Malnutrition is associated with childhood diseases such as diarrhea or other severe illness. Children who suffer from repeated episodes of diarrhea are more likely to suffer from malnutrition. In addition, the source of drinking water is a very important factor affecting the nutritional status. The objective of this study was to find out the prevalence of malnutrition condition among children aged 3 to 5 years old and the factors associated with it. A cross sectional study using simple random sampling was conducted among 220 children aged 3 to 5 years old from four kindergartens in Baghdad city, Iraq. Nutritional assessment was carried out using the indicator weight-for-age z-score based on World Health Organization cut off points. Acute malnutrition was found in 18.2 % of the respondents. In this study 65 % of the respondents used tap water to drink as compared to 35 % who used sterilized bottles as source of drinking water. The environmental factors mainly the source of drinking water was significantly associated with child nutritional status (p=0.034). The prevalence of diarrhea and admissions to the hospital due to diarrhea were also significantly associated with malnutrition (p < 0.01, p <0.01) respectively. In conclusion, the effect of diarrhea on child nutritional status is very important and till now considered the major cause of child malnutrition. Shortage of safe drinking water in Iraq can lead to an increase in diarrhea cases and eventually leading to child malnutrition.

Patients are increasingly dissatisfied with the “waiting time” and “duration of consultation” at outpatient clinics. A cross sectional study was carried out to measure waiting time and duration of consultation and to examine patients’ level of satisfaction towards waiting time and duration of consultation at the Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also examined patient’s satisfaction towards the overall clinic services. Data was collected using a self-administered questionnaire. A total of 81 patients participated in this study with a response rate of 100 percent. Findings indicated a significant difference in the mean between expected waiting time level II (from the time the patient is given the calling number till the time patient is called into the doctor’s room) and the actual waiting time level II experienced. A significant difference in the mean between the expected duration of consultation and the actual duration of consultation experienced was also noted. However, no significant difference was found between the mean of expected waiting time level I (the time patient register at the counter till the patient is given the calling number) and the actual waiting time (p>0.05). Overall, patient satisfaction towards waiting time was low (29.6%) and duration of consultation was of moderate level (41.9%). The overall satisfaction towards the clinic services were of average level (56.8%). Findings also indicated that patient satisfaction was not influenced by socio-demographic factors of respondents such as age, ethnic, education level, occupation and income level. Important findings from this study may help staff managing the clinic in addressing patients’ complaint on waiting time and improve patients’ satisfaction on the overall services of the Orthopedic clinic in UKMMC.

Children who are born in a community with insufficient micronutrients, particularly iodine in remote rural areas are associated with low intellectual functions and mental retardation. The aim of this cross-sectional study is to determine the mental performance of the schoolchildren in Bario, a highland settlement of the Kelabit people in the district of Baram, Sarawak and to determine its correlation with the availability of iodine in the environment, as well as other micronutrients such as selenium, copper and manganese. A total of 25 schoolchildren in Bario age ranging from 7 to 12 years old participated in the study. Mental performance of the schoolchildren were tested using TONI-2 (Test of Nonverbal Intelligence--second edition), a cognitive ability measures with a response format which eliminates language and reduces motoric and cultural factors. The iodine levels from several wells, soils and salt found in Bario were determined using HPLC (software version 3.05.01) whilst serum levels of selenium, copper and manganese were measured using Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS). The results showed that the median and mode scores of intelligence quotient for Bario were 82 and 75, respectively, whilst median and mode scores of intelligence percentile were 11.0 and 5.0, respectively. The maximum score achieved were at the average level with the quotient score between 90-110. It was found that salt produced from one of the wells in Bario contained high quantity of iodine. Based on standards established by the Trace Elements Laboratory, Roben Institute, University of Surrey, United Kingdom, schoolchildren in Bario are having sufficient blood levels of copper and a high selenium and manganese levels. Despite the remoteness of the study area, the schoolchildren in Bario, Sarawak showed higher mental performance compared to other isolated areas. This is probably correlated with the high micronutrients availability, particularly iodine, found naturally in Bario.
Cross-Sectional Studies ; Iodine/*blood ; Malaysia ; *Mental Processes ; Micronutrients/*blood ; Soil/*analysis ; Water/*analysis

Introduction: A culturally valid tool is lacking in order to assess vitamin D intake among Malaysians. This study aimed to develop and determine the validity and reliability of a semi-quantitative food frequency questionnaire (FFQ) for assessment of vitamin D intake among pregnant women living in urban areas of Malaysia. Method: A total of 79 volunteer mothers (aged 18 to 40 years) in their first trimester of pregnancy participated in this study voluntarily. They completed both the 3-day 24-hour dietary recalls (3DR) and semi-quantitative food frequency questionnaires (FFQ1). The FFQ1 was validated against vitamin D intake calculated from the 3DR. After one week, 41 (51.89%) subjects completed the same FFQ1 (now called FFQ2) for reliability assessment. Results: The median vitamin D intake from 3DR was 117.6 IU/ day with an interquartile range (IQR) of 54.8 to 193.7 IU/ day. The median and IQR values from FFQ1 were 147.7 and 103.7 to 233.9 IU/ day, respectively. The Spearman correlation coefficient was strong and positive, r=0.810 (p=0.01); cross-classification analyses revealed no misclassification and the Bland-Altman plot showed good agreement between the two dietary methods. The intra-class correlation (ICC) for reliability of vitamin D intake was 0.98; the cross-classification analysis showed 95.12% and was classified into the same quartile which supported a consistent habitual eating pattern. Conclusion: The new FFQ developed to assess vitamin D intake showed high correlation and high agreement with the majority of the sample population classified into the same quartile. It is concluded that the new FFQ is a valid and reliable screening tool for vitamin D intake for pregnant women in the urban areas of Malaysia.

Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values.
Anemia, Iron-Deficiency ; Pregnancy

Breast self-examination (BSE) is recommended globally as one of the methods in early detection of breast cancer. Little is known about nurses screening behavior related to BSE. A cross-sectional study was conducted to examine the knowledge, attitude and practice of Breast Self Examination (BSE) among nurses. A self-administered questionnaire was sent to a total of 114 nurses working in Obstetrics & Gynaecology wards and clinics of two tertiary hospitals. Among the 114 participants, 111(97.4%) practiced BSE. The mean age of the participants was 34.97(±9.104) years. The mean score of knowledge was 11.07(±1.020) and 81.1% had high knowledge of BSE. Majority (98.2%) of respondents showed good attitude towards BSE. Barriers was found to be a significant predictor and self confidence proved to be an influencing factor on BSE performance. Despite practicing BSE, the number of nurses that examined their breast monthly was only 35.1%. Age, working experience and marital status showed no significant relationship with knowledge and practice of BSE. However, BSE taught during their undergraduate programme was found to have a significant relationship with practice of BSE. Majority of nurses in this study were not complying with MOH recommendation for BSE in terms of frequency. Thus, intervention strategies should focus on educating nurses on performing BSE monthly, in accordance with the Ministry of Health guidelines. This is important as nurses play a primary role in promoting health behaviors in BSE practice and breast cancer awareness among women in this country.

Non-compliance to hygienic practices in contact lens wear is regarded as a significant risk factor for contact lens-related complications. Non-compliant behaviour continues to prevent efforts to improve contact lens safety despite advancements in lens materials and care solutions. The objective of this study was to identify the association between knowledge, compliance and complications of contact lens wear. A cross-sectional design was used and contact lens users among medical faculty students were identified and recruited via convenience sampling throughout October 2013 to March 2014. A total of 36 close-ended questions that focused on knowledge level, compliance to standard contact lens practice, and experience of complications were administered. A total of 188 respondents, majority of females (89.4%; n=168) participated in this study. Although majority had good knowledge level (68.1%; n=128) on care and usage of contact lens while only a small number having moderate knowledge (26.6%; n=50) and poor knowledge (5.3%; n=10), most of them were partially compliant (74.5%; n=140) to the recommended contact lens practices. However, a small group was found to be fully compliant (24.4%; n=46) and the rest being non-compliant (1.1%; n=2). There was a significant association between knowledge on contact lens usage and compliance level to standard practices (p=0.0003). In addition, a significant association also existed between compliance level to recommended practices and risk of complications from contact lens usage (p=0.023). Findings of this study showed the positive association between knowledge of contact lens usage and compliance to recommended practices and negative association between knowledge of contact lens usage and complications experienced by contact lens users. By providing basic knowledge on contact lens care and usage via education, improvement on compliance and enhancement of safety of contact lens wear could invariably be achieved.