An accurate system of identifying measles cases is critical for the measles surveillance system. The objectives were: 1) To determine the incidence rate of measles in Larut, Matang and Selama district in Perak from 2015 to 2019 2) To evaluate the measles clinical case definition by comparing the performance of the measles clinical case definition in predicting laboratory-confirmed measles case. A cross-sectional analysis was carried out looking at all suspected and laboratory-confirmed measles cases in Larut, Matang and Selama District registered on the online measles surveillance reporting system between 2015 to 2019. The sensitivity, specificity, positive predictive value and negative predictive value of the clinical case definition as confirmed by the laboratory result were calculated. The incidence rate for suspected measles showed an increasing trend from 3.96 per 100,000 population in 2015 to 28.82 per 100,000 population in 2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. The sensitivity of the clinical case definition in confirming measles was 86.67% (95% CI: 69.28%, 96.24%) , specificity 47.52% (95% CI: 41.56%, 53.52%), positive predictive value 14.95% (95% CI 12.81%, 17.36%) and negative predictive value 97.10% (93.03%, 98.83%). Measles incidence is increasing in trend. The clinical case definition is an effective tool to rule out measles in cases that failed to meet the criteria due to the high negative predictive value of the definition. However, for cases that meet the clinical case definition, laboratory confirmation or epidemiological link to a confirmed case is needed.

INTRODUCTIONDepression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic.

METHODSA cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language).

RESULTSA total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p < 0.05). These factors, arranged from highest to lowest risk, were financial problems (odds ratio [OR] 3.7, 95% confidence interval [CI] 2.2-6.2), unhappiness in the parent-child relationship (OR 3.0, 95% CI 1.2-7.5), history of serious illness (OR 2.4, 95% CI 1.1-5.2), unhappiness in family relationships (OR 2.3, 95% CI 1.1-4.7) and unhappiness at work (OR 2.2, 95% CI 1.1-4.3) (p < 0.05).

CONCLUSIONThe prevalence of depression among participants in this study was clinically significant and corresponded with the findings of other international studies. Factors associated with depression need to be highlighted and addressed accordingly. Clinicians in Malaysia should be aware of this prevalence when making diagnoses in primary care.

Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Depression ; diagnosis ; epidemiology ; etiology ; Female ; Humans ; Malaysia ; Middle Aged ; Parent-Child Relations ; Prevalence ; Primary Health Care ; organization & administration ; Regression Analysis ; Risk ; Sex Factors ; Social Class ; Surveys and Questionnaires ; Urban Health Services ; Urban Population