Lekhraj Gyanchand Rampal

The prevalence and factors associated with obesity among adult women in Selangor, Malaysia

IntroductionThe prevalence of obesity in developing countries especially among women is on the rise. This matter should be taken seriously because it can burden the health care systems and lower the quality of life.AimThe purpose of this study was to determine the prevalence of obesity among adult women in Selangor and to determine factors associated with obesity among these women.MethodsThis community based cross sectional study was conducted in Selangor in January 2004. Multi stage stratified proportionate to size sampling method was used. Women aged 20–59 years old were included in this study. Data was collected using a questionnaire-guided interview method. The questionnaire consisted of questions on socio-demographic (age, ethnicity, religion, education level, occupation, monthly income, marital status), Obstetric & Gynaecology history, body mass index (BMI), and the Patient Health Questionnaire (PHQ-9).ResultsOut of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age was 37.91 ± 10.91. The prevalence of obesity among the respondents was 16.7% (mean = 1.83 ± 0.373). Obesity was found to be significantly associated with age (p = 0.013), ethnicity (p = 0.001), religion (p = 0.002), schooling (p = 0.020), educational level (p = 0.016), marital status (p = 0.001) and the history of suffering a miscarriage within the past 6 months (p = 0.023).ConclusionThe prevalence of obesity among adult women in this study was high. This problem needs to be emphasized as the prevalence of obesity keeps increasing, and will continue to worsen unless appropriate preventive measures are taken.

Ethnic Differences in the Prevalence of Metabolic Syndrome: Results from a Multi-Ethnic Population-Based Survey in Malaysia

Introduction The prevalence of metabolic syndrome is increasing disproportionately among the different ethnicities in Asia compared to the rest of the world. This study aims to determine the differences in the prevalence of metabolic syndrome across ethnicities in Malaysia, a multi-ethnic country. Methods In 2004, we conducted a national cross-sectional population-based study using a stratified two-stage cluster sampling design (N = 17,211). Metabolic syndrome was defined according to the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (IDF/NHLBI/AHA-2009) criteria. Multivariate models were used to study the independent association between ethnicity and the prevalence of the metabolic syndrome. Results The overall mean age was 36.9 years, and 50.0% participants were female. The ethnic distribution was 57.0% Malay, 28.5% Chinese, 8.9% Indian and 5.0% Indigenous Sarawakians. The overall prevalence of the metabolic syndrome was 27.5%, with a prevalence of central obesity, raised triglycerides, low high density lipoprotein cholesterol, raised blood pressure and raised fasting glucose of 36.9%, 29.3%, 37.2%, 38.0% and 29.1%, respectively. Among those <40 years, the adjusted prevalence ratios for metabolic syndrome for ethnic Chinese, Indians, and Indigenous Sarawakians compared to ethnic Malay were 0.81 (95% CI 0.67 to 0.96), 1.42 (95% CI 1.19 to 1.69) and 1.37 (95% CI 1.08 to 1.73), respectively. Among those aged ≥40 years, the corresponding prevalence ratios were 0.86 (95% CI 0.79 to 0.92), 1.25 (95% CI 1.15 to 1.36), and 0.94 (95% CI 0.80, 1.11). The P-value for the interaction of ethnicity by age was 0.001. Conclusions The overall prevalence of metabolic syndrome in Malaysia was high, with marked differences across ethnicities. Ethnic Chinese had the lowest prevalence of metabolic syndrome, while ethnic Indians had the highest. Indigenous Sarawakians showed a marked increase in metabolic syndrome at young ages.

Variation in the Prevalence, Awareness, and Control of Diabetes in a Multiethnic Population: A Nationwide Population Study in Malaysia:

The purpose of this study was to determine the association between different ethnic groups and the prevalence, awareness, and control of diabetes in Malaysia. A population-based cross-sectional study using multistage sampling was conducted in Malaysia. Diabetes is defined as having a fasting blood glucose ≥7 mmol/L or a self-reported diabetic on treatment. Among the 7683 respondents aged ≥30 years, the prevalence of diabetes mellitus was 15.2% (95% CI = 14.1, 16.4). Multivariate analysis showed that compared with Malays, Chinese had lower odds (adjusted odds ratio [aOR] 0.71; 95% CI = 0.56, 0.91) and Indians had higher odds of having diabetes (aOR 1.54; 95% CI = 1.20, 1.98). The odds of diabetes increased with age, family history of diabetes, body mass index, and lower education levels. Among those with diabetes mellitus, 45.0% were aware and 42.7% were under treatment. Among treated diabetics, 25.1% had their fasting blood sugar under control. There is a significant association between prevalence of diabetes and different ethnic groups.

Prevalence, associated factors and predictors of depression among adults in the community of Selangor, Malaysia

Introduction Depression is one of the most common mental health disorders and is an emerging public health problem. The objectives of this paper were to determine the prevalence of depression, its associated factors and the predictors of depression among adults in the community of Selangor. Methods A cross sectional study was conducted in three districts in Selangor, from 11th June to 30th December 2012. The sampling frame was obtained from the Department of Statistics Malaysia (DOS) in May 2012, using the National Population and Housing Census 2010. Adults aged 18 years and above, living in the selected living quarters were approached to participate in the study and requested to complete a set of questionnaires. Results A total of 1,556 out of 2,152 participants participated in this study, giving an overall study response rate of 61.90%. Patient Health Questionnaire 9 (PHQ-9) was used to determine the presence of depression. The prevalence of depression was 10.3%, based on the PHQ-9 cut off point of 10 and above. Based on multiple logistic regression analysis, the predictors of depression were presence of anxiety, serious problems at work, unhappy relationship with children, high perceived stress, domestic violence, unhappy relationship with spouse, low self-esteem, unhappy relationship with family, serious financial constraint and presence of chronic diseases. When reanalyzed after removing anxiety, high perceived stress and low self-esteem, additional predictors of depression were found to be serious marital problems and religiosity. Conclusion The prevalence of depression in this study is similar to that found in other studies. Findings from this study are being used as baseline data to develop an effective program to assist in the management of common mental health disorders in the community, in particular depression. The identification of predictors of depression in the community is important to identify the target population for the program.

Effectiveness of peer-led education on knowledge, attitude and risk behavior practices related to HIV among students at a Malaysian public university--a randomized controlled trial.

OBJECTIVE Develop, implement and evaluate the effectiveness of a peer-led education program related to HIV/AIDS among university students. METHOD DESIGN randomized controlled trial with 276 university students at Faculty of Medicine and Health Sciences University Putra Malaysia (UPM), Serdang in 2011. INTERVENTION A peer-led education program on HIV prevention by university students. OUTCOME differences in knowledge, attitude and risk behavior practices related to HIV between baselines, immediate follow-up after intervention and after three months. RESULTS Significant improvement in sound knowledge in the intervention group as compared to the control group (Odds ratio, 1.75; 95% CI 1.01, 3.00; p=0.04) and improvement in good attitude related to HIV (Odds ratio 2.22; 95% CI 1.37, 3.61; p=0.01). The odds of high substance risk behavior was significantly reduced in the intervention group as compared to the control group (Odds ratio 0.07; 95% CI 0.02, 0.34; p=0.01). The association between good knowledge and intervention was modified by the different time points (baseline, immediately after intervention and 3 months after intervention), ethnicity and gender. CONCLUSION Peer-led education program in HIV prevention improves knowledge, attitude and substance risk behavior. Changes in sexual risk behavior may require a longer follow-up.

Factors Associated with Chronic Illness among the Elderly in a Rural Community in Malaysia

Chronic illness is one of the major causes of mortality and morbidity among the elderly. To determine the prevalence and factors associated with chronic illness among the elderly in a rural community setting. A cross sectional study design was used. Stratified proportionate cluster sampling method was used to select respondents in Mukim Sepang, Sepang, Selangor, Malaysia. Out of 263 elderly residents (6.2% of the total population), 223 agreed to participate in the study giving a response rate of 84.8%. The prevalence of chronic illness among the elderly in Mukim Sepang was 60.1 %. Out of 223 respondents,134 were diagnosed as having chronic illness such as hypertension, diabetes mellitus, ischaemic heart disease, bronchial asthma or gout. Chronic illness was found to be significantly associated with functional dependence among the elderly (χ2=6.863, df=1,p<0.05). The prevalence of chronic illness among the elderly in the rural community is very high. Problems facing this age-group should be addressed comprehensively in order to formulate appropriate programmes for the health care of the elderly. Asia Pac J Public Health 2004; 16(2): 109-114.

Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

Background Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART). Objective(s) Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. Methods A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention. Results The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39–96.97) as compared to the control group (87.5; 95% CI: 86.14–88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group. Conclusion Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.

Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding Tuberculosis among HIV patients in General Hospital Minna, Nigeria – A randomized control trial

Introduction The risk of development of active TB in HIV-infected individuals is 20–37 times higher than those that are HIV negative. Poor knowledge of TB amongst people living with HIV has been associated with high transmission. Objectives To determine the effectiveness of a new health education intervention module in improving knowledge, attitude, and practice (KAP) regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria. Methods A randomized control trial was carried out from July 2015 to June 2017. A random number generating program was used to allocate 226 respondents into 2 groups. The intervention group received health education regarding tuberculosis using the developed module. The control group received the normal services provided for HIV patients. Data were collected from December 2015 to September 2016 at baseline, immediate post intervention, three, six and nine months. The outcome measures were knowledge, attitude, and practice. Results There was no significant difference with respect to socio-demographic characteristics, KAP of the respondents in the intervention and control group at baseline. However, there was significant improvement in knowledge in the intervention group compared to the control group, group main effect (F = (1,218) = 665.889, p = 0.001, partial ἠ2 = 0.753, d = 5.4); time (F = (3.605, 218) = 52.046, p = 0.001, partial ἠ2 = 0.193, d = 1.52) and interaction between group with time (F = (3.605, 218) = 34.028, p = 0.001, partial ἠ2 = 0.135, d = 1.23). Likewise, there was significant improvement in attitude, group main effect (p = 0.001, d = 1.26) and time (p = 0.001, p, d = 0.65). Similarly, there was improvement in practice, group main effect, time, and interaction of group with time (p < 0.05). Conclusion The health education intervention program was effective in improving KAP regarding tuberculosis among HIV patients.

Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

Background Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia. Patients and methods This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome – regular attendee and defaulter categories – based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software. Results A total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063–0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040–16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. Conclusion Ethnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation.

The effectiveness of education intervention program for improving knowledge, attitude and practice related to hepatitis-B infection among non-medical and non-veterinary undergraduate university student in northern Nigeria, a randomized control community trial

Infections due to Hepatitis B and Hepatitis C viruses are significant health problems around the globe, Nigeria inclusive. Asymptomatic Hepatitis B and C infections are common and when occurring in pregnancy can be transmitted to the new born. To determine the prevalence rate of asymptomatic hepatitis B and C infections among pregnant women, 406 pregnant women attending antenatal clinic at University Health centre and Our Lady of Apostle hospital, all in Jos, Plateau State were recruited for the study. The study was also carried out to determine whether liver aminotransferases and serum albumin can be affected by hepatitis infection during pregnancy. Demographic and past clinical histories were obtained using a questionnaire. Serum samples from each study subject were tested using third-generation enzyme immunoassay kits for hepatitis B surface antigen (HBsAg) and antibodies against hepatitis C (HCV). Serum Alanine Aminotransferase (ALT) and serum aspartate aminotransferase (AST) activities were also estimated in all subjects using Reitman-Frankel method. Also serum albumin was measured in all subjects using Bromocresol green (BCG) method by Teitz. The results showed that 10.0% and 1.2% of the 406 blood samples tested positive on HBV and HCV, respectively. Furthermore, 1.2% of the 406 blood samples tested positive with both HBV and HCV. The mean AST levels for HBsAg negative and positive subjects were 10.55 ± 0.05 and 12.16 ± 0.29, respectively while the mean ALT levels were 5.54 ± 0.005 and 8.01 ± 0.01, respectively. The mean AST for anti-HCV negative and positive subject were 10.67 ± 0.01 and 9.01 ± 0.05, respectively while ALT were 5.71 ± 0.01 and 4.01 ± 0.05, respectively. There was a significant increase in levels of AST and ALT between the HBsAg positive and negative pregnant subjects (P < 0.05). Furthermore, the mean serum albumin level for HBsAg positive and negative pregnant subjects were 30.60 ± 2.75 and 35.58 ± 3.82, respectively. Also, the mean albumin level for HCV positive and negative pregnant subjects were 28.5 ± 2.12 and 35.55 ± 3.7, respectively. There was a significant increase in albumin level between HBsAg and HCV positive and negative pregnant subjects (P < 0.05). HBV and HCV infection can be present in pregnant women and can alter liver aminotransferases and serum albumin. Routine screening of pregnant women for HBV and HCV should be instituted in order to detect infection early and prevent or reduce vertical or prenatal transmission. Correspondence to: Onwuiri FC, Department of Plant Science and Technology, Applied Microbiology Unit, University of Jos, Nigeria, Tel: +2348065302804; E-mail: faconwuliri@yahoo.com Received: March 22, 2017; Accepted: April 19, 2017; Published: April 22, 2017 Introduction Viral hepatitis is the inflammation of the liver caused by infection with hepatitis viruses. Infection with hepatitis B virus or hepatitis C virus are public health problems and are highly endemic in SubSaharan Africa [1,2]. Worldwide, there are about 350 million HBV carriers [3]. HBV and HCV infections are major causes of morbidity and mortality. Hepatits B virus is a DNA virus of the family hepadneviridae and the causative agent of hepatitis B infection [4]. It is 50-100 times more infectious than HIV and 10 times more infectious than hepatitis C. Many carriers do not realize they are infected with the virus, thus it is referred to as a ‘silent killer’ [5]. Hepatitis C virus (HCV) is an RNA virus of the flaviviridae family and appears to have humans and chimpazees as the species susceptible to its infection [6]. About 170 million people are infected with HCV worldwide [7]. Both viruses are transmitted through contact with infected blood, sexual intercourse and vertical transmission (mother-to-child) [8]. Maternal mortality has been shown to increase in pregnant women with liver cirrhosis. HBV and HCV account for a substantial portion of liver diseases worldwide and infected individuals can remain asymptomatic for decades. However, more than 80% of them become chronic carriers which result in an increased risk of liver cirrhosis, liver cancer and liver failure 20-30 years later. They share similar modes of transmission. Coinfection is not uncommon especially in areas of high prevalence and among people at high risk for parental infection. In Nigeria, the prevalence rate of HBV and HCV in pregnant women differ from one locality to another. Yakasai et, al. [9] reported a prevalence of 7.9% HBsAg in pregnant women in Kano, Nigeria. While Oladeinde et, al. [10] reported a prevalent rate of 8 (2.2%) and 3 (0.8%) of HBV and HCV infections, respectively among pregnant women in Benin city, Nigeria. Co-infection of HBV and HCV seems to result in more severe disease than either infection alone. Globally hepatitis B virus (HBV) infection is the most common form of chronic hepatitis around the world. Chronic carriers can Onwuiri FC (2017) Prevalence of Hepatitis B Virus (Hbv) and Hepatitis C Virus (Hcv) and their effects on serum albumin and liver aminotransferases in pregnant women in Jos Volume 1(2): 2-4 Virol Res Rev, 2017 doi: 10.15761/VRR.1000108 continue to transmit the disease for many years, before becoming symptomatic [11]. Together hepatitis B and C represent one of the major threats to global health. Infection occurs very often in early childhood when it is asymptomatic and then lead to the chronic carrier state; chronic HBV infection leads to increase risk for chronic hepatic insufficiency, cirrhosis, and hepatocellular carcinoma (HCC) [11]. In many developed countries (e.g. those in Western Europe and North America) patterns of transmission are different from those in developing countries. The majority of infections in developing countries are transmitted by sexual activity and drug use especially among young adults [12]. Hepatitis B is a major infectious occupational hazard of health worker. Hepatitis B Virus is not spread by contaminated food or water and cannot be spread casually in the work place. Hepatitis B is transmitted through contact with an infected person’s blood, semen or other body fluid. Materials and methods Study area This study was carried out in the University Health Centre (UHC) and Our Lady of Apostle (OLA) hospital, both located in Jos North Local government of Plateau State. University Health Centre is located in the permanent site of University of Jos, and is positioned to take care of the health needs of students, staff and their dependents. Anti-natal care is also given to both staff and students. OLA hospital is located in the heart of the city of Jos being a popular maternity place for different ethnic and religious groups, both urban and rural women use OLA hospital for their antenatal care center. the study was conducted on 406 pregnant women attending ante-natal clinic in UHC and OLA hospitalBackground: The endemicity of Hepatitis B virus (HBV) infection is leveling off in sub-Saharan Africa; it remains at an unacceptable high level (≥8%, to <2%) with global prevalence of 3·61%. The present study assessed the effectiveness of a peer-led HBV prevention education intervention in Usman Danfodiyo University Sokoto, Nigerian on youth’s HBV-related knowledge,attitude,and practices. Methods: In a peer-led single blind randomized controlled community trial conducted between April and December 2015. 390students were selected and randomized into the intervention and control arms, each arm with 195 respondents; five out of 12 faculties were selected using multi-staged random sampling. Four surveys were conducted(baseline, immediately, three and six months using self-administered questionnaire.Analysis of data were conducted using SPSS version 22. Results: The overall response rate during the four survey were 100%, 99.4%, 98.9% and 98.4%for intervention group and 100%, 100%, 99.4%,and 98.9% for the control arm respectively. Hepatitis B- related knowledge, attitude,and practices of the respondents were statistically significant between the intervention and the control arms at immediately, three and six month’s follow-up assessment with no statistical significant difference at baseline assessment (knowledge 14.3%, 66.95%, & 62.7%, HBV-related attitude 23.56%,40.68%, & 46.12% and HBV-related preventive practices 26.14%, 6.53%,& 11.9%). Conclusions: The present study has shown an evident for its effectiveness on HBV-related knowledge, attitude and preventive practice among the undergraduate non-medical and non-veterinary university students of Usman Danfodiyo University Sokoto Nigeria.