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Background and Aim: Rattus spp. are the most common animals capable of adapting to their environment. They can be reservoirs or vectors of diseases that facilitate the transmission of zoonotic-borne parasites to humans. Hence, a study on the detection of parasites in rat populations in urban areas is crucial to prepare for emerging zoonosis. Therefore, this study aims to identify blood parasites, ectoparasites, and helminths in Rattus spp. from wet markets located in Klang Valley, an urban area with a high-density human population. Materials and Methods: A total of 32 rats were trapped in several wet markets in Klang Valley, Malaysia. They were anesthetized for morphometric examination followed by exsanguination. Various parasitological techniques such as perianal tape test, simple flotation, direct examination of the intestine, and fecal smear were performed for intestinal parasite detection; hair plucking, skin scraping, and full body combing for ectoparasite identification; and blood smear, microhematocrit centrifugation, and buffy coat techniques for blood parasite detection. Results: The rats were identified as Rattus rattus (71.9%) and Rattus norvegicus (28.1%). The only blood protozoan found was Trypanosoma lewisi. The ectoparasites identified belonged to two broad groups, mites (Laelaps spp. and Ornithonyssus spp.) and fleas (Xenopsylla cheopis), known to be parasitic zoonotic disease vectors. The zoonotic intestinal parasites were cestodes (Hymenolepis nana), nematodes (Nippostrongylus brasiliensis, Strongyloides spp., Trichuris spp., Capillaria spp., and Syphacia spp.), and intestinal protozoa (coccidian oocysts and Giardia spp.). Microscopic images showing Giardia spp. are the first report of this organism in rats in Malaysia. Conclusion: Rats caught in this urban area of the Klang Valley harbor parasites can pose a potential zoonotic threat to humans, raising public health concerns because of their proximity to densely populated urban areas.

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@#Lip print is useful in forensic investigations for individual identification. The present study aimed to discriminate sex based on lip print patterns in Malaysian Malay population in Klang Valley using a scanning technique. Lip prints of 360 subjects (180 males and 180 females) were taken using the lipstick-cellophane tape technique, pasted onto A4 papers. These papers were then scanned using Brother DCP-J100 printer (300dpi resolution). The images were analysed using a software based on Suzuki and Tsuchihashi’s classification. The lip print images were divided into six sections which are upper left, upper middle, upper right, lower right, lower middle and lower left. The Pearson chi-square test showed that there are significant differences (p < 0.05) between sexes in each section except for the upper middle section. In males, type V (irregular pattern) was the dominant pattern for upper left, upper right, lower right and lower left sections (ranging from 71.1% to 86.7%) while type IV (reticular pattern) was dominant at upper and middle sections (ranging from 57.2% to 66.1%). Type IV (48.3%) was dominant in upper middle section for female, while for the rest of the sections, type V was the dominant lip print pattern (ranging from 40% to 82.8%). These results showed that sex differentiation between males and females in Malaysian Malay population, Klang Valley can be suggested to be used for identification in forensic investigation.

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BACKGROUND: Typhoid fever causes global morbidity and mortality and is a significant health burden, particularly in low- and middle-income countries. The direct fecal-oral route is the main transmission mode, but indirect environmental transmission could occur, particularly in urban settings. This study aimed to investigate the burden and trend of typhoid fever, reporting the coverage system between government and private practice and pattern of multidrug-resistant (MDR) typhoid cases in the urban Klang Valley area from 2011 to 2015. METHODS: The data from a cross-sectional study retrieved from the e-Notifikasi System, a national reporting system for communicable diseases provided by the Disease Control Division, Ministry of Health Malaysia and secondary data of all the typhoid cases were obtained from the public and private hospitals and laboratories in Klang Valley. Descriptive analysis was performed to examine the sociodemographic characteristics, spatial mapping was conducted to examine trends, and the crude incidence rates of confirmed typhoid cases and percentage of reporting coverage were calculated. Significant differences between MDR and non-MDR Salmonella typhi were determined in the patient's sociodemographic characteristics, which were analyzed using χ2 test. P values < 0.05 were considered statistically significant. RESULTS: In total, 507 typhoid fever cases were reported in Klang Valley; however, only 265 cases were confirmed by culture tests. The crude incidence rates of confirmed cases were between 0.5 to 0.7 but peaked at 1.42 per 100,000 population in 2015. Most typhoid fever cases were observed among men (55.6%), individuals aged 21 to 30 years (27.6%), Malaysians (86.3%) and individuals of Malay ethnicity (52.1%). The reporting coverage of confirmed cases was 78.9% and non-reporting coverage of unconfirmed typhoid cases was 79.5%. The predictive value positive (PVP) was 89.3, and 7.5% were detected as MDR Salmonella typhi. Statistical significance was found in gender, citizenship and ethnicity regarding MDR Salmonella typhi (p = 0.004, p = 0.008 and p = 0.034, respectively). CONCLUSIONS: The local transmission of typhoid is still prevalent in the Klang Valley despite rapid urbanization and development in recent years. These findings are essential for policy makers to plan and implement focused and effective preventative activities to curb typhoid infection in urban areas.

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BACKGROUND: Zika fever is a mosquito-borne disease with global health concern. It has been underreported or misdiagnosed due to its unspecific clinical manifestations, including mild-influenza like and subclinical symptoms. However, its associated serious complications which include fetal microcephaly and Guillain-Barré syndrome remained a challenge to the public health sectors. This research aimed to evaluate the knowledge, awareness, and perception toward Zika virus infection among community pharmacists in the Klang Valley of Malaysia and to determine the association between the knowledge of Zika virus infectious disease and years of community practice experience among community pharmacists in this region. METHODS: This survey research was conducted from August to December 2018 through a pre-tested, self-administration, and cross-sectional random convenient sampling at various districts in the Klang Valley. A total of 275 registered community pharmacists were involved in this study by completing a pilot-tested questionnaire. Descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H test were used to analyze the data. RESULTS: The knowledge toward Zika virus infection of respondents was classified into "poor" (5.1%), "basic" (70.9%), and "broad" (24.0%). Most of the participants (n = 195, 70.9%) presented with basic knowledge toward Zika virus infection. A total of 268 (97.5%) participants presented with high awareness toward Zika virus infection. The mean score of respondents' knowledge and awareness was 15.88 ± 3.61 (maximum score = 28) and 13.96 ± 1.60 (maximum score = 16), respectively. There was a statistically significant difference between the years of practice of community pharmacists and the level of knowledge toward Zika virus infection. CONCLUSIONS: In conclusion, our respondents demonstrated a basic level of knowledge and high awareness toward Zika virus infection. Also, we highlighted some possible pitfalls in the knowledge of Zika virus infection, including the virus transmission, symptoms, diagnosis, treatment, prevention, and complications of the disease.

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@#The objective of this study was to determine the effect of smoking ban in eateries on smoking behaviors and intention to quit smoking among adult smokers in Klang Valley. A validated questionnaire was utilized for this study whereby three variables of the study (socio-demographic characteristics, smokers attitude, and intention to quit smoking) were measured. The structured questionnaire contained closed ended questions where present of dichotomous(yes/no), multiple choice questions and 7-point likert scale questions. 600 questionnaires were distributed to target respondents in eateries of Klang Valley. The inclusion criteria were local citizen of Malaysia, those who gave consent to take part in the study, literate in English, smokers aged 18 years old and above. The data were analyzed utilizing SPSS software version 21.0. There were 504 completed and usable responses received, which represented an 84% response rate. Majority of smokers in Klang Valley were male which constituted around 78.2% of the respondents. Manufactured cigarette, 75.2% was the most preferred type of nicotine among smokers. Smokers attitude and social support with a smoking ban in restaurants and eateries was significantly associated with intention to quit smoking. 73.8% of smokers agree that the smoking ban in eateries and restaurants have reduced their daily smoking frequency and 58.3% of smokers agreed that the nationwide smoking ban at eateries and public places aspire them to quit smoking.Smoking ban is beneficial to help reduce prevalence of smoking among smokers that in turn helps to reduce secondary smoking and burden of non-communicable diseases in the long run. Though only a little over half of the respondents claimed that the ban inspires them to quit smoking, this is a positive start as the ban was just introduced. When effectively implemented, they are seen as an important element of policy to support behavior change in favor of a healthy lifestyle. The Ministry of Health should push forward with the ban on public smoking as soon as possible. The ban should be in tandem with efforts to help smokers quit. Implementing this scheme nationwide would be a remunerative move to help strive for a better health and cleaner environment for this country.

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Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty-four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on "feasibility" and "relevance" criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately.

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@#The assessment of exclusive breastfeeding is important to invest the efforts to promote and support breastfeeding practices. Hence this study was carried out to compare breastfeeding practices among mothers using deuterium dose to mother technique with maternal recall breastfeeding practice. A total of 30 mother-infant pairs from a university hospital and government health clinics in Klang Valley participated and completed the study. Mother-infant pairs were recruited into the study when infants were aged 3 months ± 1 week. Anthropometric measurements (height, weight, waist circumference for mother; length and weight for infant) were carried out. Socio-demographic questionnaire was self-administered while breastfeeding practices were interview administered using maternal recall breastfeeding practice questionnaire (MRBF). This was followed by baseline saliva collection of mother-infant pairs before dose and 6 days after mothers were given 30 ± 0.01g of D2O. The post dose saliva sample of mother-infant pairs were collected 6 times at day 1,2,3,4,13 and 14. The results showed that majority of mothers (57%) were university graduates but majority were stay at home mothers. Meanwhile, mothers had BMI with mean 25 ± 4 kg/m2. The results from MRBF questionnaire showed that all mothers were practising exclusive breastfeeding and their infant never received any water sources other than their breast milk. However, the deuterium dose to mother technique revealed only 3% of mothers were actually practising exclusive breastfeeding. From the isotopic data, the calculated mean intake of milk was 721 ± 243 g/day while the mean non-milk oral intake of 122 ± 22 g/ day. In contrast exclusive breastfeeding infants received only 10 g/day non milk oral intake, demonstrating exclusive breastfeeding practice of mothers. There were different breastfeeding practice reported from mother using deuterium oxide dose to mother technique with maternal recall breastfeeding practice.

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Background@#Dengue patients in Malaysia have the choice to seek care from either public or private sector providers. This study aims to analyse the pattern of health facility use among dengue patients to provide input for the ongoing policy discussion regarding public–private integration. The focus of this study is in the Klang Valley, which has a high dengue burden as well as a high number of private facilities.@*Methods@#This is a cross-sectional study using an available secondary data source – the Malaysian national dengue passive surveillance system, e-Dengue registry. A total of 61 455 serologically confirmed dengue cases from the Klang Valley, registered in year 2014, were included. We retrospectively examined the relationship between demographic factors and the choice of health-care sector by logistic regression.@*Results@#The median age of the cohort was 26 (interquartile range: 17 to 37) years. More private facilities (54.4%) were used for inpatient care; more public facilities (68.2%) were used for outpatient care. The Chinese and urban populations showed significantly higher use of the private health-care sector with an adjusted odds ratio of 4.8 [95% confidence interval (CI): 4.6–5.1] and 2.3 (95% CI: 2.2–2.4), respectively.@*Conclusion@#Both public and private health facilities bear significant responsibilities in delivering health-care services to dengue patients. The workload of both sectors should be included in future health policy planning by public agencies.

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BACKGROUND: The demand in biobanking for the collection and maintenance of biological specimens and personal data from civilians to improve the prevention, diagnosis and treatment of diseases has increased notably. Despite the advancement, certain issues, specifically those related to privacy and data protection, have been critically discussed. The purposes of this study are to assess the willingness of stakeholders to participate in biobanking and to determine its predictors. METHODS: A survey of 469 respondents from various stakeholder groups in the Klang Valley region of Malaysia was carried out. Based on previous research, a multi-dimensional instrument measuring willingness to participate in biobanking, and its predictors, was constructed and validated. A single step Structural Equation Modelling was performed to analyse the measurements and structural model using the International Business Machines Corporation Software Package for Social Sciences, Analysis of Moment Structures (IBM SPSS Amos) version 20 with a maximum likelihood function. RESULTS: Malaysian stakeholders in the Klang Valley were found to be cautious of biobanks. Although they perceived the biobanks as moderately beneficial (mean score of 4.65) and were moderately willing to participate in biobanking (mean score of 4.10), they professed moderate concern about data and specimen protection issues (mean score of 4.33). Willingness to participate in biobanking was predominantly determined by four direct predictors: specific application-linked perceptions of their benefits (ß = 0.35, p < 0.001), issues of data and specimen protection (ß = - 0.31, p < 0.001) and religious acceptance (ß = 0.15, p < 0.05) and trust in key players (ß = 0.20, p < 0.001). The stakeholders' willingness to participate in biobanking also involves the intricate relationships between the above-mentioned factors and other predictors, such as attitudes regarding technology, religiosity and engagement. CONCLUSIONS: The findings of this study reaffirmed that stakeholders' willingness to participate in biobanking is a complex phenomenon that should be viewed from a multidimensional perspective. Stakeholder willingness to participate in biobanking is warranted when direct predictors (benefits, issues of data and specimen protection, religious acceptance, and trust in key players) as well as indirect factors are well accounted for.

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@#Malaysia was ranked at 148 by World Health Organization (WHO) in suicide statistic for 2012, where males had a highertendency to commit suicide, recording a 4.7 per 100,000 in comparison to female (1.5 per 100,000). As hanging is one ofthe most common methods to commit suicide, this retrospective study was conducted to observe the incidence of suicideby hanging in Klang Valley from four different hospitals. The current study is conducted to provide local database ofsuicide occurrence by hanging in Klang Valley. A total of 893 suicide cases by hanging from 2007 to 2016 were recordedfrom post mortem records and analysed. Suicide rates in Klang Valley showed a rising trend from 2007 to 2016. Malesfrom age group 30 to 34 years old and females from 20 to 24 years old have the highest number of suicide fatalitiescompared to other age groups. Meanwhile, fatalities from the age group of 10 to 14 years old and 80 years old and aboveshowed similar result which is only 7%. 78% of the fatalities were recognized as Malaysian and half of them were Indian.Majority of the victims/cases (45%) who committed suicide by hanging are of Hindu religious denomination. Non-citizenin Malaysia that have the highest suicide rates were from Nepal, Indonesia and Myanmar. Victims also committed suicidemore during the day and the peak hours being at 12.00 pm to 5.59 pm.

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@#Death due to firearm is more common in countries with higher gun ownership such as United States of America compared to countries with restrictive gun ownership such as European countries and Malaysia. However, the increasing number of shooting cases in Malaysia recently should not be overlooked. This study was carried out to investigate the incidence of firearm-related deaths and epidemiology in Klang Valley for 11-year period. The demographic data on the incidence of firearm-related deaths from 2006 to 2016 was collected retrospectively from four government hospitals in Klang Valley. 204 cases of firearm-related deaths were reported with irregular trend of the incidence throughout the 11-year period. The results revealed that most victims were male, aged between 30 to 34 years old and Malaysian citizen. Firearms fatalities were higher among Malaysian specifically Indian, as compared to non-Malaysian. Most firearms fatalities were homicides and took place during late night between 12.00 am to 5.59 am. The highest cause of death was head injury due to gunshot wound. It is hoped that this study will raise awareness to Malaysian citizen regarding firearm-related cases and to develop strategies to overcome the issue of gun violence in Malaysia with appropriate authorities.

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A spring is a result of karsts topography where surface water has infiltrated the earth's surface recharge area, becoming part of groundwater and emerges from below to become natural spring water. From few observations, local people tend to consume this water directly for many health reasons. The objective of the study was to determine the concentration of lead (Pb) and cadmium (Cd) in natural water resources and bottled drinking water sources, and compared with the existing standard. This field assessment was carried out in 2014 as part of the educational module for public health master student. About 13 water samples were collected directly from the tubing into the pre-washed sample bottle and rinse with the sampling water in the field. Sample preservation was achieved by acidifying to pH less 4.0 with nitric acid (HNO3). Samples were stored in a cooler with temperature between 0 to 4oC. Heavy metals were analysed by standard method for graphite furnace atomic absorption spectrophotometer (GFAAS) with Zeeman’s correction. Pb and Cd content were analysed from 13 samples which consists of eight natural spring water and five flavoured bottled drinking water. The result showed that Pb content in spring water ranges between 1.8 and 37.3ppb, while the Cd content in spring water ranges between 3.0 and 23.0ppb. In the commercialised drinking water, the amount of Pb ranges between 0.4 and 2.6 ppb, while the content of Cd ranges between 0.8 and 7.0 ppb. This study indicates that there are high content of Pb and Cd in most of the natural spring water points and some bottled drinking water that are available within Klang Valley. In the absence of any specific point sources, the possibility of urban area and high traffic source leading to run off as well as rock types may result in variations observed. Hence, very worrying, especially that these sources of water were consumed directly as drinking water or eye drops without knowing its content. Further tests, coupled with supportive soil and conductivity studies, are required to test all possible similar natural sources to safeguard the health of people.

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BACKGROUND: Motorcycle fatalities constitute the majority of road traffic deaths in Malaysia. The aims of this study were to describe the pattern of fatal injuries among Klang Valley fatal motorcyclists and to describe the factors associated with fatal (vs non-fatal) injuries. METHODS: A cross-sectional analysis was performed on data from a case series of injured (fatal and non-fatal) motorcyclists recruited from Klang Valley between 14th March 2010 and 13th March 2011. Fatal cases in the cases series were identified from the Police files. Non-fatal cases were recruited from five major hospitals in the study region. Information used in the analyses were obtained from Police crash reports, hospital medical records, and Coroner's records of the participant sample. RESULTS: Of the 177 fatal cases, 142 (80.2%) were categorised as instantaneous death while 35 (19.8%) cases were categorised as experiencing delayed death. Thirty two percent of the cases had a Maximum Abbreviated Injury Score (MAIS) of 5 with head injury being the most common cause of death. Significant predictors of fatal (vs non-fatal) injury included ethnic groups, monthly income, alcohol and drug use and road type. Alcohol and drug use was shown to be the strongest predictor with adjusted odds ratio (AOR) of 14.77 (95% CI 3.32-65.65). CONCLUSION: Factors related to the motorcyclists, road user behaviour and the road environment as well as pre-hospitalisation emergency care must be addressed efficiently in low and middle income countries to reduce the number and severity of motorcycle-related injuries.

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An increase in physical activity is a key component for effective weight loss. It helps to control weight loss by using excess calories as well as boosting metabolism and lowering insulin levels. Physical activity also helps prevent many chronic diseases and improve the overall human health. The objective of this study was to assess weight loss practice using physical activity strategies among working women in Kuala Lumpur, Malaysia. A total of 639 adult Malaysian working women were screened and 120 respondents were identified based on their experience of losing at least 10% of their highest lifetime body weight, which is a criterion for successful weight-loss. Self-administered questionnaire was used to collect information from 120 successful weight loss respondents. Physical activity was measured by using International Physical Activity Questionnaire (IPAQ) short version. Results showed that 35.8% of women had low physical activity level; slightly above than one third of women (38.3%) had moderate activity level, while 25.8% women had high physical activity level.The most common physical activity monitoring strategies implemented were exercise at least 30 minutes per day (22.5%) and incorporate physical activity into daily life (21.7%). A total of 70.8% women regained weight after significant weight loss. A total of 40.0% who regained weight as compared to 25.7% of those who did not regain weight were physically inactive (p=0.138). There was no statistically significant different in daily sitting time between the two groups (p=0.627). As a conclusion, government working women in Kuala Lumpur have low to moderate physical activity levels. Majority women regained weight after significant weight loss. Common strategies to lose weight are exercise at least 30 minutes per day and incorporate physical activity into daily life. More education and promotion regarding the importance of physical activity should be done to all community members especially to the government working women.

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BACKGROUND: Diego blood group antigen, Di(a), is very rare among Caucasians and Blacks, but relatively common among the South American Indians and Asians of Mongolian origin. The antibody to Di(a) is clinically significant to cause hemolytic disease in a new-born or hemolytic transfusion reaction. OBJECTIVES: This study was designed to determine the prevalence of Di(a) antigen among the blood donors from the three major ethnic groups in Klang Valley of Malaysia as well as to find an incidence of an antibody of the Diego antigen, anti-Di(a), in a tertiary care hospital to ascertain the need to include Di(a+) red cells for an antibody screen cell panel. MATERIALS AND METHODS: Serological tests were performed by column agglutination technique using commercial reagents and following instruction as per kit insert. RESULTS: Di(a) antigen was found with a frequency of 2.1% among the Malaysians donors in three ethnic groups viz, Malay, Chinese and Indian. It was present among 1.25% of 401 Malay, 4.01% of Chinese and 0.88% of 114 Indian origin donors. None of the 1442 patients, including 703 antenatal outpatients, had anti-Di(a) in serum. CONCLUSION: The prevalence of Di(a) antigen was found among the donors of all the three ethnic background with varying frequency. Inclusion of Di(a+) red cells in routine antibody screening program would certainly help in detection of this clinically significant antibody and to provide safe blood transfusion in the Klang Valley, though the incidence of antibody appears to be very low in the region.

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This cross-sectional study investigates the association between energy intake and macronutrient composition of the diet with overweight and obesity among Malaysian women. One hundred and fifteen adult Malay women aged 20 to 59 years (mean age 37.2±7.6 years) were interviewed. Dietary intake was assessed using the food history method. Body weight status was assessed using weight, height, waist circumference and fat percentage measurements. When energy intake was assessed for accuracy, only 41% of the subjects (n=47) were normal energy reporters. Among the normal energy reporters, 55% were of normal weight whereas 32% and 13% were overweight and obese. Mean energy intake for normal weight, overweight and obese subjects was 1685±199 kcal/day, 1810±166 kcal/day and 2119±222 kcal/day, respectively. Energy intake increased with body mass index (BMI) category. Among the overweight and obese, energy intake was respectively higher by 125 kcal/day and 434 kcal/day as compared to their normal weight counterparts (p<0.001). There was also a significant, moderate and positive correlation between energy intake and BMI (r=0.635), waist circumference (r=0.545), and body fat percentage (r=0.534). When macronutrient composition of diet was analysed (% energy and g/1000 kcal), there was no significant difference in carbohydrate, protein or fat intake between the obese, overweight and normal weight subjects. There was also no significant correlation between macronutrient composition of the diet and body weight status. Based on these findings, we conclude that the subjects’ body weight status is likely to be influenced by energy intake rather than the macronutrient composition of the diet.