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- PublicationTime series modelling and forecasting commuting accident and association with meteorological parameters in Johor Bahru and Kuala Lumpur, Malaysia (2015-2019)(2024-12)Hanafi, Nur SujaihahIntroduction: In tropical countries such as Malaysia, rainfall and temperature serve as primary meteorological parameters that potentially increase the risk of road traffic accidents (RTAs). The working population in major cities is particularly vulnerable, especially during commuting hours, resulting in a surge of commuting accidents. However, research evidence utilizing objective measures, such as time series data, to model the association between meteorological factors and commuting accidents or even the RTAs in general, particularly within the Malaysian context are substantially limited. Therefore, this study aims to model the association between rainfall and temperature with commuting accidents and forecast their future occurrence. Methods: This study employed retrospective secondary data on RTAs, rainfall, and temperature from Kuala Lumpur and Johor Bahru from 1 January 2015 to 31 December 2019. In the first phase, the outcome variable was the number of RTAs among the working population. A quasi-Poisson regression model was utilized to investigate the influence of different temporal factors on the outcome variable. Its association with temperature and rainfall was then examined using a combination of Hurdle Negative Binomial (HNB) regression and Distributed lag non-linear models (DLNM). The second phase focused on the number of commuting accidents as an outcome variable, defined as RTAs involving the working population during commuting hours (7:00 am to 8:00 pm). A combined approach using time-stratified case-crossover design and DLNM was implemented to investigate the association between temperature and rainfall with commuting accidents and subsequently, an ARIMA model was employed to forecast their future incidence. Results: In phase one, 11,877 and 8833 workers were involved in 11,531 and 8632 RTAs over five years in Kuala Lumpur and Johor Bahru, respectively. The majority of workers were male (> 75%) and aged 15-44 years (> 70%). The time of day, divided into two time zones, was significantly associated with RTAs among workers. The incidence risk ratio (IRR) was highest during T3 (12:00 pm - 5:59 pm) compared to T1 (12:00 am – 5:59 am) and during PEAK 2 (4:30 pm-7:30 pm) compared to OTHER (12:00 am – 7:29 am, 7:31 pm – 11:59 pm) in both cities. In Kuala Lumpur, workers had higher RTA risk during weekdays compared to weekend (IRR of 1.18, 95% CI: 1.10, 1.27). Weeks comprising of three or more school holiday showed a reduced RTA risk in both cities (Kuala Lumpur: IRR 0.78, 95% CI: 0.69-0.88; Johor Bahru: IRR 0.83, 95% CI: 0.72-0.95). Lower temperatures significantly affected RTA occurrence, peaking at 22°C in Kuala Lumpur (OR 1.46, 95% CI 1.10-1.94) and 26°C in Johor Bahru (OR 1.36, 95% CI 1.04-1.78). The strongest lag effect of extremely low temperature (23°C) was at lag 0, and for extremely high temperature, it was delayed up to 16 hours in Kuala Lumpur (36°C) and 24 hours for Johor Bahru (34°C). Rainfall intensity increased RTA odds, with the most pronounced effects at lag 9-hour and 12-hour in Kuala Lumpur and Johor Bahru, respectively. In phase two, 8941 and 6548 commuting accidents were recorded in Kuala Lumpur and Johor Bahru from 1 January 2015 to 31 December 2019. Kuala Lumpur showed a significant inverse linear association between daily maximum temperature and commuting accidents, with the highest odds at 28°C (OR 1.76, 95% CI 1.14-2.72), while Johor Bahru had a non-significant positive association, peaking at 35°C (OR 1.21, 95% CI 0.63-2.32). No significant association between rainfall and commuting accidents was observed in both cities. The best forecasting model for Kuala Lumpur was a regression with ARIMA (1,1,1) error, with a weekly daily minimum temperature utilized as regressor. In Johor Bahru, ARIMA (1,1,1) was identified as the best fitted model. Both models indicated no substantial changes in the projected trajectory of weekly commuting accidents during 2020. Conclusion: The study findings elucidate the association between temperature, rainfall, and their lag effect with RTAs among the working population, and subsequently on commuting accidents, underscoring the significance of incorporating meteorological parameters in public health policy related to occupational safety and health, urban planning, and road safety. These insights can also inform targeted intervention and enhance the preparedness of urban workers for extreme weather events resulting from climate change.
- PublicationHousehold air pollution and childhood bronchial asthma new onset risk in Kota Bharu Kelantan: the determinants and modelling(2024-12)Ibrahim, Muhammad NaimBackground: Rapid urbanisation and industrialisation have led to increasing environmental pollution, heightening children's vulnerability to bronchial asthma (BA). Environmental factors, including rising household product consumption and poorly regulated outdoor pollution, play a key role in this trend. Despite the growing risk, locally focused studies on household-related contributors to childhood BA remain limited. Therefore, this study aims to elucidate the relationship between household air pollution and the risk of childhood BA onset in Kota Bharu, Kelantan. It includes the development, validation, and reliability analysis of the HAPBAC-Checklist, as well as identifying the determinants of childhood BA onset and modelling them. Methodology: The study was conducted through two phases, from March 2023 to April 2024. The first phase involved the development and validation of the HAPBAC-Checklist, which included four stages: 1) the development of the checklist 2) content validation 3) face validation and 4) reliability analysis (kappa agreement analysis). Then, the second phase employed a case-control study involving 194 children; 97 newly diagnosed BA cases and 97 controls, in Kota Bharu, Kelantan. Data were collected using the HAPBAC-Checklist and air quality measurements. Descriptive analysis and logistic regression identified factors linked to childhood BA new onset, which were then used to develop accurate predictive models. Results: The final validated HAPBAC-Checklist consists of five domains (sociodemographic, family history of atopy, child’s medical history, household attributes, and outdoor attributes) with 59 items. The I-CVI scores indicated good relevancy (value ranged from 0.83 to 1.00), and the S-CVI value was satisfactory (value of 0.94). The I-FVI (at least 0.83) and the S-FVI (value of 0.96) indicating the checklist was easily understood. The kappa analysis for reliability testing for five domains combined was 0.88 (95% CI: 0.81, 0.95; p<0.001). A case-control study found that case group had a higher proportion of indoor smoking, indoor pets, new wooden furniture, and other household attributes. As for outdoor, the case group had a higher proportion vehicle near their homes, use outdoor wood stoves, and live closer to pollution sources such as major roads and garbage burning. Air quality measurements indicated higher pollutant levels among households in the case group. Multiple logistic regression revealed the significant determinants were younger age (AdjOR: 0.67, 95% CI: 0.50, 0.89; p=0.007), mother with history of atopy (AdjOR: 5.18, 95% CI: 1.54, 17.38; p=0.009), and sibling with history of atopy (AdjOR: 4.88, 95% CI: 1.51, 15.78; p=0.008); Household attributes: indoor smoking (AdjOR: 5.64, 95% CI: 1.95, 16.29; p=0.001), indoor pets (AdjOR: 3.65, 95% CI: 1.21, 11.04; p=0.022), recent home painting (AdjOR: 9.25, 95% CI: 1.56, 54.91; p=0.014), poorly ventilated kitchens (AdjOR: 12.28, 95% CI: 2.80, 53.87; p=0.001), frequent frying (AdjOR: 14.15, 95% CI: 3.01, 66.48; p=0.001), wood stove use indoor (AdjOR: 17.84, 95% CI: 1.29, 247.20; p=0.032) and fragrance indoor (AdjOR: 7.54, 95% CI: 2.23, 25.51; p=0.001); Outdoor attributes: proximity to main roads (AdjOR: 0.99, 95% CI: 0.98, 0.99; p=0.001) and nearby livestock or outdoor pets (AdjOR: 5.62, 95% CI: 1.82, 17.38; p=0.003); and air quality measurement: elevated levels of indoor PM10 (AdjOR: 1.03, 95% CI: 1.02, 1.05; p<0.001) and Aspergillus spores (AdjOR: 1.08, 95% CI: 1.01, 1.16; p=0.048). The predictive model developed from these 14 determinants showed an excellent fit (ROC curve = 0.947; 95% CI: 0.92, 0.97), effectively predicting childhood BA onset. Conclusion: The HAPBAC-Checklist is a novel tool specifically tailored to address locally identified household and outdoor factors influencing BA. The widespread determinants underscore the urgent need to prevent childhood BA. This study recommends policies promoting healthier living environments, incentives for safer practices, stricter regulation of household products, and health advocacy on key risk factors.
- PublicationAttitude and needs toward geriatric care among primary care doctors in Malaysia: A mixed methods study(2024-12)Azmi, Mohd IkhwanBackground: Primary care doctors (PCD) are pivotal in an ageing society. They must possess the appropriate attitudes in offering effective care to the older persons. Their need to deliver effective geriatric care must also be addressed to ensure they are equipped to provide high-quality care to the older persons. Therefore, this study sought to determine the attitudes of PCDs toward geriatric care and its associated factors and to explore the needs of PCDs in delivering geriatric care in Malaysia. Method: This convergent mixed-method study was conducted between December 2022 and November 2024. The quantitative method was a cross-sectional of 328 PCDs in Malaysia and used convenience sampling. While the qualitative method was an in-depth interview of 11 PCDs. This study included doctors who had worked for at least six months in a primary care setting. Doctors who did not attend to older persons were excluded from the study. For the quantitative method, the University of California Los Angeles - Geriatric Attitude Scale questionnaire was administered online. Simple and multiple linear regression analyses were used to determine associated factors. For the qualitative method, in-depth interviews were conducted among participants recruited from the quantitative study. The interviews were transcribed and analysed using thematic analysis. Result: Primary Care Doctors’ attitudes towards geriatric care in Malaysia were positive. Being a family medicine specialist (Adj. B 0.25; 95% CI: 0.13, 0.37, p ≤ 0.001) and those who perceived to have administrative support for geriatric care services (Adj. B 0.15; 95% CI: 0.06, 0.24, p = 0.001) were associated with a positive attitude. From the qualitative study, three major themes were found regarding PCDs' needs in geriatric care: “education and awareness needs,” “administrative and operational needs,” and “support system needs.” Conclusion: This study emphasizes the need for PCDs to have periodic and specialized training in geriatric care and highlights the administrative support necessary to deliver geriatric care. The community must also fully support them in delivering comprehensive geriatric care, including interagency collaboration in delivering the care service. Targeted strategies can be used to cultivate a supportive and understanding environment for PCDs, which, in turn, will positively impact their attitudes and fulfil their needs toward delivering comprehensive geriatric care.
- PublicationProbability of cardiovascular disease (CVD) events among family members of stroke survivors in Kelantan(2025)Rosidi, Mohd Izrul IshamIntroduction: Cardiovascular disease (CVD), including stroke, is still becoming a global burden across the population, and a positive family history does significantly increase the risk. CVD risk calculators such as Framingham Risk Score (FRS) help quantify these risks, highlighting the impact of factors like BMI, LDL cholesterol, and blood pressure. Concurrently, family-centered approaches to cardiovascular health are gaining attention, particularly in stroke prevention among family members. Despite that, there is still a lack of studies related to the field in Kelantan and Malaysia. Objectives: This study aimed to explore publication trends, and themes related to CVD risk among family members of stroke survivors. Additionally, it sought to assess the distribution of the CVD risk using the Framingham Risk Score and to analyse the relationship between CVD risk factors from WHO STEPS questionnaires and CVD risk scores in local population in Kelantan. Materials and Methods: A cross-sectional study involved 307 family members of stroke survivors in Kelantan over one year (June 2023 - June 2024). The research began with a bibliometric analysis of existing literature on CVD risk among the population. The Framingham CVD Risk Score was calculated based on age, gender, diabetes status, hypertension treatment, smoking status, and body mass index (BMI). An ordinal logistic regression was employed to evaluate the relationship between CVD risk factors from WHO STEPS questionnaire and CVD risk scores, followed by assessment for proportional odds assumptions. Results: The bibliometric analysis revealed a consistent increase in publications on CVD risk among family members of stroke patients since 1978, with an annual growth rate of 7.67%. The USA was identified as the leading contributor, with the journal "Stroke" being the most prolific. Study among the participants in Kelantan reported the median age of 47 years, with 60.0% being spouses to the stroke patients. The CVD risk distribution showed 57.1% classified as low risk, 25.7% as moderate risk, and 17.2% as high risk. Ordinal logistic regression showed that spouse and male gender were associated with 4.04 and 4.32 higher odds to be in higher CVD risk categories respectively. Conclusion: The findings highlighted the growing scholarly interest in CVD risk among family members of stroke patients, emphasizing the importance of familial risk factors in developing targeted prevention strategies. The local study in Kelantan underscored the influence of various factors on the Framingham CVD Risk Score. Understanding these relationships was crucial for effectively preventing and managing cardiovascular health.
- PublicationDevelopment and evaluation of rabies health education module (RAHEM) to improve knowledge and attitude among dog owners in Kelantan(2025-02)Basir, Mohammad Fazrul MohammadBackground: Rabies remains a global public health concern, particularly among dog owners, due to persistent gaps in knowledge, attitudes, and practices (KAP) related to its prevention. Existing health education initiatives often lack depth and long-term sustainability. This highlights the need for a structured and evidence-based module to enhance rabies-related awareness and promote positive attitudes among dog owners. Integrating the One Health approach ensures that rabies prevention efforts address not only human health but also the role of animals and the environment. Objectives: To determine the levels and associated factors of rabies-related KAP, as well as to develop, validate and evaluate the RaHEM in improving these outcomes among dog owners in Kelantan, Malaysia. Methodology: This study was conducted in three phases. Phase one employed a cross-sectional design with 232 adult dog owners completing the validated questionnaire, and logistic regression identified factors associated with KAP. Then, the RaHEM was developed using the Analysis, Design, Develop, Implementation and Evaluation (ADDIE) framework including the validation process through content and face validation during the second phase. Phase three followed by involving a randomized controlled trial with 80 participants to evaluate knowledge and attitude at one-month post-intervention. MANOVA was used to analyse score changes between the intervention and control groups. Result: The cross-sectional study revealed that 53.0% of participants had good knowledge, 26.7% exhibited positive attitudes, and 40.0% demonstrated good practices toward rabies prevention. Key factors associated with these outcomes included education status, prior attendance at rabies awareness programs, number of pet dogs, duration of dog ownership, household size, knowledge scores, age groups, and dog acquisition methods. The final module includes 5 main topics, 11 units, and 32 learning objectives. All the Content Validation Index (CVI) and Face Validation Index (FVI) scores exceeded the acceptable threshold of 0.83 across all unit, topic, and overall module. The randomized controlled trial demonstrated a significant difference between the intervention and control groups (Wilks' λ=0.627; F(2,77)=22.921; p-value<0.001; partial η²=0.408). Post hoc Bonferroni-adjusted pairwise comparisons revealed that the intervention group showed significantly greater improvements observed in the intervention group for both knowledge and attitude score. Conclusion: The study reveals the low levels of rabies-related KAP among Kelantanese dog owners that emphasize the need for a structured educational module while identifying key associated factors through the lens of One Health. The successful development, validation, and proven effectiveness of RaHEM underscore its potential as an impactful health education tool, particularly in enhancing knowledge and attitudes synergistically. This module reinforces its role in strengthening rabies prevention efforts, aligning with global and national goals to eliminate dog-mediated human rabies deaths by 2030.