Introduction: Premarital sexual behaviour remains an important sexual and reproductive health issue among adolescents in Malaysia. It is also a prohibited act and considered sinful among the Muslims community. This study aimed to identify the determinants of premarital sexual behaviour among the late adolescents age group in Pahang, Malaysia. Methods: An observational study was conducted among eligible late adolescents, which were recruited using probability sampling method. Only those aged 18 to19 years old, and previously attended the public secondary schools in Malaysia were included, with non-Malaysian, married and those who were absent during the data collection day were excluded. Data was collected using a valid and reliable set of questionnaires measuring the personal (demographic profile, knowledge and attitude), behavioural (premarital sexual behaviour and high-risk activities) and environmental (subjective norms and perceived parental communication) factors. Multiple logistic regression analysis was conducted to identify the determinants of premarital sexual behaviour. Results: A total of 390 adolescents aged 18 and 19 years old participated in this study, with 82.3% of respondents reported never had premarital sexual behaviour. Multiple logistic regression showed that the male and engagement in high-risk activities had higher odds in premarital sexual behaviour respectively (AOR =11.649, 95% CI: 3.615,37.536, p <0.001; AOR=19.224, 95% CI: 7.820,47.262, p <0.001). Conclusion: Male gender and engagement in high-risk activities remained important risk factors towards the ongoing concern related to premarital sexual behaviour among adolescents in Malaysia. Failure to address this issue should be explored and improve accordingly.

Introduction: A cross-sectional study was conducted to determine the associations of socio-demographic factors, eating behaviours, fast food purchasing by parents for family meals, and availability of neighbourhood fast-food outlets with BMI-for-age z-score (BAZ) among adolescents. Methods: Through multi-stage stratified cluster sampling method, a total of 420 adolescents from five selected public secondary schools participated in the current study. Data on socio-demographic factors, eating behaviours, and parent’s purchases of fast food were obtained through selfadministered questionnaires. The availability of fast-food outlets was assessed using Geographic Information System (GIS). Body weight and height of the adolescents were measured. Results: The prevalence of overweight, obesity, thinness and severe thinness among adolescents in the present study were 17.6%, 15.5%, 3.1% and 0.7%, respectively. The current findings showed that a higher monthly household income (rs =0.12, p=0.02) and less purchases of fast food by parents for family meals (rs =-0.11, p=0.03) were significantly associated with higher BAZ of the adolescents. However, there were no significant associations between eating outside of home, eating at fast-food restaurants, buying delivery fast food, and availability of neighbourhood fast-food outlets with BAZ. Multiple linear regression showed that less purchases of fast food by parents for family meals significantly contributed towards higher BAZ (β=−0.25, p=0.02). Conclusion: A higher household income and less fast food purchasing by parents were associated with higher BAZ. Fast food purchasing of adolescents were not associated with BAZ. Therefore, an appropriate obesity intervention programme should focus on adolescents and their parents from middle- and high-income households in Labuan.

The role of caregivers is very important in the management of person with dementia, where it is not uncommon for them to experience psychological distress. However, the level of distress can be managed and reduced through strategic educational intervention. A systematic review has been conducted through searching Medline, Science direct, Cochrane library and EMBASE databases to provide a narrative synthesis that elaborate on methods and outcomes of the educational intervention among informal caregiver of person with dementia. From a total of 5125 records, eight studies were selected and included in this review, where the results show that educational intervention can be implemented either as individual or group intervention. Group intervention methods mainly focus on training programs such as workshops and lectures, and also group-based discussions. While for individual intervention, most of the activities were implemented through self-learning using technology or computer-based systems. In conclusion, based on the outcome of the studies, both methods of implementations are found to be useful in reducing psychological distress of the informal caregiver.

Introduction: There is a strong body of evidence advocating parent training programmes in the management of behavioral problems in children. In these programmes, attrition is a major challenge. We aimed to examine the sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems as rated by mothers who completed (PC) and mothers who dropped out (PD) of a parent training programme. We also aimed to determine whether there was any change in their children’s behaviour scores before and after intervention. We hypothesized that parent and child sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems would be different between PC and PD, and that children of PC would experience significant improvements in their behaviour. Methods: Data from a randomised controlled trial (RCT) involving 35 mothers and children aged 6–12 years old with behavioural problems who were enrolled in a parent training programme were examined. Child behaviour was measured using the Strength and Difficulties Questionnaire. Results: No significant differences were found between PC and PD in terms of the sociodemographic and clinical profiles, parental motivation, and pre- or post-intervention child behaviour. After programme completion, PC (n=27) reported improvements in all the behaviour subscales; total difficulties (p<0.001), emotional problem (p=0.004), conduct problem (p=0.001), hyperactivity symptoms (p<0.001), peer problems (p=0.036), and prosocial behaviour (p=0.001). Conclusion: The parent training programme produces significant child behaviour improvements in mothers who complete the programme. Nonetheless, the study has some limitations which restrict the generalizability of these findings.

Introduction: There are a growing number of parents who hesitate to vaccinate their children. Therefore, the current study was conducted to assess future parents-to-be intention to vaccinate their children, as well as to investigate contributing factors of vaccination intention and to identify sources of information on childhood vaccination. Method: A cross-sectional study was conducted among Foundation Program students at a public university for five months, from April to August 2019. Factors studied included sociodemographic characteristics, knowledge and attitudes toward childhood immunization, and religiosity. Data were collected using a validated self-completed questionnaire. Simple random sampling was conducted, with a total of 371 students were recruited as respondents. Multiple logistic regression was performed to determine the predictors. The significance level is set at alpha less than 5%. Results: Approximately 95% of respondents indicated an intention to vaccinate their future. The mean age of respondents was 19 ± 0.37 years old. A motive to vaccinate their future children was high among females (AOR: 4.20, 95% CI: 1.59, 11.08, p: 0.004), having sufficient knowledge about childhood vaccination (AOR: 3.92, 95% CI: 1.23, 12.45, p: 0.021), and having a positive attitude toward childhood vaccination (AOR: 9.56, 95% CI: 2.15, 42.46, p: 0.003). There was no significant association between intention to have their future children vaccinated and religiosity. The sources of information about childhood vaccination were mainly the Internet (72%), mass media (68.2%), and social media (61.7%). Conclusion: Readiness of foundation program students was satisfactory. However, policymakers and program planners should target improving knowledge and attitudes of young people about childhood immunization especially among young men as they will head the household. This effort may sustain the readiness of young people to vaccinate their future children. The approach should include the Internet, mass media, and social media.

Introduction: Over the last decade, tuberculosis (TB) has remained the main cause of death from communicable diseases in Malaysia. This study was aimed to determine the risk factors of unfavourable treatment outcomes (UTO) among new TB cases in Hulu Langat. Methods: A cohort study was prospectively conducted among the new TB cases registered in the government health clinics of Hulu Langat district. The event was defined as any one of the UTO (default, transferred out, treatment failure and death) whichever came first. This data was analysed using SPSS version 25.0. Survival pattern was assessed by Kaplan-Meier plots and Log rank test. Hazard ratios of unfavourable TB treatment outcomes among the new TB cases at 95% confidence interval and level of significance set at 0.05 were calculated using Cox proportional hazard model. Results: Of the 321 patients analysed, 80.4% (n=258) had favourable treatment outcomes and 19.6% (n=63) had UTO with 10.9% (n=35) transferred out, 6.9% (n=22) defaulted and 1.9% (n=6) died. There was no treatment failure. The mean survival time was 5.2 (SD=0.09) months. The risk factors of hazard probability of UTO were male, ethnicity type Others, positive human immunodeficiency virus (HIV) status and not done sputum at 2 months of treatment. Conclusion: Transferred out and default formed the bulk of the UTO in Hulu Langat. New interventions to improve the existing TB prevention and control program should be planned in the first three months of treatment.

Introduction: Malaria is a vector-borne disease caused by the bites of infected female mosquitoes that transmit the parasite to humans. In Guinea, the entire population is at risk of malaria infection. The objective of this study is to develop, implement and evaluate the effectiveness of the Malaria Free Zone program using the Health Belief Model (HBM) to improve malaria prevention knowledge, attitudes, and practices among university students in Conakry, Guinea. Methods: The study design is a clustered randomized controlled trial (RCT). Students are selected using the clustered sampling method, with each university representing one group, either the intervention or control group. The sample size is 113 university students from each group. The content of the Malaria Free Zone program includes eight sessions, which are based on the HBM constructs. This program takes approximately 6 hours and 30 minutes to complete. Respondents are required to complete a questionnaire over four time points. Generalized Estimating Equation (GEE) will be used to determine the effectiveness of the Malaria Free Zone program on malaria prevention knowledge, attitudes, and practices, adjusted with covariates. Conclusion: It is expected that there will be a significant difference in knowledge, attitude, and practice of malaria prevention in the post-test, 2-week and 2-month follow up of the intervention group after the Malaria Free Zone program. Students in the intervention group will have significant higher knowledge, attitude and practice of malaria prevention compared to students in the control group. Trial Registration: PACTR202102614259601

Introduction: The instructor-led CPR training method has been used for over 4 decades. However, nurses’ knowledge and skills are still low. Instructor-led CPR training is an extremely capital-intensive programme that requires more time, workforce, and space, thus serving as an impediment to effective learning among the prospective nurses’ trainees. Self-directed training method is suggested to improve the knowledge and skills of CPR among healthcare practitioners due to the low cost and flexibility. This study aims to evaluate the effectiveness of self-directed method in improving nurses’ knowledge and skill retention from baseline to post-test, one, three-, and six months. Method: A two-arm double-blinded randomised controlled trial will be conducted in two referral hospitals. The control group training consists of a one-day session taught by AHA-certified instructors, whereas the intervention group training entails participants learning on computers in a simulation lab for seven days. A generalised estimated equation model will be used for statistical analysis. Discussion: Through the self-directed training method, participants will have significantly better knowledge and skills of CPR compared to the conversational training method across the time points. Self-directed training method is a simple, cost-effective and flexible method, which can facilitate the training of more nurses in the acquisition and retention of knowledge and skills, especially for those who prefer to learn at their own pace. Trial Registration: Registration Code: UDUTH/NHREC/30/012/2019 and NHREC/28/01/2020/AKTH/EC/2934

Objective: This retrospective, cross-sectional, observational study assessed the duration of coronavirus disease 2019 (COVID-19) symptoms during the second wave in Brunei Darussalam. Methods: Data from COVID-19 cases admitted to the National Isolation Centre during 7–30 August 2021 were included in the study. Symptom onset and daily symptom assessments were entered into a database during hospitalization and disease was categorized by severity. The time between symptom onset and hospital admission, the duration of symptoms and length of hospitalization were assessed separately by age group, disease severity and vaccination status using one-way analysis of variance with Bonferroni post hoc corrections. Results: Data from 548 cases were included in the study: 55.7% (305) of cases were male, and cases had a mean age of 33.7 years. Overall, 81.3% (446) reported symptoms at admission (mean number of symptoms and standard deviation: 2.8 ± 1.6), with cough (59.1%; 324), fever (38.9%; 213) and sore throat (18.4%; 101) being the most common. Being older, having more severe disease and being unvaccinated were significantly associated with the time between symptom onset and hospital admission, symptom duration and length of hospitalization. Discussion: Knowing which factors predict the duration of COVID-19 symptoms can help in planning management strategies, such as the duration of isolation, predict the length of hospitalization and treatment, and provide more accurate counselling to patients regarding their illness.

Introduction: Poor appetite is prevalent among older adults and may negatively impact on their overall health. This is especially true for institutionalised residents. Despite this, there is a paucity of research on appetite and its associated factors among institutionalised residents, which signified the present study. Methods: A cross-sectional study was conducted among elderly residents at long-term care facilities in the state of Selangor, Malaysia to ascertain their appetite status and its associated factors. Results: A total of 97 residents with mean age of 74.2±8.4 years old were recruited. They comprised 61.9% females and 38.1% males. More than 50% had poor appetite with early satiety. There were 63.0%, 82.4%, and 94.8% who had poor oral health, poor sleep quality, and depression, respectively. Ethnicity (OR=2.73; 95% CI=1.00-7.44; p=0.049) was the only factor that predicted poor appetite among older adults in long-term care facilities, with Malay residents having poorer appetite than their Chinese and Indian counterparts. Conclusion: The prevalence of poor appetite was high among residents staying at long-term care facilities in Selangor, Malaysia, especially among Malays. This issue deserves further studies to identify the specific underlying factors contributing to poor appetite among older adults from different ethnicities. Acknowledging the high prevalence of poor appetite among older adults and its possible unfavourable outcomes, appropriate nutrition interventions are therefore needed to address this issue among institutionalised elderly.