Environmental Factors Contributing to Stunting among Under Six Years Old Children: A Scoping Review IntroductionStunting among young children is a serious public health issue worldwide. Stunting is also one of the major risk factors for poor physical and mental development of these children. It is known that children’s health and wellbeing are a result of exposure to unhealthy environment and a lack of stimulating activities especially in the low- and middle-income countries ultimately leading to the increase in the number of stunted children. This scoping review aims to identify environmental factors that contribute to stunting less than six years old children.MethodsIn this review, PRISMA-ScR checklist to search Scopus, PubMed, and Web of Science databases. We included all original articles published between 2018 and 2022 and written in the English Language using combination of primary keyword (child*) and its MeSH and synonyms for population, and two secondary keywords (environ*) for exposure and (stunt*) for outcome as searching strategy. By using PRISMA extension for scoping reviews, 65 articles were reviewed and finally 25 eligible studies were included.ResultsThe included studies showed that lack of cleanwater access, poor sanitation, and poor hygiene practice were associated with higher risk of stunting among these children. Improper solid waste management, area of residence and type of housing, poor quality of cooking fuels and poor air quality, presence of intestinal parasitic infection and increased blood lead levels, were also noted as potential environmental factors that affect stunting.ConclusionsInvestment in infrastructure to provide safe and clean water and adequate sanitation facilities in communities with expanded health promotion activities focusing on hygiene practices and waste management may thus stunting and improve children’s health outcome.

Breastfeeding Under Siege: A Scoping Review of Flood Impacts on Lactating Mothers Introduction Floods, as one of the most frequent and devastating natural disasters, create unique challenges for breastfeeding mothers. However, there is limited understanding of the multifaceted impacts of floods on breastfeeding practices. This review aims to examine the impact of floods on breastfeeding mothers and aims to guide disaster response strategies to support maternal and infant health. Methods A scoping review was conducted using the Arksey and O'Malley framework and the PRISMA-ScR methodology. A systematic search of PubMed, Web of Science, and Scopus databases identified eight studies that met predefined inclusion criteria. Eligibility criteria encompassed peer-reviewed articles with quantitative, qualitative, or mixed methods designs. Studies were included if they focused on breastfeeding mothers affected by floods. Results Eight studies from diverse geographic regions reported significant impacts on breastfeeding practices, including environmental hazard, sociocultural, malnutrition and psychosocial impacts dimensions. Displacement and lack of privacy (e.g., overcrowded shelters, absence of breastfeeding-friendly spaces) disrupted feeding routines. Additionally, maternal malnutrition, stress, and unregulated distribution of formula milk further undermined breastfeeding efforts. Conclusions Flood disasters pose significant challenges in terms of environmental hazard, sociocultural, malnutrition and psychosocial impacts on breastfeeding mothers, jeopardizing maternal and infant well-being. Addressing these issues requires integrated disaster response strategies, including breastfeeding-friendly facilities, nutritional aid, and mental health support. These findings underscore the importance of prioritizing breastfeeding in disaster preparedness and response plans to enhance resilience and reduceinfant mortality during crises.

Pregnant adolescents have been shown to have a higher incidence of health and non-health-related complications that affect both mothers and infants. These include increased risk of pregnancy-related diseases such as anemia and pre-eclampsia, preterm and low-birth-weight babies, as well as other social consequences such as educational and financial difficulties. This mini review evaluates selected articles which explain the attitudes, knowledge, behavior and other risk factors associated with pregnancy among adolescents in developing countries. It also revealed that inadequate knowledge among adolescents about reproductive and sexual health, other social, cultural and peer influences, parenting values, and poor financial and educational status were factors that contribute to adolescent pregnancy. Likewise, a lack of support from parents, educators and healthcare workers had negative impacts on healthy sexual behavior among adolescents, which may ultimately lead to adolescent pregnancy. We conclude that the factors discussed in this review need to be evaluated and taken into consideration by policymakers and healthcare workers when formulating strategies to prevent pregnancies among adolescents.

Introduction: Caring for gastrointestinal cancer patients can be demanding and to some, caregivers, burdensome; resulting in them having low quality of life (QOL) and thus they may become the next potential patients. Hence, true heartfelt experiences need to be captured to highlight issues and preventive measures that are not voiced out as most often caregiving is done in silence and out of responsibility. Therefore, this study aimed to explore on the caregivers’ insights on how caregiving experience has resulted in their low QOL. Methods: Seven family caregivers were purposively selected from two oncology centres in the Klang Valley, Malaysia for this qualitative case study. The selection was based on the low scores obtained from Malay Caregiver Quality of Life Cancer (MCQOL) questionnaire during an initial cross-sectional study. Following that, in-depth interviews were performed on those selected caregivers. Interview data were triangulated with the questionnaire and observations for validity. Member and expert checking were conducted to ensure credibility and trustworthiness. A thematic content analysis was later performed. Results: Thematic analysis revealed four distinct contributors to the caregivers’ QOL; namely, patients’ financial and stress management; impact towards physical, psychological, social (including relationship) wellbeing, communication; and support from families, organisation and community. Conclusion: The qualitative study discovered evidence for collaborative support needed to ensure better QOL for the caregivers.

Background: The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. Methods: A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). Results: Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. Conclusion Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

Background: The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. Methods: A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). Results: Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. Conclusion Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

Introduction: Dyslexia, which is a learning disability that affects many aspects of children’s development, has a prevalence of 5 – 17%, worldwide. There are many negative perceptions towards children with dyslexia, and one of it is when there is lack of teachers’ knowledge about this problem. Aim: The objective of this study is to develop and discuss on a newly developed module on dyslexia, i.e. Dyslexia Health Education Module (DHEM) for preschool teachers, Method: This module is developed using the ADDIE model (A-Analysis, D-De- sign, D-Develop, I- Implement, E-Evaluate). The content of DHEM consists of general information for pre-school teachers about dyslexia, identification and intervention for dyslexia among children as well as its mental health implications. Results: The newly developed module was found to have a good content validity with a score of 0.7 when evaluated by eight expert panels from respective fields. The Cronbach alpha’s value for reliability test was 0.90. These findings suggest that this module is good, reliable and applicable. Discussion: It is hoped that with the development of DHEM, this would increase teachers’ knowledge on dyslexia among children in Malaysia, especially in recognizing at-risk children and consequently may lead to early intervention in managing the problem. This study also suggests that future longitudinal studies should be carried out using this module to ensure its effectiveness in the long run.

Introduction: Measles outbreaks are endemic in Southeast Asia. A possible reason for such outbreaks is low vaccine coverage. In Malaysia, there is a lack of studies on measles outbreaks. The urban district of Petaling in Selangor, Peninsular Malaysia, reported a high number of outbreaks in 2014–2018. Thus, we analysed the trend of measles outbreaks and identify the common characteristics of measles cases in Petaling District. Methods: This was a cross-sectional study using secondary data from the Petaling District Health Office online surveillance system. Data from 2014 until 2018 from the e-Measles and eWabak systems were extracted, and the trend and common characteristics of measles cases were analysed. Results: A total of 48 outbreaks involving 124 cases were reported during the period investigated. The outbreaks showed an increasing trend from 2.1% in 2014 to 37.5% in 2016, and decreased slightly from 29.2% in 2017 to 27.1% in 2018. The common characteristics were age 1 to <7 years (50.8%), female sex (55.6%), Malay ethnicity (89.5%), Malaysian citizenship (95.2%) and being unvaccinated (55.6%). Of the cases, 63.7% were admitted to hospital, and siblings were the common source of infection (75.8%). Most cases occurred at home (75.8%). Most of the children who were infected at home were unvaccinated (60.6%). Conclusion: Unvaccinated children aged 1 to <7 years are at highest risk of contracting measles and spreading it to their siblings. Thus, awareness of the importance of vaccination needs to be emphasized to their parents to prevent related issues such as vaccine hesitancy.

Introduction: Mental health problem is an important public health issue which causes deterioration in quality of life, function and financial capabilities. According to the National Health and Morbidity Survey (NHMS) 1996, the prevalence of mental problem among adults in Malaysia was 10.7% and this has increased to 29.2% in NHMS 2015. The aim of this study was to evaluate the burden of depression, anxiety and stress among adults in a city in Klang Valley, Malaysia including its associated factors. Methods: A cross-sectional study was conducted by analysing secondary data obtained from screening program performed in six primary health clinics in the city throughout 2016. There were 576 adults participated in the screening program which consisted of mental health screening using Depression, Anxiety, Stress 21 (DASS-21) questionnaire and health status screening using Health Status Screening Form. Results: The prevalence of depression was 20.5%, anxiety was 44.5%, while stress was 10.1%. By using logistic regression, history of being abused was the only significant protective factor associated with depression, anxiety and stress with OR of 0.062 (95% CI 0.007; 0.563, p=0.004), OR of 0.001 (95% CI 0.000; -, p=0.001) and OR of 0.026 (95% CI 0.003; 0.238, p<0.001) respectively. Other independent variables were not statistically significant. Conclusions: As conclusions, surprisingly the risk of depression, anxiety and stress were not increased among participants who reported history of being abused. This was probably due to good coping mechanism among them. Nevertheless, early intervention needs to be emphasized to prevent mental disorders among this group of people in community.

Background: The Strengths and Difficulties Questionnaire (SDQ) is a screening questionnaire that measures children’s emotional and behavioural problems. This study examines the reliability and validity of the Malay parent-report version of the SDQ. Methods: The Malay adult-report version of the SDQ was administered to 495 parents and 432 teachers, respectively. At the same time, a newly translated Malay child-report version of the SDQ was also administered to 150 children aged 13 to 14 years old in this community study. W e measured internal reliability using Cronbach’s Alpha for all reported data. Construct validity of the parent-report data was assessed using factor analysis. Confirmatory Factor Analysis (CFA) was also subsequently perform on parent-report data to explain the model fit indices of this questionnaire. Result: Cronbach’s Alpha was acceptable for all parent, teacher and child-report data with values of 0.74, 0.77 and 0.78, respectively. Factor analysis of the parent’s report showed a fivefactor solution, which was consistent with other psychometric evaluations of the SDQ in other languages. CFA showed good model fit of the original five factor model which consists of Emotional, Conduct, Hyperactivity, Peer problem and Pro-social scale. Conclusion: This study shows that the psychometric properties of the Malay parent-report version of the SDQ were similar to other parent-report version of the SDQ questionnaires in other languages, although cross-cultural differences may still exist.