PREVALENCE, RISK FACTORS AND ASSOCIATION WITH GALLSTONE DISEASE OF NON-ALCOHOLIC FATTY LIVER DISEASE AMONG RURAL INDIGENOUS COMMUNITIES: A CROSS-SECTIONAL STUDY IN SARAWAK, MALAYSIA Introduction: This study aimed to evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) among Dayak communities in Malaysia, shedding light on an underexplored population. Methods: A cross-sectional study was undertaken among Dayak villagers in Sarawak aged 18 years and above using an interview-based questionnaire, followed by an anthropometric measurement, a blood test and an abdominal ultrasound. Results: A total of 324 participants met the inclusion criteria. Among them, 42.9% were men, and the mean age was 49.85±14.9 years. The prevalence of NAFLD was substantially high at 58%, with 43.1% of the participants having mild fatty liver (grade 1). NAFLD was closely associated with waist circumference and body mass index (BMI) (P<0.001). Central obesity, as indicated by waist circumference and BMI, emerged as a potent risk factor, with higher values correlating with an increased likelihood of NAFLD. A higher prevalence of NAFLD was observed in the participants with an advancing age, an elevated triglyceride level (66.7%) and a lower high-density lipoprotein cholesterol level (81.6%). However, these associations did not remain significant in the multivariate analysis. Gallstones, which share common risk factors with NAFLD, were not significantly associated with NAFLD in this population (P=0.853). Conclusion: This study defines the prevalence and association of NAFLD with sociodemographic characteristics, health profiles and gallstone disease among indigenous villages in Dayak communities. A high BMI and central obesity are found to be independent risk factors of NAFLD.

eToyBox is a learning management system for preschool teachers to improve their health literacy, which ultimately aims to improve children’s obesity-related behaviour. As part of the development process of eToyBox, assessment on digital literacy, acceptance of digitization of education materials, and perceived barriers in adopting online learning is needed. Fifty-four preschool teachers under the Community Development Department (KEMAS) in Kuala Lumpur, Selangor, and Sarawak, who participated in ToyBox Study Malaysia intervention in 2018, took part in this cross-sectional study. An online self-administered questionnaire was used to assess sociodemographic background, use of communication tools and media, and teacher’s views on adapting the ToyBox modules to digital education materials. Respondents were contacted, and questionnaire link was shared through WhatsApp messages. Most participants (74.0%) were Malay females aged 31 to 40 years old. Most participants had internet access (94.4%) and owned at least a smart phone, laptop or tablet (94.4%). Participants perceived their computer skills to be average (75.0%). Majority of respondents (65.0%) reported advanced and higher abilities in word processing and email, but only 22.0% in spreadsheet skills. The main barrier to accessing online material was unstable internet connection (74.1%). Most respondents (90.0%) agree that adapting effective modules to online learning will be beneficial for professional development and teaching practices. In conclusion, most participants supported digitizing Toybox Study Malaysia educational content and were comfortable 72 with its implementation via an online learning platform. The findings from this study can advise future development of online learning materials for preschool teachers in Malaysia.

EXPLORING THE COVID-19 PANDEMIC IMPACTS ON MALAYSIAN RURAL SMALLHOLDER FARMERS IN KUCHING, SARAWAK The current study aims to explore the Coronovirus 2019 (COVID-19) pandemic impacts on Malaysian rural smallholder farmers in Kuching, Sarawak. Purposive sampling was employed and a qualitative descriptive approach was adopted. This study centred on a group of rural smallholder farmers actively participating in a food assistance programme for impoverished urban communities in Kuching. The farmers played a pivotal role in supplying vegetables and crops for the food assistance programme. The data were collected through semi-structured individual in-depth interviews. A thematic analysis was conducted, which revealed several major themes, namely the challenges encountered by smallholder farmers during the pandemic, the responses to the crisis, the recovery strategies, and subsequent plans. The current study not only enriched the understanding of the challenges encountered by rural smallholder farmers but also determined the underlying issues. The insights could serve as a foundation for developing specific solutions by relevant authorities to address rural smallholder farmers’ respective needs.

DEVELOPMENT AND VALIDATION OF THE NEWBORN CLUBFOOT SCREENING CHECKLIST TO IMPROVE THE DETECTION OF POSTNATAL CONGENITAL TALIPES EQUINOVARUS AMONG NEWBORNS BY NON-ORTHOPAEDIC-TRAINED HEALTHCARE WORKERS IN SARAWAK GENERAL HOSPITAL: A CROSS-SECTIONAL PROSPECTIVE STUDY Introduction: Non-orthopaedic-trained healthcare professionals face challenges in identifying postnatal clubfoot deformities due to the lack of suitable assessment tools, resulting in misdiagnosis. Therefore, this study aimed to develop and validate the Neonatal Clubfoot Screening Checklist (NCSC) to assist non-orthopaedic-trained healthcare professionals in postnatal clubfoot assessment. Methods: The NCSC development involved five phases: conceptual understanding of deformity components, creation of pictorial representations, tool structure design, content and face validation, pilot study and field study. A cross-sectional prospective study was conducted in Sarawak General Hospital from January to June 2021. Non-orthopaedic-trained healthcare professionals were randomly assigned to two groups: one utilising the NCSC for newborn screening and another without it. Results were compared with assessments by the paediatric orthopaedic team. Kappa agreement tests and sensitivity and specificity analyses were performed to evaluate the tool’s reliability and validity, respectively. Results: The content and face validity were satisfactory. Six hundred twelve feet were screened using the NCSC, and 596 feet were checked without the tool. The kappa agreement tests showed strong concordance (kappa coefficient=0.725–1.000, P<0.001) between the non-orthopaedic-trained personnel and paediatric orthopaedic team for all NCSC items. The NCSC exhibited 100% sensitivity, specificity and positive and negative predictive values. Conclusion: The NCSC is a reliable tool for postnatal clubfoot screening, offering high sensitivity and specificity. It facilitates accurate differentiation of true-positive congenital talipes equinovarus from other foot conditions, reducing misdiagnoses and unnecessary referrals. The NCSC is valuable in resource-constrained settings and for healthcare professionals lacking specialised orthopaedic training.

Introduction: Food insecurity is a public health concern that may lead to malnutrition in children. The purpose of this study was to determine the relationship between demographic characteristics and food security level with nutritional status among children from food-insecure households in Simunjan District, Sarawak. Methods: This study involved a total of 171 mother-and-child pairs from two Maternal and Child Health Clinics (Simunjan and Gedong) using non-probability convenience sampling technique. Food insecurity status was determined using Radimer/Cornell Hunger Food Insecurity Instrument, while child’s weight and height were measured following standard procedures. Chi-squared test of independence and binary logistic regression were used during data analysis. Results: The prevalences for household food insecurity, individual food insecurity, and child hunger were 70.8%, 15.2%, and 14.0%, respectively. The main nutritional problems for children aged 24–59 months were underweight (17.9%) and stunting (17.9%), while for children aged 60–144 months were overweight and obesity (27.5%). Children of mothers over 34 years old (AOR=2.367; 95% CI: 1.085, 5.164), and those aged 60–144 months (AOR=3.619; 95% CI: 1.521, 8.613) had increased odds of being overweight or obese. Meanwhile, children of working mothers (AOR=6.526; 95% CI: 1.108, 38.449) were more likely to have a thinness problem than children of unemployed mothers. However, no association was found between the severity of food insecurity with children’s nutritional status. Conclusion: Malnutrition in children remains a public health concern in Simunjan District, and it is linked to mother’s age and employment status. An intervention programme is required to ameliorate the situation.

Introduction: Hypertension is an emerging health concern among children owing to its increasing prevalence and association with obesity. However, hypertension screening is uncommon, and childhood hypertension-related data are limited. This cross-sectional study determined the prevalence and associated factors of hypertension among primary school children in Kuching, Sarawak. Methods: Standard procedures and validated equipment were used to measure blood pressure and anthropometric indicators. The body mass index (BMI)-for-age and waist-to-height ratio (WHtR) were calculated. Questionnaires were used to obtain family sociodemographic data and health history. Results: A total of 1,314 children aged 6–12 years were enrolled, of whom 107 (8.1%) and 178 (13.5%) were hypertensive and pre-hypertensive, respectively. The chi-squared test indicated that hypertension was significantly associated with male sex (P<0.05), ≥1 standard deviation BMI-for-age (P<0.001), percentage of excess body fat (BF)(P<0.001), 5th to 95th height percentile (P<0.001), >90th excess waist circumference (WC) percentile (P<0.001), >90th WHtR percentile (P<0.001), clerical, service, sales and skilled parental work (P<0.05), excess weight (P<0.05) and cardiovascular disease (P<0.01). Multivariate logistic regression analysis showed that the percentage of excess BF [odds ratio (OR): 4.84, 95% confidence interval (CI): 2.01–11.66] and excess WC (OR: 2.33, 95% CI: 1.15–4.72) were significantly related to hypertension after adjusting for sex and age. Conclusion The prevalence of hypertension among the study population is higher than that among children worldwide. Childhood hypertension-related factors must be identified to aid in routine blood pressure screening, which is crucial for early detection and intervention to reduce future morbidity burden.
Hypertension ; Obesity ; Waist Circumference ; Child

Introduction: The COVID-19 Movement Control Order (MCO) has caused a concern on the food consumption among university students. This study aimed to assess food diversity and its relationship with accommodation among university students in Sarawak. Methods: This cross-sectional study was conducted among students of the University Malaysia Sarawak in Kota Samarahan during the MCO. Data on socio-demographic characteristics and food diversity were collected using an online questionnaire. Results: A total of 478 respondents participated in this study. The majority of the respondents were women (77.4%), and almost half were Malays (49.6%). Half of the respondents stayed at home with their family, while 36.4% stayed in their college dormitories. Except for legumes, nuts and seeds and milk and milk products, all other food groups were common in the respondents’ diet, with the highest consumption observed from cereal and cereal products, followed by meat and meat products and water. One-way ANOVA showed that there were significant differences in the intake of fish and seafood; legumes, nuts and seeds; milk and milk products; and fruits between those who stayed in college dormitories, at home with their families and in rented houses (P<0.01). Conclusion Despite reduction in food availability and accessibility, the total energy intake of the university students did not change. University students should be continuously educated on the importance of a balanced diet consisting of all food groups.
Food ; Diet ; COVID-19

Introduction: Most working women experience poor physical and mental health during their postpartum period. This prospective study aimed to describe the physical and mental health issues faced by working mothers during their postpartum period. Methods: Respondents were recruited using the proportional sampling method among mothers who attended the Maternal and Child Health Clinic in the Kuching division in Sarawak, Malaysia. Face-to-face interview was conducted using a questionnaire that consisted of items on socio-demographic data as well as perinatal, prenatal and postpartum factors, and the Edinburgh Postnatal Depression Scale and a checklist of 28 specific postpartum symptoms were used during the first 6 weeks and after 12 weeks of childbirth. Results: A total of 281 respondents participated in this study. Fatigue (42.7%), back or neck pain (36.3%), breast discomfort (16.4%), dizziness (13.5%) and nipple irritation (11.0%) were among the most common symptoms experienced by the mothers during the first 6 weeks after childbirth. There was a significant decrease in the physical symptom scores of the respondents from the first 6 weeks to after 12 weeks of childbirth (1.73±1.96 vs 0.16±0.42; P<0.0005). A significant decrease was also found in the depression scores (6.26±4.26 vs 1.35±1.85, P<0.0005). Conclusion: The prevalence of postnatal depression was higher during the first 6 weeks of postpartum than after 12 weeks of postpartum. Screening and treatment of poor postpartum mental health among working women are essential owing to the impacts on occupational outcomes.

Introduction: The COVID-19 Movement Control Order (MCO) has caused a concern on the food consumption among university students. This study aimed to assess food diversity and its relationship with accommodation among university students in Sarawak. Methods: This cross-sectional study was conducted among students of the University Malaysia Sarawak in Kota Samarahan during the MCO. Data on socio-demographic characteristics and food diversity were collected using an online questionnaire. Results: A total of 478 respondents participated in this study. The majority of the respondents were women (77.4%), and almost half were Malays (49.6%). Half of the respondents stayed at home with their family, while 36.4% stayed in their college dormitories. Except for legumes, nuts and seeds and milk and milk products, all other food groups were common in the respondents’ diet, with the highest consumption observed from cereal and cereal products, followed by meat and meat products and water. One-way ANOVA showed that there were significant differences in the intake of fish and seafood; legumes, nuts and seeds; milk and milk products; and fruits between those who stayed in college dormitories, at home with their families and in rented houses (P<0.01). Conclusion: Despite reduction in food availability and accessibility, the total energy intake of the university students did not change. University students should be continuously educated on the importance of a balanced diet consisting of all food groups.

Introduction: Hypertension is an emerging health concern among children owing to its increasing prevalence and association with obesity. However, hypertension screening is uncommon, and childhood hypertension-related data are limited. This cross-sectional study determined the prevalence and associated factors of hypertension among primary school children in Kuching, Sarawak. Methods: Standard procedures and validated equipment were used to measure blood pressure and anthropometric indicators. The body mass index (BMI)-for-age and waist-to-height ratio (WHtR) were calculated. Questionnaires were used to obtain family sociodemographic data and health history. Results: A total of 1,314 children aged 6–12 years were enrolled, of whom 107 (8.1%) and 178 (13.5%) were hypertensive and pre-hypertensive, respectively. The chi-squared test indicated that hypertension was significantly associated with male sex (P<0.05), ≥1 standard deviation BMI-for-age (P<0.001), percentage of excess body fat (BF)(P<0.001), 5th to 95th height percentile (P<0.001), >90th excess waist circumference (WC) percentile (P<0.001), >90th WHtR percentile (P<0.001), clerical, service, sales and skilled parental work (P<0.05), excess weight (P<0.05) and cardiovascular disease (P<0.01). Multivariate logistic regression analysis showed that the percentage of excess BF [odds ratio (OR): 4.84, 95% confidence interval (CI): 2.01–11.66] and excess WC (OR: 2.33, 95% CI: 1.15–4.72) were significantly related to hypertension after adjusting for sex and age. Conclusion: The prevalence of hypertension among the study population is higher than that among children worldwide. Childhood hypertension-related factors must be identified to aid in routine blood pressure screening, which is crucial for early detection and intervention to reduce future morbidity burden.