Entamoeba histolytica, the causative agent of human amoebiasis remains a significant cause of morbidity and mortality in developing countries and is responsible for up to 100,000 deaths worldwide each year. Entamoeba dispar, morphologically indistinguishable from E. histolytica is more common in humans in many parts of the world. Similarly Entamoeba moshkovskii, which was long considered to be a free-living amoeba is also morphologically identical to E. histolytica and E. dispar, and is highly prevalent in some E. histolytica endemic countries. Humans are the host of infection and there would not appear to be other meaningful animal reservoirs of E. histolytica. Entamoeba. histolytica can be present in sewage and contaminated water. The infection is mainly transmitted via ingestion of water or food contaminated by faeces containing E. histolytica cysts. Clinical features of amoebiasis range from asymptomatic colonization to amoebic dysentery and invasive extraintestinal amoebiasis, which is manifested most commonly in the form of abscesses in liver and lungs. The epidemiology of amoebiasis has dramatically changed since the separation of E. histolytica and E. dispar species and the worldwide prevalence of these species has not been estimated until recently. Morever, E. moshkovskii, another morphologically indistinguishable human parasitic Entamoeba was not mentioned or considered as a contributor to the prevalence figures in endemic areas. Amoebiasis is still a major health problem especially in aboriginal settlements and amongst people living in remote area in Malaysia. However, until now there is only one data currently available to indicate the true prevalence and incidence of E. histolytica and E. dispar. Further studies are needed to determine the burden of E. histolytica, E. dispar and E. moshkovskii infections in Malaysia. In the present review, we briefly summarize all methods use in diagnosing Entamoeba species, ranging from microscopic identification to molecular detection such as culture and isoenzyme analysis, antibody detection tests, antigen detection tests, immunochromatographic assays, conventional PCR, real-time PCR and loopmediated isothermal amplification (LAMP).

Cultural attitudes of the societies have long been identified as one of the important determinants of Quality of Life (QoL). Yet there is a dearth of socio-culturally validated instruments for local population to assess the impact of socio-cultural practice on health. The aim of this validation study is to develop and test the validity and reliabilityof a questionnaire on culture dimensions.Respondents were asked about their engagement in socio-cultural aspects including beliefs and practice oftraditional customs and culture using a set of newly developed questionnaire.A total of 275eligible respondentsparticipatedwith150(54.5%)from the general population and 125 (45.5%)from the Orang Asli population. Kaiser-Meyer Olkin measure of Sampling Adequacy (KMO) was 0.791 and 0.677 for the general and Orang Asli population respectively. Bartlett’s test for both population was significant (p<0.001). By Principal Common Analysis, four factorswere extracted (Eigen values >1.0) that jointly accounted for 54.7% and 52.0% of the total variance among the general population and Orang Asli respectively.The Cronbach alpha value score was 0.785and 0.730 for the general population and Orang Asli population respectively. The Cronbach alpha values foreach of the four domains ranged from 0.477-0.865 and 0.543-0.758 for the general population and Orang Asli population respectively.These results suggest that the newly developed questionnaire appeared to have adequate validity and reliability in measuringsocio-cultural factors in the population.
general population & ; Orang Asli ; cultural believe & ; practice

We investigated the association between housing conditions with a primary focus on basic housing infrastructure and WHOQOL BREF score among the Orang Asli and non-Orang Asli populations. A cross–sectional study was conducted between August 2014 and May 2015 among the Orang Asli and non-Orang Asli populations in Kuala Langat, Selangor. Sampling of the population was done through multistage sampling while eligible respondents participated conveniently. The socio-demographic information collected consisted of age, ethnicity, marital status, educational level, and employment status. Basic housing infrastructure variables including the types of housing unit, wall construction material, availability and types of toilet, availability of electricity, source of water supply, and availability of garbage collection facilities were obtained. Among the Orang Asli respondents, having the pour type of toilet in the house was significantly (p=0.003) associated with a reduction in the physical health domain score by 0.36 (95% CI: -0.61,-0.12). Conversely, having no toilet in the house and living in a semi-detached house had significantly (p=0.023 and p=0.026 respectively) increased the social relationships domain score by 0.81 (CI: 0.11, 1.51) and 3.90 (CI: 0.47, 7.34) respectively. Unavailability of garbage disposal facilities was found to be significantly (p<0.001) associated with a reduction in the environmental domain score by 0.70 (95% CI: -1.05, 0.35). This study have added to the evidence that housing programs of the Orang Asli population need to be further strengthened and supported by a range of policies and practices that address the critical intervention points for more potential health gains.
Orang Asli ; non-Orang Asli population ; Quality of Life ; basic amenities and infrastructure

Intestinal microsporidia is an emerging human disease caused by microsporidia. A study was conducted to determine the prevalence of microsporidia in patients with gastro-intestinal symptoms and to examine the clinical manifestations associated with intestinal microsporidiosis. A descriptive cross-sectional study using a well-structured questionnaire; a review of medical records was also undertaken. Positive stool samples were defined as presence of one or more pinkish-violet ovoid structures with a belt-like stripe under high power field (100x) using modified gram-chromotrope stain (MGC). A total of 353 faecal specimens of patients was examined and 100 patients were found to have positive stool samples for microsporidia. The overall prevalence of microsporidia was 28.3%. Acute and chronic diarrhoea were seen in 49.0% and 36.0% patients, respectively. The commonest clinical presentations were diarrhoea (85.0%) with 83.0% of patients having loose or watery stools, vomiting (75.0%), foul-smelling stools (60.0%), nausea (59.0%) and cramping abdominal pain (39.0%). The least common symptoms were fever (15.0%), mucous in stool (5.0%) and blood in stool (4.0%). This study concludes that the prevalence of microsporidia is still high (28.3%) and the majority of patients (93.0%) are symptomatic; the most common gastro-intestinal symptom is diarrhoea with loose or watery stools. Hence, it is recommended that a stool screening for microsporidia be done in selected patients presented with gastrointestinal symptoms.
Feces ; symptoms <1> ; Prevalence aspects ; Intestinal microsporidiosis ; Clinical

Routine diagnosis of intestinal microsporidiosis in clinical diagnostic laboratories relies mostly on detection of microsporidial spores via special staining and microscopic techniques. This paper describes the comparative evaluation of Calcofl uor White M2R method, with modifi ed Gram-chromotrope Kinyoun method as the reference standard. One hundred and six stool samples were examined for the presence of microsporidial spores. Sensitivity, specifi city, positive and negative predictive values of the Calcofl uor White M2R method compared to the reference technique were 95.2%, 4.3%, 78.2% and 20.0%, respectively. The positive predictive value (PPV) was 78.2% and the negative predictive value (NPV) was 20.0%. Despite low specifi city of the CFW method due to its ability to stain chitinous wall of microorganisms, the presence of distinct deep-blue horizontal or equitorial stripes in microsporidial spores in modifi ed Gram-chromotrope Kinyoun would likely reduce the false positive results obtained in the Calcofl uor White M2R. Hence, the simultaneous use of these two methods would give better performance and accuracy for the detection of microsporidial spores in patients with intestinal microsporidiosis.

The present study was conducted to investigate the clinical outcomes of Entamoeba histolytica infection in symptomatic and asymptomatic Orang Asli (aborigine) communities in Malaysia. Examination was performed on 500 stool samples obtained from Orang Asli communities in 3 different states using formalin-ether concentration, trichrome staining, and single-round PCR techniques. Out of 500 stool samples, single infection of E. histolytica, Entamoeba dispar, and Entamoeba moshkovskii was identified in 3.2%, 13.4%, and 1%, respectively. In addition, 10 samples had mixed infections with E. histolytica and E. dispar. Six samples containing E. dispar were also positive for E. moshkovskii, and only 2 samples had E. histolytica in association with E. dispar and E. moshkovskii. Seventeen E. histolytica-positive samples were from symptomatic subjects, whereas the remaining 11 samples came from asymptomatic subjects. These findings suggest a predominant distribution of pathogenic potential of E. histolytica strains in this community. Therefore, further studies on genotyping of E. histolytica is required, to find out association between E. histolytica genotype and the outcome of the infection.
Adolescent ; Adult ; Asymptomatic Diseases ; Child ; Child, Preschool ; Coinfection/parasitology/pathology ; Entamoeba/*classification/isolation & purification/*pathogenicity ; Entamoebiasis/parasitology/*pathology ; Feces/parasitology ; Female ; *Genetic Variation ; Humans ; Malaysia ; Male ; Middle Aged ; Treatment Outcome

Objectives To determine the prevalence and risk factors of Blastocystis among underprivileged communities living in rural Malaysia. Methods This cross-sectional study was conducted among 253 participants aged between 1 and 85 years. Stool samples were examined using Wheatley's trichrome stain after in-vitro cultivation in Jones' medium to detect the presence of Blastocystis. Information pertaining to the demography, socioeconomic and environment were collected using pre-validated questionnaires. Results The total prevalence of Blastocystis infection was 40.7%. The multiple logistic regression analysis revealed that age ≥15 years (OR = 2.72; 95% CI = 1.47–5.04) and presence of infected family members (OR = 8.56; 95% CI = 4.47–16.38) were the significant risk factors associated with blastocystosis in these communities. Conclusions Blastocystosis is revealed through this study to be still prevalent among Orang Asli communities in rural Malaysia. The two main approaches that should be implemented by the public health authority in battling this infection would be the screening of other family members and giving treatment to the infected individuals. Moreover, it is imperative for health education on good personal and food hygiene practices are provided in order to reduce the morbidity and transmission of Blastocystis infection among the Orang Asli in their communities meaningfully.

Behavioural change interventions for weight loss have been found to be effective in the short term, but their long-term effectiveness remains a question. The objective of this study was to evaluate the effectiveness of the 36 weeks F.E.A.T program combining behavioural changes of healthy eating and physical activity. A quasi-experimental study of overweight adults was conducted in Malacca. A total of 53 subjects (mean age 47.4 ± 7.2 years) completed the program in three stages. In the first stage (T1: weeks 1–12), the intervention group (n = 28) participated in the F.E.A.T program activities, while the control group (n = 25) did not receive the intervention. In the second stage (T2: weeks 13-24), the activity was supervised and monitored by the peer support group. Sustainability of activity was measured at the third stage (T3: weeks 25-36). The effectiveness of the program was measured by changes in dietary intake, physical activity score, body weight, body mass index (BMI), waist circumference (WC) and body fat percentage at T0 (pre-intervention), T1, T2 and T3. All parameters showed significant interaction effects (time*group) except for energy intake. The intervention group showed significant decreases from T0 to T3 for energy intake (-14.3%), body weight (-4.3%), BMI (-4.2%), WC (-10.5%) and body fat percentage (-3.6%). While physical activity level increased by 109.6% for the intervention group. There were no significant differences in all of these parameters among the control group. The results show the effectiveness of the F.E.A.T program on dietary status and physical activity changes during the 36-week of intervention period.