Introduction: Increasing prevalence of dementia and the associated caregiving burden are expected due to longer life expectancy. This review aimed to critically assess dementia-driven caregiving burden and the associated factors in Malaysia. Methods: A systematic search using several combinations of keywords was conducted in Ovid Medline, PubMed, Science Direct, ProQuest, and Ebscohost databases. The primary outcome was the score or level of caregiver burden, while the secondary outcome was the factors associated with such burden. The quality of the individual articles was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Results: The systematic search resulted in seven studies being reviewed, consisting of six cross-sectional studies and one quasi-experimental study. Using the Zarit Burden Interview, two studies reported moderate caregiver burden with mean scores of 35.4 (15.08) and 46.0 (17.0). High levels of burden or strain were reported using the Caregiver Strain Index in other studies. The three main associated factors with burden identified in these studies were the presence of behavioural and psychological symptoms of dementia (BPSD), higher education level, and lack of social support. Conclusion: Moderate to severe caregiving burden level were found to be experienced by dementia caregivers in this country. High education, lack of support, as well as taking care of patient with BPSD being the most prominent factors associated with burden. Therefore, burden should be regularly assessed among the dementia caregivers especially among those with lack of social support and manage family members with BPSD, as to prevent adverse outcome from dementia caregiving.

Introduction: Unintentional injuries among children are considered a major public health concern since they are one of the leading causes of child death and disability. Inadequate study has been done on whether and how parental influences are linked to childhood injury at home especially among the community with low-socioeconomic status. The study aims to determine the factors affecting unintentional home injury prevention practice among low socioeconomic status (B40) parents of under-five children in Selangor, Malaysia. Methods: This is a cross-sectional and quantitative study. A sample size of 453 parents will be sampled among B40 parents with under-five children in Selangor using a stratified random sampling method. For analysis, only complete questionnaires will be used. Data entry and statistical analysis will be carried out using IBM SPSS version 28.0. Chi-square/Fisher Exact test and simple logistic regression will be used for data analysis. Multiple logistic regression will be used to examine the predictors of poor home injury prevention practice. Discussion: Findings from the study will provide insight on challenges experienced by B40 parents of children under five in implementing preventive injury measures at home.

Aims: Children below five years have been the target of screen time guidelines. The adverse health outcomes associated with it require focusing on prime strategies for reducing screen time. The current study reviews parental intervention strategies to reduce screen time among preschool-aged children. Design: Systematic review. Data sources: A total of five databases of the Cochrane register of controlled trials, CINAHL, Medline PubMed, and Scopus databases were searched from May 1 to 31, 2020. Review Methods: The keywords of “screen time”, “television”, “video”, “computer”, “mobile device”, “hand phone”, “media use”, “preschool-aged children”, “interventions”, and “strategies” used for search. The inclusion criteria are limited to specific study populations, intervention, comparison and outcomes (PICOs), language, and published study types. The quality of articles was assessed using the Cochrane Risk of Bias (RoB) tool. Results: A total of six studies that met the inclusion criteria were further analysed. It showed that besides providing knowledge and awareness regarding screen time, restrictive practices, offering alternative activities to parents and removing the screen from the child’s bedroom were the most common strategies used by successful studies. The duration of intervention between 6-8weeks was sufficient to observe screen time reduction, while faceto-face methods dominated the mode of delivery. Increasing parental self-efficacy, listing outcome expectations, and reinforcement strategies targeting both the parents and their home environment were beneficial in reducing screen time. Conclusion: Future screen time reduction studies could benefit from incorporating the above approaches for screen time reduction intervention among preschool children.

Introduction: The universal truth surrounding the benefits of exclusive breastfeeding has seldom been disputed. However, the success of exclusive breastfeeding has not been guaranteed despite the availability of numerous interventions. The objective of this study is to review the effectiveness of various breastfeeding promotion education delivery methods in promoting exclusive breastfeeding. Design: A systematic search of leading databases was conducted for scholarly peer-reviewed randomized trials published between January 2014 and May 2019. Data sources: Eight articles were identified as relevant, all were published in English and assessed exclusive breastfeeding. Review Methods: Articles were analyzed for overall quality of evidence using the PEDro Scale. Results: A significant increase in the duration of exclusive breastfeeding was found in seven of the eight studies, with three interventions using combination verbal and written delivery methods and four interventions delivered verbally. Conclusion: Verbal delivery method was the most effective method and many studies use combination method of verbal and written to achieve the objective of their studies.

Introduction: Hypertension treatment aims to reduce morbidity and mortality from cardiovascular and renal com- plications. In Malaysia, there is a high prevalence of uncontrolled hypertension among patients on treatment. This study aimed to identify the predictors of uncontrolled hypertension among patients receiving treatment from public primary care clinics in Pulau Pinang, Malaysia. Methods: An unmatched case-control study with 1:1 ratio was con- ducted among 334 hypertensive patients receiving treatment from selected public primary care clinics. Mean blood pressure measurements from the last two clinical visits were used to determine the hypertension status, and uncon- trolled hypertension was defined as 140/90 mm Hg or higher. The cases were those with uncontrolled hypertension, while the controls were those with controlled hypertension. Participants were recruited by simple random sampling. Independent variables were sociodemographic factors, clinical and psychosocial factors, medication adherence, lifestyle modification, and clinical inertia. Data were collected using validated questionnaires and review of medi- cal records. Multiple logistic regression analysis was performed by using IBM SPSS Statistics 25. Results: The mean age of respondents was 59 years (SD=11). Patients with medication non-adherence had 11.36 times higher odds of uncontrolled hypertension (aOR=11.36, 95% CI=6.59, 19.56, p<0.001). Clinical inertia increased 7.82 times the odds of uncontrolled hypertension (aOR=7.82, 95% CI=2.65, 23.09, p<0.001). Conclusion: Addressing medication adherence and clinical inertia are vital in reducing uncontrolled hypertension. The findings would help to prioritise interventions to improve the clinical management of hypertension and patient outcomes.

The American College of Obstetricians and Gynaecologists (ACOG), US Department of Health and Human Services (HHS), and American College of Sports Medicine (ACSM) recommend that all pregnancies with medical clearance should engage in moderate-intensity physical activity (PA) at least 150 minutes per week. However, most of them are physically inactive. Thus, this article aims to identify predictors of physical inactivity among antenatal women. Four databases were used to search relevant articles using PICO strategy systematically. The screening began with examining titles, abstracts, and keywords, followed by scrutinizing and assessing full articles. Finally, a total of five studies were included for the data extraction, and the predictors are sociodemographic (trimesters, parity, marital status, and pre-pregnancy PA status), socioeconomic (household income), lifestyle (smoking and eating unhealthy diet) and health-related factors (multiple pregnancies, received fertility treatment, being unwell, musculoskeletal pain, symptom of early pregnancy and uterine contraction). All these predictors provide crucial information for the success of future physical activity intervention.

Introduction: Short Interpregnancy interval (IPI) is defined as the interval between the live birth outcome and the next pregnancy conception of less than 24 months. It has been linked to adverse maternal and perinatal outcomes. The objective of this study was to determine the prevalence and the predictors of short IPI among antenatal mothers. Methods: A cross-sectional study was conducted among 452 antenatal mothers attending health clinics in Klang in April 2018. Probability sampling was used and data was collected by using a validated self-administered questionnaire. The dependent variable of the study was short IPI and the independent variables were sociodemographic, obstetric history and planning of pregnancy. Analysis of data collected in the study was performed by using IBM Statistical Package for Social Science (SPSS) version 24. Results: The prevalence of short IPI found in this study was 48%. Seven identified predictors of short IPI were: age less than 25 years old (Adjusted Odd Ratios; AOR 12.16, 95%CI: 4.72, 31.30), age of 26 to 30 years old (AOR 5.20, 95%CI: 2.62, 10.32), age of 31 to 35 years old (AOR 2.90, 95% CI: 1.50, 5.64), higher education (AOR 2.11, 95% CI: 1.34, 3.34), parity more than three (AOR 3.12, 95% CI: 1.42, 6.84), irregular menstruation (AOR 2.17, 95% CI: 1.40, 3.37) and unintended pregnancy (AOR 2.88, 95% CI: 1.88, 4.40). Conclusion: Innovative programmes, for example by making IPI information available through online resources, could effectively target young mothers as the younger generation prefers quick, easily-accessible and reliable information.

Postpartum depression is a depressive episode that can start at any point during the first year after childbirth. There are several tools that can be used for PPD screening. The need to define a predictive tool that is clinically useful and has acceptable sensitivity and sensitivity is important especially to be used in the primary care setting. This systematic review investigates the evidence of the sensitivity and specificity of screening tools used for PPD screening. The Standard for Reporting of Diagnostic Accuracies (STARD) guidelines were used to conduct the review as a basis for our methodology. PubMed, ScienceDirect and Springerlink databases between 2007 until 2017 were comprehensively searched EPDS and BDI instrument has sensitivity of more than 80% but findings for specificity was inconclusive. The heterogeneity across studies could be the result of methodological differences in validation of the instruments. In addition, these studies were conducted across continents and settings with different cultures, languages and resources. We have identified 5 different instruments used to screen for postpartum depression. The EPDS was the most validated instrument in the review and we found that EPDS and BDI have higher accuracy to screen postpartum depression because the sensitivity reported were more than 80%.

Abstract Introduction: Even though exclusive breastfeeding prevalence has increased from 19.3% in 2006 to 47.1% in 2016, this practice was slightly higher in urban areas (48.3%) compared to rural area (45.1%) in Malaysia. National Plan of Action for Nutrition of Malaysia III has set an indicator to achieve at least 70% exclusive breastfeeding by 2025. Therefore this study is to identify predictors that influenced exclusive breastfeeding practice in rural areas. Methods: This cross-sectional study was conducted in six rural health clinics in Hulu Langat District, Selangor among mothers with youngest child aged 6-48 months old. Respondents were selected through systematic random sampling. Validated self-administered questionnaire was used to assess sociodemographic factors, maternal factors, external factors and child’s factors. Mother’s height and weight was measured and body mass index was calculated. Data were analyzed using SPSS version 23. Multivariate logistic regression was used to determine the predictors for exclusive breastfeeding practice. Results: Response rate was 96% with a total of 311 mothers participated in this study. More than half of the mothers exclusively breastfed (52.4%). The predictors for exclusive breastfeeding were Malay ethnicity (AOR=3.951, 95% CI: 1.374-11.358), having tertiary education (AOR=2.401, 95% CI: 1.100-5.241) and positive attitude toward breastfeeding (AOR=7.755, 95% CI: 1.382-43.502). Conclusion: Prevalence of exclusive breastfeeding was higher in this study than the national level. Programme planners should pay special attention to Chinese and Indian ethnicities, mothers with lower level of education and negative attitude in order to improve breastfeeding practice among rural mothers.

Abstract Women with gestational diabetes mellitus (GDM) during their pregnancy have a greater risk of developing overt diabetes mellitus and dysglycemia (prediabetes, impaired glucose tolerance or impaired fasting glucose) later in future, compared to mothers with normal pregnancy. Postpartum screening is crucial for early identification of type 2 diabetes (T2DM) in women with GDM. Nevertheless, despite various strategies, its rate remains low. A systematic review using databases of PubMed/Medline, Science Direct and CINAHL from 2008 to 2018, was conducted to identify the factors influencing the attendance of postpartum diabetes screening. Open access English articles, focusing on observational studies were reviewed. Primary screening of titles and abstracts of 91 articles were done, secondary screening of 31 articles resulted in 6 articles, included in this manuscript. Various factors identified to be associated with the attendance to postpartum diabetes screening, which are age, education, ethnicity, some obstetric factors like multiparty, and history of insulin usage previously. Many women fail to be screened for diabetes during the postpartum period, and this delays T2DM diagnosis, which in turn gives rise to various complications. Further research that considers these factors is necessary for developing interventions to improve postpartum T2DM screening for mothers with GDM during their pregnancy