Introduction: Breastfeeding is vital for child survival and development, yet its practices are influenced by cultural, social, and informational factors. There is inadequate data concerning breastfeeding knowledge, attitudes, and practices (KAP) among the Orang Asli in Malaysia. This study aims to assess the KAP related to breastfeeding among Orang Asli in Peninsular Malaysia. Methods: A cross-sectional study was carried out between July 2022 and November 2023 among Orang Asli women aged 18 years and older with at least one child. Respondents were selected from sub-ethnic groups across three main indigenous categories. Data were gathered through a structured questionnaire, administered by interviewers which covered socio-demographics, knowledge, attitudes, and practices. Descriptive statistics were used for analysis. Results: One hundred respondents participated in the study. The majority (89%) had practiced exclusive breastfeeding, and 90% intended to continue in the future. About 98% correctly recognized that adequate breastfeeding helps infants sleep better, and 94% knew that complementary feeding should begin at six months. But several cultural or misinformation-related beliefs persisted. For example, 42% believed colostrum should be discarded, and 49% thought breastfeeding should be stopped if the mother had cracked nipples. Overall, respondents demonstrated positive attitudes and consistent breastfeeding practices. Although 58% found exclusive breastfeeding tiring for the mother. Conclusion: Despite high breastfeeding rates and positive intentions, mixed feeding practices and misconceptions persist among Orang Asli mothers. Culturally sensitive, community-based education is needed to reinforce accurate breastfeeding knowledge and support exclusive breastfeeding practices.

Introduction: Despite rising healthcare needs, Malaysia faces a concerning stagnant growth in the number of paediatricians, which has raised apprehension about meeting the nation’s future healthcare demands. The study aims to determine the factors influencing the final year medical students at public universities in their decision to pursue a career in paediatrics. Methods: A cross-sectional study was performed between October 2024 and April 2025, targeting final-year medical students from various public universities in Malaysia. Recruitment was facilitated through convenience sampling by university representatives. Data were gathered via an online self-administered questionnaire from the validated ‘Motivators for Medical Specialist Career Choice’ Questionnaire. The questionnaire comprised three parts: sociodemographic characteristics, speciality preferences, and 33 sub-constructs under seven main factors influencing speciality choice, assessed using a 5-point Likert scale. Results: A total of 420 students participated, with 164 students (39%) choosing Paediatrics as one of their first five choices of subspecialty. Upon analysis, only the personal factor was statistically significant (p-value=0.041, OR 1.943, CI 1.02,3.68) from simple logistic regression. This factor, along with patient care characteristics (p-value=0.155), was subjected to multiple logistic regression analysis. Only personal factor has shown a trend towards statistical significance (p-value=0.051, adjusted OR 1.80, CI 0.99,3.24). Conclusion: Personal factors are the single factor approaching significance that affects the career choice of paediatricians among current medical students in Malaysian public universities. Other factors were less significant due to the possibility of generational gaps with different paradigms of career perspectives.

KNOWLEDGE AND PRACTICE OF CHILDHOOD IMMUNISATION AMONG PARENTS IN KELANTAN, MALAYSIA: A CROSS-SECTIONAL STUDY Introduction: Parents are key decision-makers in the immunisation practice and compliance of children. This study aimed to determine the knowledge and practice of immunisation among parents in Kelantan, Malaysia, and their associated factors. Methods: A cross-sectional study was conducted using a validated online questionnaire from May to June 2021. An invitation was distributed to parents attending a university hospital and extended families of staff through online platforms. A total of 311 parents participated in the study. The questionnaire consisted of 10 questions each on knowledge and practice and three questions on vaccination status. Descriptive analysis was performed. The associations between the sociodemographic characteristics and knowledge and practice scores were determined using the chi-square test, and predictive factors were identified using logistic regression analysis. Results: Most respondents were Malay (94.2%), Muslim (94.5%), women (79.7%) and married (96.1%). The median score for immunisation knowledge and practice was 8 (interquartile range [IQR]=2) and 7 (IQR=3), respectively. Multiple logistic regression revealed that parents who were unmarried or single, less educated, and had lower incomes were predicted to have poor knowledge of childhood vaccination (P<0.05). Conversely, those living outside Kota Bharu, less educated, and younger parents were predicted to have poor vaccination practice of childhood vaccination (P<0.05). Most respondents (97.8%) indicated completing their children’s vaccination schedule. Conclusion: Parental education and household income are associated with immunisation knowledge and practice. Improving access to information about childhood vaccination among targeted groups may further boost immunization coverage.

Introduction: Malaysian Paediatricians suffer from psychological challenges and stresses, but unfortunately, their quality of work life (QWL) has yet to be studied. This study aims to explore the QWL score and its predictors among the qualified paediatricians of Universiti Sains Malaysia (USM). Methods: A cross-sectional study using a validated QWL questionnaire was performed from June to December 2022. The graduates of Master of Medicine in Paediatrics (USM) were invited to participate in the study, through an online built QWL questionnaire. Reminders were sent a few times to increase the response rate. The QWL was used due to a good internal consistency with Cronbach alpha of 0.95. Descriptive statistics were used to analyse the sociodemographic characteristics. The variables for QWL were determined using logistic regression analysis. Results: The study included the participation of 123 paediatricians. Majority of the participants were Malay (87.8%), Muslim (90%) and married (78%). Among all participants, 53.6% has good QWL score. Factors that associated with good QWL were married status (p= 0.02) and higher salary (p=0.012). Individuals whose are married and having higher income are 3.2 and 5.2 times respectively more likely to have good QWL. Conclusion: More than half of qualified paediatricians had good QWL and necessary steps should be strived at improving these factors for a better work-life balance.

Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.

X-linked agammaglobulinaemia (XLA) is caused by mutation of the BTK gene. Early immunological screening is important in children with recurrent infection to avoid delay in diagnosis and treatment. A 9-year-old boy with delayed XLA diagnosis presented with a history of recurrent sinopulmonary infection since the age of 1 year old. He had a severe Achromobacter xylosoxidans bacteraemia at the age of 8 years that was successfully treated with intravenous antibiotics. Further immunological screening and genetic testing confirmed the diagnosis of XLA and he was treated with intravenous immunoglobulin replacement therapy. This case provides a valuable information on the diagnosis, treatment and management of XLA, emphasising the importance of early immunological investigations to avoid diagnostic delay.

Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.

Introduction: Compliance with Hand hygiene (HH) has been considered as a simple and the most efficient strategy to reduce hospital-acquired infections (HAIs). Compliance with this practice is not often assessed in Nigeria and thus posed a significant risk to the quality of care and patient safety and especially in this era of the COVID-19 pandemic. The study aimed to assess neonatal nurses’ compliance to “my five moments for HH”. Method: A cross-sectional observational study was carried out in a Nigerian federal hospital, using an adapted version of a standardized observational WHO tool of ‘’my five moments of HH’’. A Chi-square test was employed to examine the relationship of HH compliance across units, shifts, and “my five moments for HH” opportunities. Results: The observer recorded 425 HH opportunities and the total HH compliance rate was (62.8%). There was no association between the units, working shifts, and nurses’ HH compliance. Compliance to HH was dependent on the five moments of HH (p < 0.000), better compliance was seen after body fluid exposure (100%), followed by after newborn contact (86.3%), and after contact with newborn surroundings (63.4%), while compliance before newborn contact (28.5%), and before an aseptic procedure (9.1%) were poor. Conclusion: The findings of this study showed a significant gap with the HH compliance among neonatal nurses, suggesting multiple opportunities for neonatal infections despite the current awareness of HH in the Covid-19 pandemic. Hence, there is a need to intensify infection control practices in Nigeria, especially on HH practice.

Introduction: The aim of the study is to determine the prevalence of burnout and correlation between burnout score and stressor domain score and to determine the association between sociodemographic and occupational related factors with overall burnout among nurses caring for children in Hospital Universiti Sains Malaysia (Hospital USM). Methods: This was a cross-sectional study using bilingual validated questionnaire; the General Stressor Questionnaire (GSQ) and Copenhagen Burnout Inventory (CBI) conducted among nurses providing medical service for children in Hospital USM particularly in wards and clinics. All 159 eligible nurses were recruited and 157 completed questionnaires were analysed. Pearson’s correlation analysis was applied to study the correlation while simple logistic regression and multiple logistic regressions were applied to study the association. Results: The prevalence of burnout among nurses caring for children in Hospital USM was 28.7% (95% CI = 21.6, 35.7) with the majority of them experienced personal burnout (49.7%, 95% CI = 41.9, 57.5). There was a significant moderate positive correlation between different stressor domain score with overall burnout score with p-value < 0.05. Work placement and bureaucratic constraints were identified as the main contributory factor leading to overall burnout. Conclusion: Burnout among nurses providing medical services for children in Hospital USM is of concern especially involving personal burnout. The main stressor related factors of burnout were work placement and bureaucratic constraints. Therefore, burnout among nurses providing care for children must be addressed in order to enhance their psychological well-being.

To study the characteristics of paediatric patients admitted to two non-COVID-19 teaching hospitals before and during the implementation of the Movement Control Order (MCO) in Malaysia. The retrospective study was performed in two phases (before MCO between February to March 2020, and during MCO lockdown between March to April 2020) in two teaching hospitals on the East Coast of Peninsular Malaysia. Hospitalized children <18 years were included and those coming for elective procedures or oncology treatment were excluded. The clinical data were retrieved from both hospitals’ admission records. There was a total of 496 and 191 admissions to two teaching hospitals on the East Coast of Peninsular Malaysia, respectively. A significant reduction in the number of non-COVID-19 hospital admissions was seen in both hospitals. For Hospital Universiti Sains Malaysia, the daily hospital admissions were reduced with a mean of 10 (before MCO) to 7 (during MCO) admissions/day (95% CI 1.54,7.54, p=0.001). In Sultan Ahmad Shah Medical Centre, a reduction in hospital admission was seen from 5 (before MCO) to 3 (during MCO) admissions/day (95% CI 0.61, 3.15, p=0.005). Our study observed a general drop in non-COVID-related respiratory illnesses and infectious disease cases during the MCO period. There were significant differences in neurological (p=0.029) and accident (p = 0.001) cases admissions observed between the two periods. Public health social distancing has indirectly reduced the non-COVID-19 related cases in the hospital settings with an increase in accidental injuries among the children during the MCO period.
COVID-19