Pusat Pengajian Sains Perubatan - Tesis
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- PublicationSurvival outcomes and prognostic factors of mortality for female breast cancer patients in Malaysia from 2015 to 2019(2025-06)Saharudin, Siti NurhafizahBackground: Breast cancer remains the leading cancer among women in Malaysia, with survival influenced by sociodemographic and clinical factors. Despite advances in detection and treatment, national level data on survival outcomes and mortality predictors remain limited for evaluating program effectiveness. Objective: This study aimed to estimate survival outcomes and identify prognostic factors of mortality among female breast cancer patients in Malaysia from 2015 to 2019. Methodology: A retrospective cohort study was conducted using data from the Malaysian National Cancer Registry. Data for female patients diagnosed with breast cancer from 2015 to 2019 were followed for five years. Survival was estimated using Kaplan-Meier method, and prognostic factors were assessed with Cox proportional hazards regression. Result: A total of 26,867 eligible cases were analysed. The 5-year survival rate was 57.5% (95% CI: 57.2-57.8) with four prognostic factors were identified. Women aged ≥50 years had a higher mortality risk than younger women (adjusted hazard ratio [aHR]: 1.24; 95% CI: 1.19–1.29; p<0.001). Ethnicity was significant, with Chinese (aHR: 0.78; 95% CI: 0.75–0.81; p<0.001) and Indian (aHR: 0.85; 95% CI: 0.80–0.91; p<0.001) women showing lower risks of mortality than Malays. Stage at diagnosis was the important prognostic factors in this analysis, with mortality risk increasing substantially for stage II (aHR: 1.87; 95%CI: 1.66, 2.10; p<0.001), stage III (aHR: 4.13; 95% CI: 3.69, 4.62); p<0.001), and stage IV (aHR: 11.03; 95% CI: 9.88, 12.32; p<0.001) compared with stage I. Tumor morphology was also associated with variation in survival outcomes. Conclusion: This nationwide study provides updated evidence on breast cancer survival in Malaysia and its key prognostic factors. Strengthening early detection, equitable access to treatment, and registry-clinical data integration are essential to enhance outcomes.
- PublicationFactors associated with confirmed measles cases among notified measles of children in Perak 2017-2024(2025-06)Dzulkifli, Nur FazlinaBackground: Measles is a highly contagious and vaccine preventable disease. It remains a significant public health concern globally, particularly among children, despite the availability of the vaccines. Thus, it is crucial to understand the associated factors of measles in children to strengthen the prevention strategies. Objective: This study aimed to determine the proportion and factors associated with confirmed measles cases among notified measles as well as to describe the clinical presentation of confirmed measles cases of children in Perak from 2017 to 2024. Methods: A cross-sectional study was conducted using secondary data extracted from the SM2 measles surveillance database of the Perak State Health Department for the years 2017 to 2024. Simple random sampling was applied to obtain the sample size of 498. The relevant data were collected by using proforma checklist. The data were analysed by using descriptive analysis, simple and multiple logistic regression analyses. Results: A total of 498 notified measles cases of children were included in the study. The proportion of confirmed measles cases among notified measles of children in Perak was 15.1% (CI: 12.0,18.2) and ranged from 2.9% to 29.2% per year throughout the year 2017 to 2024. Among the 75 confirmed measles cases in children, the most frequently reported clinical features were fever and maculopapular rash (98.7%) followed by cough (62.7%), coryza (57.3%) and conjunctivitis (22.7%). The significant factors associated with confirmed measles cases were ethnicity, measles vaccination status, history of contact with confirmed measles case and hospital admission. Orang Asli children had significantly greater odds of confirmed measles than other ethnic groups (Adj OR 3.37, 95% CI: 1.05,10.88, p-value 0.042). Incomplete and no vaccination were associated with higher odds of measles confirmation compared to complete vaccination (Adj OR 2.27, 95% CI: 1.09,4.71, p-value 0.028) and (Adj OR 3.42, 95% CI: 1.63,7.19, p-value 0.001) respectively. Contact with a confirmed measles case showed a strong association with confirmed measles (Adj OR 51.76, 95% CI: 11.25,238.21, p-value < 0.001), as did hospital admission (Adj OR 4.198, 95% CI: 1.51,11.65, p-value 0.006). Conclusion: Ethnicity, measles vaccination status, history of contact with confirmed measles case, and hospital admission were identified as significant factors associated with confirmed measles cases among notified measles of children in Perak from 2017 to 2024. These findings underscore the importance of formulating targeted public health interventions to enhance the effectiveness of measles prevention and control measures particularly among children.
- PublicationThe proportion and associated factors of prematurity among neonatal death in Kelantan 2020-2023(2025-06)Ghazali, Mohd Faiz MohdBackground: Neonatal deaths accounted for nearly 47% of all under-five child deaths globally in 2022, with prematurity being a major contributor. Although the neonatal mortality rate in Kelantan has remained below the Sustainable Development Goal (SDG) target, the trend in Kelantan has shown a progressive increase since years 2020 that warrants attention. The neonatal mortality rate in Kelantan increased from 2.79 to 4.88 per 1,000 live births between 2020 and 2023. This study aims to determine the proportion of prematurity and its associated factors among neonatal death cases in Kelantan, from 2020 to 2023. Methodology: This cross-sectional study was conducted from December 2024 to May 2025 based on a retrospective review of neonatal death data reported to the Kelantan State Health Department from 2020 to 2023. Secondary data for this study were obtained from Under-5 Mortality Notification System and the Neonatal Death Investigation Form. A total of 475 neonatal death cases were selected using simple random sampling with SPSS. Sociodemographic, maternal, fetal and intrapartum factors were extracted from the records and analysed using descriptive analysis, simple logistic regression, and multiple logistic regression to identify factors associated with prematurity. Results: among 475 neonatal deaths reviewed, the proportion of prematurity was 32.0%. Prematurity was significantly associated with several maternal and fetal risk factors, including hypertension (aOR = 4.72, 95% CI: 1.08, 20.53), prolonged rupture of membranes (aOR = 3.89, 95% CI: 1.86, 8.11), and fetal congenital anomaly (aOR = 2.66, 95% CI: 1.58, 4.47). The odds of premature birth increased markedly with decreasing birth weight, with extremely low birth weight (<1000g) showing the highest association (aOR = 20.54, 95% CI: 10.08, 41.83). Conclusion: Prematurity accounted for a significant proportion of neonatal deaths in Kelantan. Maternal and neonatal factors such as hypertension, prolonged rupture of membranes, birth weight and fetal congenital anomaly were significantly associated with prematurity among neonatal death. Identification of these contributing factors may support the improvement of future strategies and interventions, including enhancing antenatal care, optimising intrapartum management, and strengthening the capacity of neonatal and maternal healthcare services. This could improve the quality of services and contribute to the reduction of neonatal deaths due to prematurity birth in the Kelantan.
- PublicationHealth-related quality of life and its association among medical officers in Selangor(2025-06)Ariffin, KhairunnisaIntroduction: Health is a fundamental human right and a vital resource for societal productivity and well-being. For health professionals, particularly medical officers (MOs), maintaining optimal physical, mental, and social well-being is crucial, as it affects both their quality of life (QoL) and the quality of patient care. Despite their essential role, MOs are increasingly affected by occupational stressors, including extended working hours, administrative burdens, job insecurity, and system inefficiencies, which negatively impact their QoL. Objectives: This study aims to assess the QoL of medical officers in Selangor and examine the underlying factors influencing their well-being. The findings are expected to contribute to policy recommendations that enhance work-life balance, reduce psychological distress, and improve healthcare delivery. Methods and Results: 165 MOs were selected through simple random sampling from hospitals and health clinics. Data were collected using an online questionnaire with sociodemographic information and the WHOQOL-BREF to measure QoL. The analysis involved descriptive statistics and linear regression. The mean score for the psychological health domain was 55.45, lower than the general population norm, indicating considerable psychological challenges among MOs. Multiple linear regression analysis identified two significant factors associated with better psychological health: normal body mass index (BMI) and permanent employment status. MOs with a normal BMI scored 3.61 points higher in psychological well-being than those who were overweight (p = 0.030). Additionally, MOs in permanent positions had psychological scores 9.55 points higher than those employed on a contract basis (p = 0.003). These results suggest that physical health and employment stability are important determinants of psychological well-being among MOs. Conclusion: The results highlight the impact of lifestyle and job security on mental health. Holistic interventions addressing work conditions and personal health are essential to improve the quality of life and performance of MOs.
- PublicationTrend and associated factors of food poisoning outbreaks in secondary schools in Kelantan, from 2022 to 2024(2025-06)Sha’ari, Ahmad ZulfahmiBackground: Food poisoning is a recurring challenge in Malaysia’s public health system, consistently ranking among the nation’s top five communicable diseases. In Kelantan, the concern over the increasing trend of food poisoning involving school settings has been growing. Objective: This study aimed to describe the trend of food poisoning outbreak cases, to describe the proportion of food poisoning outbreak cases and to determine the factors associated with food poisoning cases during outbreaks among secondary school students in Kelantan within the same period. Methodology: This study conducted a cross-sectional design to describe the trend and proportion of food poisoning outbreaks reported among secondary school students in Kelantan from 2022 to 2024. For the analysis of associated risk factors, a case-control design with a 1:3 ratio was applied, where student cases from selected outbreaks were compared with matched controls. Data were extracted from the final outbreak reports using the “Borang Siasatan Keracunan Makanan (FWBD/KRM/BG 001), Revision 2008”. Result: The findings showed an upward trend in food poisoning outbreaks from 2022 to 2023, followed by a plateau in 2024. The proportion of outbreaks involving secondary schools was 90.9% in 2022, 44.4% in 2023, and 33.3% in 2024, with an overall combined proportion of 45.9% across the three years. The mean age of affected students was 14.77 years (SD = 1.38), with 62.5% in the lower secondary age group (13-15 years). Schools under the Ministry of Education (MOE) accounted for 73.5% of the cases, and 55.9% of outbreaks occurred in rural areas. Notably, 85.3% of incidents were linked to hostel canteens. Poultry was identified as the leading food vehicle (50.0%), while Salmonella spp. emerged as the most common microbial agent (64.7%). Inadequate cooking and reheating and improper storage were the most frequent critical control point (CCP) failures (64.7%). Male students were found to have a lower likelihood of being affected (AOR = 0.76; 95% CI: 0.60,0.96; p = 0.023). Conversely, consumption of red meat significantly increased the risk of food poisoning (AOR = 4.45; 95% CI: 3.25,6.08; p < 0.001), as did exposure to inadequate cooking and reheating (AOR = 1.50; 95% CI: 1.20,1.89; p < 0.001). Conclusion This study revealed a clear link between food poisoning outbreaks in Kelantan’s secondary schools and specific operational practices within school. While non-modifiable factors like student’s sex influenced susceptibility, the more concerning aspects were preventable factors particularly in cooking, reheating, and storage of high-risk foods such as red meat. These findings highlighted the need for strengthening food safety training for canteen personnel, enforcing strict CCP monitoring, and integrating targeted health literacy for students in preventing future outbreaks.