Objectives: Dengue remains hyperendemic in Malaysia despite extensive vector control activities. With dynamic changes in land use, urbanisation and population movement, periodic updates on dengue transmission patterns are crucial to ensure the implementation of effective control strategies. We sought to assess shifts in the trends and spatial patterns of dengue in Kelantan, a north-eastern state of Malaysia (5°15’N 102°0’E). Methods: This study incorporated data from the national dengue monitoring system (eDengue system). Confirmed dengue cases registered in Kelantan with disease onset between January 1, 2016 and December 31, 2018 were included in the study. Yearly changes in dengue incidence were mapped by using ArcGIS. Hotspot analysis was performed using Getis-Ord Gi to track changes in the trends of dengue spatial clustering. Results: A total of 10 645 dengue cases were recorded in Kelantan between 2016 and 2018, with an average of 10 dengue cases reported daily (standard deviation, 11.02). Areas with persistently high dengue incidence were seen mainly in the coastal region for the 3-year period. However, the hotspots shifted over time with a gradual dispersion of hotspots to their adjacent districts. Conclusions A notable shift in the spatial patterns of dengue was observed. We were able to glimpse the shift of dengue from an urban to peri-urban disease with the possible effect of a state-wide population movement that affects dengue transmission.

BACKGROUND: Pelvic floor muscle exercise is effective for pelvic floor muscle dysfunction. Despite the high prevalence of pelvic floor muscle dysfunction in women in the community, pelvic floor muscle exercise recognition is low in Malaysian society; thus, this intervention is not frequently used . This study assessed the knowledge of, attitudes towards, and use of pelvic floor muscle exercise among antenatal women before and after educational classes. The study also determined factors associated with exercise practice. METHODS: An interventional study was conducted in 121 antenatal women selected through systematic random sampling between June and December 2010. Baseline knowledge of, attitude towards, and practice of pelvic floor muscle exercise were assessed using self-administered validated questionnaires at first visit and at 2 months postpartum. All participants attended two exercise education classes on their next two visits before delivery. A paired t-test and multivariate analysis were used for data evaluation. RESULTS: The mean pre-intervention scores for knowledge, attitudes, and practice were 24.98, 24.25, and 3.51, respectively, with statistically significant mean score increments after intervention (P < 0.001). The mean differences were 4.67 (95% confidence interval [CI], 3.86–5.49), 3.77 (95% CI, 3.05–4.50) and 3.45 (95% CI, 2.90–4.00) for knowledge, attitudes, and practice, respectively. Lack of baseline information on pelvic floor muscle exercise was significantly associated with practice change following an educational class. CONCLUSION: Education is effective in improving knowledge of, attitude towards, and practice of pelvic floor muscle exercise. There is a need for greater effort to increase exercise awareness in our community, especially during antenatal class.
Education* ; Female ; Humans ; Malaysia* ; Multivariate Analysis ; Pelvic Floor* ; Postpartum Period ; Prenatal Education ; Prevalence

Background: Diastasis rectus abdominis (DRA) involves the separation of the midline abdominal muscles and linea alba and affects more than half of postpartum women. This study aimed to assess the effect of a split tummy exercise program (STEP) on DRA closure in postpartum mothers. Methods: A randomized controlled trial was conducted from 2008 to 2020 at the Obstetrics and Gynaecology Clinic of the Universiti Kebangsaan Malaysia Medical Centre. Primigravida mothers diagnosed with DRA were selected and randomly assigned to the intervention (n=21) or control (n=20) group. The intervention group underwent a home-based STEP consisting of three phases of nine abdominal exercises. DRA size was assessed at baseline and at 8 weeks postpartum using two-dimensional ultrasound. Results: The mean age of the participants was 28 years (standard deviation, 3.6), with the majority of Malay ethnicity (87.8%) and working mothers (78%). After 8 weeks, the intervention group showed a significant reduction in DRA size of up to 27% (mean difference, 6.17 mm; 95% confidence interval, 3.7–8.7; P<0.001). No significant intergroup DRA changes were observed after 8 weeks of follow-up. Conclusion Early postpartum screening for DRA should be advocated to allow early STEP intervention to ensure favorable outcomes. STEP intervention is an effective postnatal training program for managing DRA.

Introduction: HIV is the leading cause of mortality and morbidity worldwide. There are two types of HIV, HIV-1, and HIV-2, which are geographically different in epidemiology and determinants. Objective: To determine the epidemiology and determinants of HIV-1 and HIV-1&2 in the three tertiary hospitals of Eastern Peninsular Malaysia. Method: A cross-sectional study of confirmed serologically HIV-1 and HIV-1&2 from January 2016 until December 2018. SPSS analysed all collected data, descriptive statistics for sociodemographic data and Pearson chi-square for the association between type of HIV with HCV, HBV, syphilis, and tuberculosis. In identifying the risk factor associated with HIV-1&2, several variables were tested by the Multiple Logistic Regression Model. A P-value of <0.05 was considered statistically significant. Results: Out of 519 serologically diagnosed HIV, 344 (66.28%) were HIV-1, and 175 (33.72%) were HIV-1&2. HIV positive were highly distributed in Malay male in both groups. Most HIV-1 patients were single, unemployed, and presented with tuberculosis. HIV-1&2 were single and employed, mostly asymptomatic at diagnosis. The commonest mode of transmission for HIV-1 was by sexual contact (31.87%), whereas IVDU (13.63%) in HIV-1&2. Co-infection with tuberculosis (P=0.005) and HCV (P<0.001) were significantly higher in HIV-1 as compared to HIV-1&2. IVDU was a significant determinant to develop HIV-1&2 (Adjusted OR: 3.5, 95% CI=1.875-5.227, P<0.001). Conclusion: HIV-1&2 was high in this study. Patients with HIV-1&2 present in less severe symptoms compared to the patient with HIV-1. A further molecular diagnostic study should be tested to confirm the type of HIV.