, and educational level were significantly associated with correct malaria transmission and risk activities. In addition, age and educational level were significantly associated with correct malaria symptoms. Subsequently, only the variable ethnicity showed a significant association with the correct malaria prevention measures. Conclusion: In general, the prevalence of ever heard of malaria was considered high since the survey was performed based on a non-specific malaria population. However, the prevalence of correct knowledge of malaria symptoms and risk activities were considered low. It is concluded that educational level is one of the major factors associated with correct malaria knowledge, along with age and ethnicity. Therefore, based on these findings, targeted intervention and innovation should be planned by malaria programme managers to sustain malaria elimination in Malaysia.

Introduction: Dengue is among the most important mosquito-borne diseases, with more than half of the world’s population at risk of infection in dengue endemic countries. Environmental management, which includes any activities that involve environmental modification, environmental manipulation and changes to human behaviour have been used to mitigate the risk of dengue transmission. In this protocol, we will integrate the data from various sources to assess the overall effect of environmental management on the incidence of dengue and other entomological indices. Methods and analyses: We will conduct a systematic review of intervention that assess the effect of environmental management on the incidence of dengue and/or entomological indices. We will include any studies that include intervention through environmental management for dengue control, involving environmental modification, environmental manipulation and changes to human behaviour. A comprehensive search will be performed in electronic databases PUBMED, CENTRAL, SCOPUS, Web of Science and relevant research websites such as PROPSERO, WHO ICTRP and ClinicalTrials.gov to identify studies that meet our inclusion criteria. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic reviews and Meta-Analysis. Titles, abstract, keywords for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using quality assessment tool for studies with diverse design and Cochrane risk of bias tool. The characteristics of the selected articles will be described based on the study design, types of intervention and outcomes of the study in various countries. These include the types of environmental management intervention methods and the effectiveness of the intervention in reducing dengue cases or incidence and impact on entomological indices. Ethics and dissemination: We will register this systematic review with the National Medical Research Register, Ministry of Health Malaysia. This protocol also had been registered with the PROSPERO. No ethical approval is necessary, as there will be no collection of primary data. The results will be disseminated though a peer-reviewed publication and conference presentation. Trial registration number: CRD42018092189.

Dengue is a mosquito-borne disease that rapidly spreads throughout tropical and subtropical regions. An estimated 2.5 billion people live in dengue-endemic countries and millions of cases occurring each year. Identifying key breeding containers are important to prevent dengue epidemics. This study aims to identify key breeding containers and to evaluate the risks of dengue transmission in the dengue outbreak localities in Kepong District, Kuala Lumpur. Entomological surveillance was done between January 2016 to December 2017 in 38 different outbreak localities. Both indoors and outdoors water-holding containers were inspected for the presence of mosquito larvae. All collected larvae have identified the species, types of breeding containers were recorded, and three larval indices, House Index (HI), Container Index (CI), and Breteau Index (BI), were calculated. Of the 2,067 containers inspected, 227 (10.98%) containers were positive for Aedes larvae. The four main breeding container types in this study were plastic containers (31.72%), water drums (22.47%), drains (18.06%), and flowerpots (14.98%). The HI, CI, and BI varied from 0 to 52.94, from 1.72 to 32.76, and from 2.33 to 75.00, respectively. Key breeding containers of Aedes larvae found in this study provide guidance for health service providers to educate residents to eliminate the common indoors and outdoors Aedes mosquito breeding containers in the study area.

Dengue is a major vector-borne disease caused by any one of four closely related dengue viruses. The viruses are transmitted to humans by the bite of an infected mosquito (Aedes aegypti or Aedes albopictus). The study was conducted in the Seksyen 7, Shah Alam where there is a marked increase of dengue cases evidenced during the last few years. This study aimed to establish spatial density of dengue incidence in Seksyen 7, Shah Alam using Geographical Information System (GIS) and spatial statistical tools. Methodology: We analysed 23 ovitrap index and 2389 dengue cases from 2013 to 2014. Data were collected from Petaling District Health Office and Shah Alam City Council. Spatial statistical tools were used to show spatial correlation of dengue cases and kernel density was implemented to identify dengue hotspot localities. Results: The result showed that dengue cases were spatially random (p<0.001) by using spatial autocorrelation analysis. Average Nearest Neighbour analysis showed that dengue cases were highly clustered and occurred at an average distance of 219.2 meters. Location especially residential areas had been identified as hotspot by using kernel density estimation analysis. Discussion and Conclusion: Our results showed that GIS and spatial statistical tools could be an effective mean to establish spatial density of dengue. Mapping of dengue cases would serve as guidance for stakeholders to identify source of outbreaks. It will generate more hypotheses and further investigations. Understanding the spatial of Aedes index and its impact on human health, particularly outbreaks of dengue is important in controlling the transmissions of the disease.

The elimination of most productive breeding sites for Aedes spp has been applied worldwide in order to keep vector density below a critical threshold. Key-breeding container plays important roles in determining the most suitable and effective methods for vector control. This study was conducted to identify the key-breeding container of Aedes spp. larvae as a baseline data for Cheras District and to suggest suitable Aedes prevention and control steps based on Integrated Vector Management strategies. An entomological survey was done in 20 Dengue outbreak localities in Cheras district, Kuala Lumpur, in 2016 involving all types of properties. The location of breeding was determined by indoor or outdoor, and type of mosquito species was identified. Descriptive statistics and chi-square analysis were done to identify differences in breeding containers by type of property (Low-rise vs High-rise). Statistical significance was set at P-value less 0.05. All the study sites were 100% positive for Aedes breeding. For all study sites, entomology indices showed a high risk of Aedes index (15%), medium risk for breeding index (55%) and medium risk for container index (70%). Of 546 potential breeding containers included in the survey, 11.7% were positive, indoor (2.6%) and outdoor (9.2%). The most common type of container was plastic container (30%) and there is no significant difference of indoor and outdoor breeding by high-rise and low rise, p-value= 0.0613. Artificial containers are key breeding habitats in dengue outbreaks. Therefore, community mobilisation towards eliminating human made containers, either indoor or outdoor, is vital for dengue control program.

Among several vector control methods commonly used, environmental management is one of the control measures to mitigate dengue in such vulnerable communities. Since there is no curative treatment for dengue yet, targeted environmental and ecosystem management is increasingly relevant. Hence, this review was conducted to identify the effectiveness of environmental management intervention strategy to reduce dengue cases. We searched PUBMED, CENTRAL, SCOPUS, Web of Science, CIJE, WHO ICTRP, and ClinicalTrials.gov up to January 2021. A total of 521 articles were screened. Only 16 studies were included in this review. There were 6 studies that applied all three types of environmental management interventions (manipulation, modification and behavior), 8 studies applied two types of interventions (manipulation and behavior) and 2 studies applied one type of intervention (manipulation or behavior). All included studies reported reduction of Aedes entomological indices. The studies showed reduction in dengue cases and density of Aedes population through environmental interventions. It is recommended for the health authority to incorporate environmental management intervention in dengue control activities and enhanced the community involvement to ensure sustainability with high impact on dengue reduction.

Background: Typhoid fever causes global morbidity and mortality and is a significant health burden, particularly in low- and middle-income countries. The direct fecal-oral route is the main transmission mode, but indirect environmental transmission could occur, particularly in urban settings. This study aimed to investigate the burden and trend of typhoid fever, reporting the coverage system between government and private practice and pattern of multidrug-resistant (MDR) typhoid cases in the urban Klang Valley area from 2011 to 2015. Methods: The data from a cross-sectional study retrieved from the e-Notifikasi System, a national reporting system for communicable diseases provided by the Disease Control Division, Ministry of Health Malaysia and secondary data of all the typhoid cases were obtained from the public and private hospitals and laboratories in Klang Valley. Descriptive analysis was performed to examine the sociodemographic characteristics, spatial mapping was conducted to examine trends, and the crude incidence rates of confirmed typhoid cases and percentage of reporting coverage were calculated. Significant differences between MDR and non-MDR Salmonella typhi were determined in the patient’s sociodemographic characteristics, which were analyzed using χ 2 test. P values < 0.05 were considered statistically significant. Results: In total, 507 typhoid fever cases were reported in Klang Valley; however, only 265 cases were confirmed by culture tests. The crude incidence rates of confirmed cases were between 0.5 to 0.7 but peaked at 1.42 per 100,000 population in 2015. Most typhoid fever cases were observed among men (55.6%), individuals aged 21 to 30 years (27.6%), Malaysians (86.3%) and individuals of Malay ethnicity (52.1%). The reporting coverage of confirmed cases was 78.9% and non-reporting coverage of unconfirmed typhoid cases was 79.5%. The predictive value positive (PVP) was 89.3, and 7.5% were detected as MDR Salmonella typhi. Statistical significance was found in gender, citizenship and ethnicity regarding MDR Salmonella typhi (p = 0.004, p = 0.008 and p = 0.034, respectively). Conclusions: The local transmission of typhoid is still prevalent in the Klang Valley despite rapid urbanization and development in recent years. These findings are essential for policy makers to plan and implement focused and effective preventative activities to curb typhoid infection in urban areas.

Construction sites are often blamed for dengue outbreaks in surrounding localities. The environment is suitable for immature mosquitoes to develop without predators and the convenience of female mosquitoes to feed on the exposed construction workers. The purposes of this study were to identify the species of mosquitoes present at construction sites and the types of their preferred breeding habitats, and also to determine the vertical distribution of the mosquitoes. Nineteen construction sites in the Federal Territory of Kuala Lumpur were cross-sectionally surveyed for the presence of immature mosquitoes in 2018. All waterholding containers were inspected for the presence of immature mosquitoes. Types of water-holding containers were recorded and counted. The number of immature mosquitoes was counted from each positive container and then transferred to the laboratory for species identification. A total of 1,643 immature mosquitoes were collected, comprising 1,287 larvae and 356 pupae. Aedes aegypti immature was the most abundant mosquito species (76%), followed by Culex quinquefasciatus (19%), and the Aedes albopictus (5%). The most productive breeding sites were flooded floors, drains, plastic containers, elevator shafts, water drums, and pails. We discovered that the immature mosquitoes were most abundant from the ground floor to the second floor, with Ae. aegypti immature could disperse up to the thirteenth floor. This study has provided useful information to the health department regarding the preferred breeding habitats of vector mosquitoes at construction sites. Consequently, it contributes to effective and efficient vector prevention and control measures, thus saving time and manpower.