Introduction: Khat chewing has been a common habit throughout the Horn of Africa and the Arabian Peninsula for thousands of years. It is estimated that more than 20 million people in Africa and the Arabian Peninsula are adolescents. This study aimed to assess the knowledge, attitude, and self-efficacy of khat chewing among adolescents in Mogadishu, Somalia. Method: A cross-sectional study with a sample of 284 adolescents was used. A self-administered pretested questionnaire was used after obtaining an ethical approval from Universiti Putr Malaysia. Data were coded, entered, and statistically analyzed. Results: The prevalence of khat chewing among respondents was 10.2%. Almost more than half of the participants had poor knowledge (184, 64.8%) and self-efficacy (154, 54.2%), while 140 (49.3%) respondents had positive attitudes. Significant predictors of the students’ knowledge of khat chewing included monthly income of more than 500$ (AOR: 2.145), family history such as cousin (AOR=0.347), fathers with a high school (AOR=1.75) and a college degree (AOR=2.21). Significant predictors of the students’ attitude towards khat chewing included family income of 100-299 USD (AOR=0.5), fathers’ with a high school (AOR=2.5) and college (AOR=2.4). Significant predictors of the students’ self-efficacy to resist khat chewing included family income of 100- 300$ (AOR=2.25), fathers with a high school (AOR=2.6), and khat accessibility that is fairly difficult (AOR=0.63) and fairly easy (AOR=0.55). Conclusion: The study highlights the need for increased awareness and education about the adverse effects of khat chewing and the importance of addressing social norms and peer pressure in shaping adolescent attitudes toward Khat.

Introduction: Despite the importance of postpartum type-2 diabetes mellitus (T2DM) screening to ensure early detection and effective management of T2DM among women previously diagnosed with gestational diabetes mellitus, low uptake has been reported. In view of the proven effectiveness of theory-based interventions, this study aimed to evaluate the effectiveness of Information Motivation Behavioural Skills (IMB)-based intervention to improve postpartum T2DM screening uptake among pregnant women with GDM in Negeri Sembilan, Malaysia. Methods: A prospective quasi-experimental study was carried out among comparable respondents in the intervention and control groups, involving 61 and 55 respondents respectively. Validated and reliable self-administered questionnaire was used to measure pre- and post-intervention of knowledge, attitude and self-efficacy, based on the constructs of the IMB model, with postpartum T2DM screening uptake measured at 6-week postpartum. Results: The IMB-based intervention was effectively improved knowledge on gestational diabetes mellitus (GDM), and attitude as well as self-efficacy related to the screening, with significant difference in the 6-week postpartum T2DM screening uptake between the intervention and control groups. Between groups comparison revealed significantly higher mean scores for knowledge (ηp 2 =0.11), attitude (ηp 2 =0.031) and self-efficacy (ηp 2 =0.52) in the intervention group compared to the control group, with self-efficacy is showing the largest size effect. Conclusion: The IMB-based health intervention had effectively improved the 6-week postpartum T2DM screening among women with GDM in the intervention group, through the significant improvement of knowledge on GDM and attitude as well as self-efficacy related to the screening.

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: Malaria is a vector-borne disease caused by the bites of infected female mosquitoes that transmit the parasite to humans. In Guinea, the entire population is at risk of malaria infection. The objective of this study is to develop, implement and evaluate the effectiveness of the Malaria Free Zone program using the Health Belief Model (HBM) to improve malaria prevention knowledge, attitudes, and practices among university students in Conakry, Guinea. Methods: The study design is a clustered randomized controlled trial (RCT). Students are selected using the clustered sampling method, with each university representing one group, either the intervention or control group. The sample size is 113 university students from each group. The content of the Malaria Free Zone program includes eight sessions, which are based on the HBM constructs. This program takes approximately 6 hours and 30 minutes to complete. Respondents are required to complete a questionnaire over four time points. Generalized Estimating Equation (GEE) will be used to determine the effectiveness of the Malaria Free Zone program on malaria prevention knowledge, attitudes, and practices, adjusted with covariates. Conclusion: It is expected that there will be a significant difference in knowledge, attitude, and practice of malaria prevention in the post-test, 2-week and 2-month follow up of the intervention group after the Malaria Free Zone program. Students in the intervention group will have significant higher knowledge, attitude and practice of malaria prevention compared to students in the control group. Trial Registration: PACTR202102614259601

Introduction: In the recent years, there is remarkable increased in the prevalence of Type 2 Diabetes Mellitus (T2DM) in Middle East countries including Oman. There is good evidence that Mediterranean Diet (MedDiet) is effective over diabetes control and several cardiovascular risk factors in different populations, with little compelling evidence among Omanis. This paper describes the protocol of a wait-list, open labelled, randomized control trial, with its main objective aimed to determine the effectiveness of Mediterranean Diet intervention on glycaemic control and cardiovascular risks among T2DM patients in Oman. Methods: A total of 140 eligible T2DM patients will be recruited. Participants in the intervention group will undergo a six-month MedDiet program comprising of different activities (individual dietary counseling, cooking classes, phone calls and social media messages) while the control group will continue with standard diabetes care. Data collection will be conducted at baseline, after three and six months. The 2 x 3 mixed-design ANOVA will be used to determine the mean changes in outcome variables over the full study period between the two groups. Discussion: Epidemiology studies on nutrition and health had focused on dietary pattern, which provides an opportunity to account for nutrient-nutrient interactions lately. Mediterranean Diet has produced consistent findings on its protective role in diabetes management, with little information on its effectiveness in population outside of Mediterranean basin, including Oman. The outcomes of current study will be used to inform community and health care professionals on the effectiveness and practically of MedDiet on diabetes management.

Introduction: There are a growing number of parents who hesitate to vaccinate their children. Therefore, the current study was conducted to assess future parents-to-be intention to vaccinate their children, as well as to investigate contributing factors of vaccination intention and to identify sources of information on childhood vaccination. Method: A cross-sectional study was conducted among Foundation Program students at a public university for five months, from April to August 2019. Factors studied included sociodemographic characteristics, knowledge and attitudes toward childhood immunization, and religiosity. Data were collected using a validated self-completed questionnaire. Simple random sampling was conducted, with a total of 371 students were recruited as respondents. Multiple logistic regression was performed to determine the predictors. The significance level is set at alpha less than 5%. Results: Approximately 95% of respondents indicated an intention to vaccinate their future. The mean age of respondents was 19 ± 0.37 years old. A motive to vaccinate their future children was high among females (AOR: 4.20, 95% CI: 1.59, 11.08, p: 0.004), having sufficient knowledge about childhood vaccination (AOR: 3.92, 95% CI: 1.23, 12.45, p: 0.021), and having a positive attitude toward childhood vaccination (AOR: 9.56, 95% CI: 2.15, 42.46, p: 0.003). There was no significant association between intention to have their future children vaccinated and religiosity. The sources of information about childhood vaccination were mainly the Internet (72%), mass media (68.2%), and social media (61.7%). Conclusion: Readiness of foundation program students was satisfactory. However, policymakers and program planners should target improving knowledge and attitudes of young people about childhood immunization especially among young men as they will head the household. This effort may sustain the readiness of young people to vaccinate their future children. The approach should include the Internet, mass media, and social media.

Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.

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: Despite the effectiveness of postpartum type 2 diabetes mellitus (T2DM) screening to detect and manage T2DM among women with a history of gestational diabetes mellitus (GDM), the uptake remains low, indicating the potentially low level of relevant knowledge. This study aims to identify the prevalence of postpartum T2DM screening and its associated factors. Methods: A cross-sectional study was conducted involving 116 pregnant women with GDM who attended antenatal care follow-up at government health clinics in Seremban District, Negeri Sembilan. Multistage cluster sampling was performed to recruit the respondents from 6 mukims and 10 public health clinics. The data were collected using a validated and pre-tested questionnaire, with Cronbach’s alpha values ranging from 0.81 to 0.95 for each section of the questionnaire. Data were collected through face-to-face interviews during the respondents’ routine antenatal follow-ups for blood sugar monitoring. Results: Poor knowledge on postpartum T2DM screening (55.2%) was observed, which was significantly predicted by low educational level (AOR = 6.898, 95% CI 3.62–9.055) and low self-efficacy (AOR =17.905, 95% CI 5.470–58.611). Conclusion Most of the respondents had poor knowledge regarding postpartum T2DM screening, which was predicted by low education and self-efficacy. The findings highlight the need for continuous education and health promotion during antenatal follow-up targeting women with GDM with low self-efficacy and education level in order to ensure better adherence to screening.
Diabetes, Gestational ; Postpartum Period ; Malaysia