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.

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

Objectives: Physical inactivity is the fourth leading global risk factor for mortality, followed by obesity. The combination of these risk factors is associated with non-communicable diseases, impaired physical function, and declining mental function. The World Health Organization recommends physical activity to reduce the mortality rate. Thus, this study examined the effects on anthropometric measurements of a 12-week walking program for elderly people in Samarahan, Sarawak, Malaysia with a 7000-step goal and weekly group walking activities. Methods: A quasi-experimental study was conducted involving 109 elderly people with a body mass index (BMI) ≥25.0 kg/m2. BMI, body composition, and average daily steps were measured at baseline, 6 weeks, and 12 weeks. Data were analyzed using SPSS version 26.0, and repeated-measures analysis of variance with the paired t-test for post-hoc analysis was conducted. Results: In total, 48 participants in the intervention group and 61 participants in the control group completed the study. A significant interaction was found between time and group. The post-hoc analysis showed a significant difference between pre-intervention and post-intervention (within the intervention group). The post-intervention analysis revealed an increase in the mean number of daily steps by 3571.59, with decreases in body weight (-2.20 kg), BMI (-0.94 kg/m2), body fat percentage (-3.52%), visceral fat percentage (-1.29%) and waist circumference (-2.91 cm). Skeletal muscle percentage also showed a significant increase (1.67%). Conclusions A 12-week walking program combining a 7000-step goals with weekly group walking activities had a significant effect on the anthropometric measurements of previously inactive and overweight/obese elderly people.

Objectives: Physical inactivity is the fourth leading global risk factor for mortality, followed by obesity. The combination of these risk factors is associated with non-communicable diseases, impaired physical function, and declining mental function. The World Health Organization recommends physical activity to reduce the mortality rate. Thus, this study examined the effects on anthropometric measurements of a 12-week walking program for elderly people in Samarahan, Sarawak, Malaysia with a 7000-step goal and weekly group walking activities. Methods: A quasi-experimental study was conducted involving 109 elderly people with a body mass index (BMI) ≥25.0 kg/m2. BMI, body composition, and average daily steps were measured at baseline, 6 weeks, and 12 weeks. Data were analyzed using SPSS version 26.0, and repeated-measures analysis of variance with the paired t-test for post-hoc analysis was conducted. Results: In total, 48 participants in the intervention group and 61 participants in the control group completed the study. A significant interaction was found between time and group. The post-hoc analysis showed a significant difference between pre-intervention and post-intervention (within the intervention group). The post-intervention analysis revealed an increase in the mean number of daily steps by 3571.59, with decreases in body weight (-2.20 kg), BMI (-0.94 kg/m2), body fat percentage (-3.52%), visceral fat percentage (-1.29%) and waist circumference (-2.91 cm). Skeletal muscle percentage also showed a significant increase (1.67%). Conclusions A 12-week walking program combining a 7000-step goals with weekly group walking activities had a significant effect on the anthropometric measurements of previously inactive and overweight/obese elderly people.

Objective: To determine the socio-demographic and clinical profile of exotropia surgery outcomes amongst paediatric patients. Methods: This is a descriptive, retrospective, clinical study of surgeries performed between 2014 and 2016 at the Sarawak Heart Centre, Malaysia. Medical records of patients with primary and secondary exotropia were reviewed. The following factors that affected the surgical outcomes were collected: onset age of squint, age at the time of surgery, the interval between diagnosis and surgery, the type of exotropia, visual acuity, presence of amblyopia, previous patching, anisometropia, refractive error, type of surgery, preoperative and postoperative deviation, pre-existing ocular comorbidity and systemic illness. Result: A total of 15 patients were studied with more than two thirds being females. Seven patients had primary exotropia while eight patients had secondary exotropia. Average interval between diagnosis and surgery was 1.3 years (±0.82) for primary exotropia and 1.2 years (±0.84) for secondary exotropia. Average pre-operative angle for primary exotropia was 50.57PD (±10.83) whereas secondary exotropia was 39.38PD (±8.63). Seven patients had successful surgical outcomes of within 10 prism dioptres, five for primary exotropia and two for secondary exotropia. The response to surgery was 3.0PD/mm (±0.59) for primary exotropia and 2.2PD/mm (±0.74) for secondary exotropia. Conclusion: In our study, primary exotropia had larger preoperative angle than secondary exotropia. The response to surgery was positively correlated with the preoperative angle of deviation. Primary exotropia showed better surgical outcome.

Introduction: This study aimed to determine the blood pressure profile for preschool children in Kuching Sarawak and its relationship with sociodemographic characteristics, nutritional status and parental hypertension. Methods: This was a cross sectional study conducted in a government preschool in Kuching district from January to June 2017. Data were collected using questionnaire as well as anthropometric and blood pressure measurements. Data were entered into and analyzed using SPSS Version 22. Results: A total of 229 preschool children participated in this study (response rate of 81%). About 9.7% of the respondents were at risk for hypertension. The mean systolic blood pressure was 95.6 mmHg (SD=8.36), and the mean diastolic blood pressure was 59.9 mmHg (SD=6.09). Ten percent of the children were overweight and 7.4% were obese. Binary logistics regression analysis indicated that gender (Male: OR = 3.085, p< 0.05), parent’s education level (comparing primary education and below with secondary education: OR = 4.88, p<0.05; comparing primary education and below tertiary education: OR = 7.63, p<0.05) and ethnicity (comparing Malay with Chinese: OR = 0.10, p< 0.01) were significantly associated with being at risk for hypertension. Conclusion: The study showed that 9.7% of the children were at risk for hypertension and that 17.4% had abnormal body weights. Identifying and tackling the factors leading to these issues will help to improve and ensure a better quality of non-communicable disease programs offered in primary health clinics and school health programs.

Introduction: Caregivers have a high risk of mental health disorders. The quality of patient care is inseparable from the mental health status of caregivers. The objective of this research was to study the mental health status among caregivers of psychiatric patients and its associated factors. Method: A cross-sectional study was conducted among 198 caregivers in Kuching from January till July 2014. The respondents were recruited using systematic sampling and were required to provide information on sociodemographic and environmental factors as well as complete the Hospital Anxiety and Depression Scale (HADS) questionnaire. The data was analysed using the IBM SPSS Statistical Software Version 20.0. Results: The prevalence rates of anxiety and depression among caregivers were 32.8% and 27.8%, respectively. The caregiver’s age (OR=0.97, 95% CI = 0.953 - 0.996), the perception of caregiving as an economic burden (OR= 2.70, 95% CI= 1.256 - 5.803) and the dependence of the patient (OR= 2.27, 95% CI= 1.087 - 4.719) were associated with anxiety. A caregiver who was male (OR= 2.21, 95% CI= 1.143 - 4.262), a caretaker who held the perception that a patient was dependent on them (OR=2.53, 95% CI= 1.203 - 5.337) , and a caretaker who lacked stress-coping skills (OR=2.48, 95% CI= 1.030 - 5.973) were found to be significant factors in depression. Conclusion: A high prevalence of probable anxiety and depression among caregivers points to the need to screen caregivers. There is a vital need to train healthcare workers to be able to detect early anxiety and depression. Culturally sensitive research should be carried out for different ethnicity, and improving the support system for caregivers is necessary

Introduction: Physical inactivity is the one of the leading causes of major non-communicable diseases in the world. The aim of this study is to assess the feasibility of an intervention program based on the stages of change, physical activity levels and health profiles of selected overweight and obese adults in Sarawak. Methods: This intervention study was carried out using selected overweight and obese adults in Sarawak. A total of 75 participants were placed in the intervention group, and 80 respondents were placed in the control group participated. Respondent-determined weekly aerobic exercise sessions were conducted for six months. The Malay version of the long-form International Physical Activity Questionnaire (IPAQ) and Transtheoretical model of change (TTM) questionnaire were used, together with anthropometric measurements and the collection of venous fasting blood profiles. Data was entered and analyzed using SPSS Version 20. Results: The intervention group had significant better stage transitions compared to the control group (p<0.01). They also had significantly lower total cholesterol, although both groups showed significant results (difference= 0.53, p<0.01; difference= 0.38, p=0.01). The respondent-determined intervention program was effective in improving stage transition; however, an intervention of longer duration could provide more conclusive health outcomes. Conclusion: Physical activity plays a role in assisting overweight and obese adults to be more active and healthier.