Pusat Pengajian Sains Kesihatan - Tesis

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Haemoglobin A1c, blood pressure and ldl-cholesterol goals attainment and its associated factors among adults with early-onset type 2 diabetes in Terengganu, 2023
(2024-06)
Zulrushdi, Mohd Fariz
Background: The global and local increase in prevalence of diabetes mellitus presents a significant public health challenge. Early-onset type 2 diabetes, diagnosed between ages 18 and 45 years, is increasingly common and associated with a heightened risk of complications. Therefore, achieving the ABC goals (HbA1c <7%, blood pressure <140/90 mmHg, and LDL-C <100 mg/dL) is essential for managing diabetes and reducing the complications. Objective: This study aims to determine the attainment of two or more ABC goals and its associated factors among adults with early-onset type 2 diabetes in Terengganu in 2023. Methodology: A cross-sectional study design was employed, utilizing secondary data of adults with early-onset type 2 diabetes who were audited in the National Diabetes Registry in Terengganu in 2023. A simple random sampling was applied to select the required sample of 675. Data on sociodemographic characteristics, lifestyle factors, and diabetes treatment profiles were extracted and analysed using SPSS version 28. Descriptive statistics and multiple logistic regression were used to summarize the data and identify factors associated with achieving two or more ABC goals. Results: The mean age of the participants was 46.8 years (SD 7.86). The majority of the patients were female (68.3%), of Malay ethnicity (97.9%), and non-smokers (95.4%). The proportion of attainment two or more goals was 36.4%. Women are 38% less likely than men to achieve two or more ABC goals, with a statistically significant odds ratio (OR) of 0.63 (95% CI: 0.44 to 0.88, p=0.007). Regarding treatment types, individuals on oral treatment alone have 2.49 times higher odds of achieving these goals compared to those on a combination of oral treatment and insulin (95% CI: 1.77 to 3.49, p<0.001). Additionally, those not on any treatment have 2.76 times higher odds of reaching the goals compared to those on the combination treatment (95% CI: 1.11 to 6.91, p=0.030). Conclusion: These findings highlight significant challenges in comprehensive diabetes control among adults with early-onset type 2 diabetes in Terengganu, with notable sex-based disparities and treatment profiles in goal attainment. Effective diabetes management requires addressing gender-specific challenges and modality of treatment profiles through public health campaigns, interdisciplinary strategies, and personalized care. Additionally, achieving the recommended ABC goals is more likely in patients who take fewer medications for diabetes.
Translation and validation of adult carer quality of life (ac-qol) questionnaire and mediation analysis of depression, anxiety and stress on quality of life of informal caregivers of stroke
(2024-08)
Khan, Erwan Ershad Ahmad
Introduction: As the global population ages and the prevalence of chronic illnesses rises, the demand for caregivers has grown substantially, prompting increased interest in understanding caregivers' quality of life (QoL). Caring for stroke survivors presents unique challenges and rewards, impacting caregivers' QoL. Objectives: To determine the characteristics of publications on caregivers' QoL through bibliometric analysis, to translate and validate the Malay version of the Adult Carer Quality of Life Questionnaire (AC-QoL), to model relationships between informal caregivers’ and stroke survivors’ factors with informal caregivers’ QoL and to estimate the mediation effects of depression, anxiety, and stress. Materials and Methods: Bibliographic data were extracted from the Scopus database using terms like “caregivers” and “quality of life”. The analysis included original articles or reviews in English up to August 2023, utilizing the 'bibliometrix' package in RStudio. The second study was a cross-sectional study that translated the AC-QoL into Malay through a ten-step process. Content and face validation were conducted with six experts and ten subjects, respectively. Confirmatory factor analysis (CFA) was performed on data from 222 informal caregivers. 60 informal caregivers were subjected for retesting for stability. The third study, another cross-sectional study, analysed data from 250 informal caregivers. Linear regression modelled relationships between stroke survivors’ and informal caregivers’ factors with informal caregivers’ QoL. Hayes's PROCESS macro model 4 for bootstrapping indirect effects was used to estimate the mediation effects of depression, anxiety, and stress Results: Since 1989, 1859 original research articles and reviews were published, with a 15.52% annual growth rate. The USA led with the most publications (327), citations (9993), and collaboration activity. Key keywords included “depression”, “anxiety”, “stroke”, “dementia”, “cancer”, and “burden”. Clusters for “depression”, “anxiety”, “cancer”, and “family caregivers” dominated current research, while “dementia” and “Alzheimer's disease” are emerging topics. In the second study, content validity indicated rephrasing for two items. Face validity was high for all items. CFA suggested removing four items due to low factor loading, resulting in a model with satisfactory indices: CFI (0.889), TLI (0.877), RMSEA (0.066), and SRMR (0.064). Composite reliability ranged from 0.77 to 0.91. Significant differences were observed in QoL scores among informal caregivers with varying levels of depression, anxiety, and stress. The questionnaire showed good stability (ICC = 0.86). In the third study, stroke survivors’ dependency (b = 0.14), informal caregivers’ depression (b = -0.81), and anxiety (b = -0.73) were significantly associated with informal caregivers’ QoL. Depression (effect = 0.02) and anxiety (effect = 0.01) partially mediated the relationship between stroke survivors’ dependency and informal caregivers’ QoL. Conclusion: Informal caregivers' QoL is profoundly influenced by the demands of caregiving, particularly for stroke survivors. The bibliometric analysis highlights the evolving research landscape, while the validation of the AC-QoL provides a reliable tool for assessing informal caregivers' QoL in Malaysia. The mediation analysis underscores the significant role of psychological distress, specifically depression and anxiety, in modulating the impact of stroke survivors’ dependency on informal caregivers' QoL. These insights emphasize the necessity for targeted screening and interventions to alleviate informal caregivers' psychological burdens, ultimately enhancing their quality of life.
Trends and factors associated with tuberculosis-related mortality during the intensive phase of anti-tuberculosis treatment in Johor from 2013 to 2022
(2024-06)
Ramlan, Dzul Hairy Mohd
Background: Tuberculosis (TB) remains a major global health challenge. In Malaysia, recent TB data reveal a significant deviation from the targets set by the End TB Strategy, with a 28% increase in TB fatalities in 2022 compared to 2021. Despite extensive TB control efforts, Johor state has witnessed fluctuating mortality rates during the intensive phase (IP) of anti-TB treatment, underscoring the need for an in-depth analysis of associated factors. Objective: This study aimed to describe the proportion and trends of TB-related mortality and its associated factors during the IP of anti-TB treatment in Johor from 2013 to 2022. Methods: A case-control study was conducted in January 2024 until the end of May 2024 using secondary data from the MyTB system. The proportion of TB-related mortality and total of TB cases were calculated based on the data extracted from MyTB system with no sampling method applied, A case (n=372) consists of a TB patient who dies due to TB during the IP and the the control group (n=1671) was randomly selected from TB cases who survived during the IP. Descriptive statistics and logistic regressions were employed for data analysis using SPSS version 29. Results: The proportion of TB-related deaths during the intensive phase (IP)IP in Johor from 2013 to 2022 ranged between 0.8% and 3.6%, with 2022 having the highest rate. Of the 2,043 participants, the average age was 49.2 years for cases and 42.5 years for controls. Most were male (76.3%), Malaysian (89.5%), from urban areas (65.1%), HIV-negative (81.5%), had received BCG vaccination (86.8%), were new TB cases (92.2%), had positive sputum AFB (79.3%), were initially treated at government hospitals (88.4%), and did not adhere to DOTS (80.1%). The significant independent risk factors for TB-related mortality during IP were being older than 65 years (AOR: 10.14; 95% CI: 1.27, 80.7; p=0.029), living in an urban area (AOR: 0.55; 95% CI: 0.35, 0.86; p=0.008), HIV-positive (AOR: 2.95; 95% CI: 1.53, 5.69; p=0.001), AFB positive (AOR: 2.42; 95% CI: 1.43, 4.10); p=0.001), far-advanced lesions on chest radiograph (AOR: 14.53; 95% CI: 7.12, 29.64; p<0.001), initiating treatment at a government hospital (AOR: 5.73; 95% CI: 2.07, 15.86; p<0.001), and adherence to DOTS (AOR: 0.009; 95% CI: 0.006, 0.015; p<0.001).[d2][NN3] Conclusion: This study highlights fluctuating trends in TB-related mortality during the IP, with a notable peak in 2022. Public health strategies should focus on early detection, integrated TB-HIV care, and strict adherence to DOTS, particularly for high-risk populations. In line with the National TB End Strategy, these findings are crucial for guiding future interventions and policies aimed at reducing TB mortality rates and improving treatment outcomes in Johor and similar settings.
Job satisfaction and its associated factors among medical and health officers in Terengganu
(2024-06)
Introduction: Understanding job satisfaction is crucial for enhancing higher levels of engagement, dedication, and commitment to work, which will improve the overall quality of healthcare services provided. Thus, this study investigated job satisfaction and its associated factors among medical and health officers working in primary healthcare in Terengganu. Methodology: In this cross-sectional study, medical and health officers from all eight district health offices and state health departments of Terengganu were randomly and proportionately selected as participants. These participants had worked for at least three months in the district health offices and state health departments of Terengganu. The study used the Malay version of the Psychosocial Aspect of Work Questionnaire (PAW-M) which was self-administered using a Google form link. It consists of 15 items that measure three aspects of work: job satisfaction, social support, and the mental stress of work, and scored using a 5-point Likert scale. The data was analyzed using SPSS version 27, and linear regression analyses were applied to identify the factors that are associated with job satisfaction. Results: A total of 200 medical and health officers participated in the study. The study indicates that medical and health officers had a mean (SD) job satisfaction score of 26.41 (4.7). The mean age of the participants was 35.45 (4.80), the mean of social support was 16.67 (2.32) and the mean of mental stress was 17.29 (2.07). The study identifies that satisfied with income (95% CI: 0.118, 2.317, p=0.030), permanent employment status (95% CI: 0.104, 3.403, p=0.037) and social support score (95% CI: 0.979, 1.432, p<0.001) as the significant associated factors for job satisfaction among study participants. Conclusion: The study found that the mean job satisfaction score was 26.1, associated with satisfaction of income, permanent employment status, and social support score. Addressing these factors will boost job satisfaction among medical and health officers and thus improve the quality of healthcare services.
Comparative analysis of notified hand, foot, and mouth disease cases between Kelantan and Penang
(2024-06)
Aziz, Aina Syazwani
Background: Hand Foot and Mouth Disease (HFMD), primarily caused by enteroviruses like EV 71 and CV-A16, remains a significant public health issue in Malaysia, particularly affecting children. Despite extensive efforts to manage HFMD, the incidence rate continues to rise, necessitating further investigation into regional differences and associated risk factors. Objectives: This study aims to estimate the incidence rates and risk factors of notified HFMD cases between the states of Kelantan and Penang from 2017 to 2021. Specifically, it seeks to identify differences in incidence rates and the distribution of cases by age, gender, and race. Methodology: A comparative cross-sectional study design was employed, utilizing secondary data from the Communicable Disease Control Information System (CDCIS) e-Notification. The study population included all notified HFMD cases in Kelantan and Penang from 2017 to 2021. Statistical analyses, including chi-square tests, were conducted using R software to estimate incidence rates and demographic factors between the two states. Results: From 2017 to 2021, 18,243 HFMD cases were reported, with 7,846 in Kelantan and 10,397 in Penang. The average incidence rate was higher in Penang (1.18 per 1,000 population) compared to Kelantan (0.49 per 1,000 population). The incidence was highest among children aged 0-4 years in both states, with significant differences in age distribution (χ2 (3) = 303.48, p < 0.05). Males had a higher prevalence of HFMD in both states, with a statistically significant difference in gender distribution (χ2 (1) = 6.885, p = 0.009). The Malay ethnic group had the highest number of cases in both states, but significant differences were observed in racial distribution (χ2 (4) = 4290.40, p < 0.05). Conclusion: The study reveals significant regional differences in HFMD incidence rates and demographic factors between Kelantan and Penang. The findings highlight the need for targeted public health interventions, particularly focusing on young children and incorporating comprehensive health education tailored to different ethnic groups. Enhanced surveillance systems are crucial for early detection and effective management of HFMD outbreaks.

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