Environmental and Health Impacts of Pesticide-Based Malaria Control in Low- and Middle-Income Countries: A Scoping Review Introduction Malaria remains a major public health challenge in tropical and subtropical regions, necessitating effective vector control strategies. This scoping review aims to evaluate the environmental and health impacts of pesticide-based malaria control in low-and middle-income countries (LMICs). Methods A comprehensive search was conducted across Scopus, Web of Science and PubMed for studies published between 2004 and 2024, using a predefined search string based on the PEO framework. Inclusion criteria focused on studies addressing malaria control programmes and their effects on the environment and human health. Data extraction followed PRISMA 2020 guidelines. Results 12 studies were included, most of which focused on indoor residual spraying (IRS) and insecticide-treated nets (ITNs). The review identified significant direct and indirect impacts. While effective in reducing malaria transmission, IRS and ITNs pose substantial risks. Direct health effects included acute poisoning and long-term neurodevelopmental issues linked to pesticide exposure, with residues detected in breast milk. Environmental impacts included soil and water contamination, biodiversity loss and ecological disruption. The overlap of pesticide use in malaria control and agriculture was found to exacerbate insecticide resistance in mosquito populations. Conclusions Pesticide-based malaria control, while crucial, carries significant unintended consequences for human health and the environment. The findings underscore the urgent need for Integrated Vector Management (IVM) strategies that reduce reliance on chemical pesticides, mitigate resistance, and ensure environmental sustainability and public health safety.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42– 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16– 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42– 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16– 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Introduction: This study looks at the patient’s perspective to determine the Catastrophic Health Expenditure (CHE) level and the possible factors which can be associated with CHE in cancer patients. Methods: This cross sectional study was done in National Cancer Institute, Malaysia with 206 patients sampled using the multilevel sampling method and data collected from interview with patients using a validated questionnaire. The CHE definition used in this study is when the monthly health expenditure exceeds more than 10% of the monthly household income. Results: This study showed a CHE level of 26.2%. CHE was higher in Indian ethnicity (P = 0.017), single marital status (P = 0.019), poverty income (P < 0.001), small household size (P = 0.006) and without Guarantee Letter (GL) (P = 0.002) groups. The significant predicting factors were poverty income aOR 5.60 (95% CI: 2.34 – 13.39), home distance near to hospital aOR 4.12 (95% CI: 1.74 – 9.76), small household size aOR 4.59 (95% CI: 1.07 – 19.72) and lack of Guarantee Letter aOR 3.21 (95% CI: 1.24 – 8.30). Conclusion: The information from this paper can be used by policy makers to formulate better strategies in terms of health financing so that high risk for CHE cancer patients groups can be protected under a better health financing system.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42– 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16– 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42– 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16– 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42– 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16– 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

PRENATAL DIAGNOSIS OF ACHONDROPLASIA IN PRIMARY CARE SETTINGS – RECOGNISING THE SOFT MARKERS: A CASE REPORT Achondroplasia, a genetic disorder causing limb shortening, is the most common form of disproportionate dwarfism. It can be diagnosed prenatally through sonographic findings and postnatally through clinical and radiological findings. Currently, an increasing number of affected foetuses are diagnosed antenatally since prenatal ultrasonography is routinely conducted in primary care settings. Herein, we present the case of a healthy 26-year-old primigravida who received a diagnosis of achondroplasia for her foetus during the late third trimester based on her prenatal ultrasonographic findings. Following birth, the diagnosis was confirmed by the baby’s clinical and radiological findings, which showed shortening of the long bones. This case highlights the importance of recognising the soft markers of achondroplasia during routine third-trimester ultrasonography in primary care settings. Early diagnosis of achondroplasia is important to ensure timely referral to tertiary centres and adequate preparation of parents for the delivery of their baby.

Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.