Malay Ethnicity Research Articles

Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study.

Excessive screen time interferes with the health and development of children. However, the screen time situation among Malaysian children remains poorly understood. This study aims to identify the prevalence and determinants of excessive screen time among children under five years in Selangor, Malaysia, using the latest World Health Organization guidelines. In this cross-sectional study, 489 parent–child dyads were randomly selected from nine government health clinics in Petaling district, Selangor. Total screen time and factors were assessed using validated self-administered questionnaires and analysed using multiple logistic regression. The overall prevalence of excessive screen time was 91.4% with a median of 3.00 h. The majority of children utilized television (66%), followed by handheld devices (30%) and computers (4%). Determinants of screen time identified were Malay ethnicity, (aOR 3.56, 95% CI 1.65–7.68), parental age of ≥30 years (aOR 3.12, 95% CI 1.58–6.16), parental screen time >2 h a day (aOR 2.42, 95% CI 1.24–4.73), moderate self-efficacy to influence a child’s physical activity (aOR 2.29, 95% CI 1.01–5.20) and the positive perception on the influence of screen time on a child’s cognitive wellbeing (aOR 1.15, 95% CI 1.01–1.32). Parents play an important role in determining their child’s screen time. Future interventions should focus on addressing parental determinants to ensure age-appropriate screen time.

Factors influencing fear of falling in community-dwelling older adults in Singapore: a cross-sectional study

BackgroundFear of falling (FoF) has far-reaching implications including activity restriction, functional decline and reduced quality of life. It is a common consequence of falls but may be present even in non-fallers. This study aimed to determine the factors associated with FoF in a segment of Singapore’s community-dwelling older adults.MethodsThis descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors, clinical factors such as multi-morbidity, falls characteristics such as history of falls, injuries, and reasons for falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale–International (Short FES-I), cut-off score of 14 and above indicated high FoF. Logistic regression was used to determine factors associated with high FoF.ResultsOut of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history of falls in the past six months. Almost half (43.1%) were mildly to moderately frail and most (80.6%) had multi-morbidity. The mean FoF score was 15.5 (SD 5.97) and 60.8% reported high FoF. There were statistically significant differences in age, gender, ethnicity, marital status, educational level, use of walking aid, multi-morbidity, frailty status, history of falls within six months and reason for falls between patients who had high FoF versus those who had moderate or low FoF. Logistic regression found that Malay ethnicity (OR = 5.81, 95% CI 1.77–19.13), marital status, use of walking aids (OR = 3.67, 95% CI = 1.54–8.77) and frailty were significant factors associated with high FoF. Compared to those who were never married, the odds of high FoF were significantly higher in married older adults (OR = 6.75, 95% CI 1.39 to 32.76), those who were separated or divorced (OR 10.40, 95% CI 1.13 to 95.76) and those who were widowed (OR = 7.41, 95% CI 1.51 to 36.41). Compared to well older adults, the odds of high FoF were significantly higher in pre frail older adults (OR = 6.87, 95% CI = 2.66–17.37), mildly frail older adults (OR = 18.58, 95% CI = 4.88–70.34) and moderately frail older adults (OR = 144.78, 95% CI = 13.86–1512.60).ConclusionsThe study found that pre frail to moderately frail older adults as determined by CFS have significantly higher risk of high FoF. The demographic factors such as marital status and ethnicity and falls characteristics associated with FoF in this study will be helpful to develop targeted and tailored interventions for FoF.

Replacing dietary carbohydrates and refined grains with different alternatives and risk of cardiovascular diseases in a multi-ethnic Asian population

Cardiovascular diseases (CVDs) are a major cause of deaths worldwide, but prospective data on dietary risk factors for CVD in South and Southeast Asian populations are sparse. We aimed to evaluate the relation between macronutrient and food intakes and incidence of major adverse cardiovascular events (MACEs) in a multi-ethnic Asian population. We used data from the Singapore Multi-Ethnic Cohort (n=12,408), a prospective cohort of ethnic Chinese, Malay, and Indian adults aged 21‒65 y recruited between 2004 and 2010. Dietary intakes were assessed using a validated food-frequency questionnaire, and the incidence of MACEs was ascertained through data linkage with national registries. A Cox proportional hazards model was used to evaluate the associations between dietary intakes and MACE risk. Over a mean (SD) follow-up of 10.1 (2.3) y, 746 incident cases of MACEs were documented. We observed a direct association between carbohydrate intake and MACE risk (highest vs. lowest quartile, HR: 1.35; 95% CI: 1.07, 1.71; P-trend = 0.001). Replacing 5% of energy from carbohydrate with polyunsaturated fat (HR: 0.79; 95% CI: 0.69, 0.91) but not saturated fat (HR: 0.95; 95% CI: 0.84, 1.09) was significantly associated with a lower MACE risk. In terms of food groups, replacing 1 serving/d of refined grains with fruit (HR: 0.93; 95% CI: 0.87, 0.99), vegetables (HR: 0.92; 95% CI: 0.85, 1.00), and dairy (HR: 0.90; 95% CI: 0.82, 0.98) was associated with lower MACE risk. Cholesterol intake was associated with a higher MACE risk in ethnic Indians (highest vs. lowest quartile, HR: 2.40; 95% CI: 1.53, 3.75; P-trend<0.001) but not in ethnic Malay or Chinese (P-interaction = 0.015). Moderating carbohydrate intakes by increasing polyunsaturated fat intake and replacing refined grains with fruits, vegetables, and dairy was associated with lower MACE risk in Asian populations.

Recognition of diabetes and sociodemographic predictors: results of a cross-sectional nationwide population-based survey in Singapore

ObjectiveTo assess recognition of diabetes among a nationally representative multiethnic sample of Singapore’s general public. Also, to explore the sociodemographic predictors associated with the ability to correctly recognise diabetes.Design and...

Nap patterns of children in kindergartens and childcare transit facility: a study in northern Peninsular Malaysia.

ObjectiveThe purpose of this study was to compare the duration of sleep and nap patterns between children in private kindergartens and those in a tabika-transit facility, in Malaysia.MethodsThe sleep duration of children aged 3-6, who attended either a kindergarten or a childcare transit facility (tabika-transit in Malay) was investigated. Observational sleeping records were maintained for 24 hours, over 14 consecutive days. A self-administered questionnaire for caregivers investigated the children’s lifestyles. Naps were optional at kindergartens but mandatory at the tabika-transit.ResultsOf 35 participating children, data from 33 were analyzed. All respondents belonged to the Malay ethnicity, with 16 boys (48.5%) and 17 girls (51.5%). The average age of the children was 5.4 years; 11 of them were from kindergartens and 22 from a tabika-transit. The children slept longer and woke up later on weekends than on weekdays. There was a significant difference in the naptaking rate between the two groups; it was 100% in the tabika-transit, and 30% in the kindergartens during weekdays. However, on weekends, 19 of 22 tabika- transit children did not nap on any of the days (86.4%). The kindergarten group’s naps showed no outstanding differences between weekdays and weekends. Concerning the bedtime and wake-up times, no differences were found between the two groups.DiscussionDuring weekdays, all children in the tabika-transit took naps, whereas one-third of them did in the kindergartens. Larger study is needed to assess how this mandatory napping style affects children’s lifestyle and development.

The Analysis of Students’ Interest in A State Vocational High School (SMKN) 3 Based on Ethnics in Singkawang

&lt;em&gt;This research aims to find out the students' interest in studying in State Vocational High School 3 of Singkawang based on ethnics that live in Singkawang which area consists of Dayak, Malay, Madura, and Chinese. The qualitative method was used in this research. The subjects of this study were 5 students from each ethnic which the total of them are twenty students who were considered able to represent and provide the data needed by researchers. The object of the study was students' learning interests based on Dayak, Malay, Madura, and Chinese ethnics. In this study, sampling techniques were used purposive sampling techniques. The data analysis in this study used the Miles and Huberman model by collecting data at the time the learning process takes place, and after completion of data collection within a certain period. The results of this study showed that students' learning interests based on ethnics were: (1) students who come from the Dayak ethnic tend to be more enthusiastic and interested in learning if the teachers who teach are from the same ethnic and have a tendency to only be interested in certain lessons in their field; (2) most students from the Malay ethnic have a high interest in learning in all the lessons in their field and a tendency to like teachers who have different ethnics; (3) Madura students have a higher learning interest when they were taught by teachers from the same ethnic and most students only interested in certain lessons, (4) most students from Chinese ethnic do not mind the ethnic background of the teacher who teaches and they have very high enthusiasm and interest in pursuing their field.&lt;/em&gt;

Prevalence and predictors of metabolically healthy obesity in severely obese Asian children.

Obese individuals who have little or no metabolic syndrome components are proposed to be "metabolically healthy obese (MHO)". This study aim to evaluate the prevalence of MHO and examine the predictors associated with MHO in a multi-ethnic Asian cohort of severely obese children. This study included a cross-sectional cohort of 406 Chinese, Malay and Indian children aged 5-20 years old with BMI for age ≥ 97th percentile. Metabolic syndrome (MS) and metabolic health (MH) definitions based on the presence or absence of metabolic abnormalities (High triglycerides, low HDL cholesterol, elevated blood pressure and high glucose) were used to define MHO in the cohort. The prevalence of MHO is 63.5% by MS definition and 22.4% by MH definition. Maternal healthy metabolic status (OR: 2.47), age (OR: 0.83, 0.80), paternal obesity (OR: 0.48, 0.53), Malay (OR: 1.97) and Indian ethnicity (OR: 6.38, 3.21) (compared to Chinese ethnicity) are independent predictors for MHO phenotype based on different MHO definitions. Adiposity measures are not associated with MHO phenotype, but instead younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype in a multi-ethnic Asian cohort of severely obese children. The prevalence of metabolically healthy obese (MHO) in our multi-ethnic Asian cohort of severely obese children is 63.5% and 22.4%, respectively, based on different MHO definitions. Adiposity measures are not associated with the MHO phenotype. There are other factors that contribute to the metabolic phenotype in obese individuals. Younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype. Parental influence is important in predicting metabolic health in obese individuals.

Ethnic differences in serum testosterone concentration among Malay, Chinese and Indian men: A cross-sectional study.

To investigate non-urological patients with multiple comorbidities for factors contributing towards differences in testosterone concentration in multiethnic Malaysian men. An observational study. Sexually active men, ≥40 years, with no known urological problems, were recruited at the phlebotomy clinic at our centre. A brief history along with latest fasting lipid profile and plasma glucose levels were obtained. An Aging Male Symptoms questionnaire was administered; waist circumference (WC) and serum testosterone concentration were measured. Analysis of testosterone concentration between Malay, Indian and Chinese men was performed. Statistical tests such as analysis of variance, χ2 test, univariate and multivariable regression were performed. Any p < .05 was noted as statistically significant. Among the 604 participants analysed, mean testosterone concentration was significantly lower in Malays (15.1 ± 5.9 nmol/L) compared to the Chinese (17.0 ± 5.9 nmol/L) and Indian (16.1 ± 6.5 nmol/L) participants. The mean WC was also found to be higher among the Malays (96.1 ± 10.9 cm) compared to Chinese (92.6 ± 9.6 cm) and Indians (95.6 ± 9.9 cm). Testosterone concentration tended to be lower with higher age, but this was not statistically significant (p > .05). In the multivariable analysis only Malay ethnicity, WC ≥ 90 cm and low high-density lipoprotein (HDL) were associated with lower testosterone concentration. In this study, Malaysian men of Malay origin had lower testosterone concentration compared with Indian and Chinese men. WC and low HDL were also associated with lower testosterone concentrations.

Single center experience of transcatheter aortic valve implantation in severe aortic stenosis: study of mid-term clinical outcome

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) had revolutionized the treatment and outcome of symptomatic severe aortic stenosis (AS) since its introduction. In 2009, our center performed the first TAVI in Malaysia and since then it has provided an alternative treatment for severe AS patients. The objective of the study is to evaluate the clinical outcome of severe AS patients who had undergone TAVI in our center. METHODS A retrospective observational study was conducted. All TAVIs performed in our center between 01 Jan 2009 and 31 December 2020 were included. Patients’ baseline characteristic, clinical outcomes post procedure at 1-year and 3-year mortality were studied. Data were collected by using case report form and reviewing patient’s case note. RESULTS A total of 107 patients had TAVI performed during this period of time. The mean age (±SD) was 77.4 ± 5 (range 61-90 years). 50.5% of the patients were male (n = 54) and 45.8% were Malay ethnicity (n = 49). Majority of the patients had hypertension (86.9%, n = 93), dyslipidaemia (84.1%, n = 90) and ischemic heart disease (60.7%, n = 65). 26.2% of patients (n = 28) had previous coronary artery bypass surgery and 2.8% of patients (n = 3) had previous valvular operation. 85.9% of patient was in NYHA II – IV (n = 92). Mean EuroScore II and STS score were 4.82 and 4.564 respectively. Average hospitalization stay was 5 days. Total of 60 (56.1%) CoreValve were deployed followed by 46 Edwards Sapien (43%) and 1 MyVal (0.9%). 89.7% of procedure was performed via transfemoral access (n = 96) followed by transapical (6.5%, n = 7), transaortic (2.8%, n = 3) and subclavian (0.9%, n = 1). 98.1% (n = 105) procedure was successfully performed. There were 6 in-hospital mortality (5.6%) during indexed TAVI admission, of which 5 out of 6 were TAVI related. Kaplan Meier analysis of predicted survival rate with freedom from all-causes mortality at 1 year was 86.9% and 73.7% at 3 years. CONCLUSIONS Untreated severe AS was associated with poor outcome. High success rate of TAVI had provided another option of treatment to severe AS patient who are not the suitable candidate for surgical intervention.

Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study

ObjectivesWomen with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM)...

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours.

BackgroundAdolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.MethodsWe conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13–18 years were included in the study. The data were analysed using STATA (v.15).ResultsThe prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.ConclusionOur findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

An Update on Vitamin D Deficiency Status in Malaysia.

Vitamin D is essential for maintaining serum calcium levels, ensuring sufficient bone mineralization, immunomodulatory properties, and a protective effect on the cardiovascular system, renal disease, cancer, as well as in pregnancy. Vitamin D deficiency is prevalent worldwide, and it is not related to a country’s development index. However, the data on vitamin D deficiencies are primarily taken from out-of-date, small-scale studies on target age groups or specific diseases, rather than from large-scale, population-based surveys. In Malaysia, for the past 16 years, studies were conducted involving adult men and women, pregnant women, postmenopausal women, adolescent, and children especially with specific diseases such as spina bifida, epilepsy, chronic liver disease, and atopic dermatitis. Only a few large surveys were conducted involving children and adolescents. Across the specific target population studied, vitamin D deficiency and insufficiency were seen particularly among females, Indians, and those of Malay ethnicity. This is related to widely known causes of vitamin D deficiency such as skin type (melanin) and sun avoidant lifestyles that include covering clothes, largely practiced by Malay Muslims in Malaysia. Other related causes or the high-risk groups are breastfed infants, the elderly, the obese, those on medications, and those characterized by fat malabsorption and geophysical factors. Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches, depending on the severity. The objective is to raise serum vitamin D to a normal level, hence, relieving the symptoms and reducing the adverse health outcomes. Despite no clear guidelines in treating vitamin D deficiency in Malaysia, this condition can be prevented with taking adequate vitamin D in food resources, sun exposure, or supplementation. Special attention should be given to high-risk groups including infants, obese patients, and the elderly.

Intention and practice on breastfeeding among pregnant mothers in Malaysia and factors associated with practice of exclusive breastfeeding: A cohort study.

BackgroundExclusive breastfeeding rate in Malaysia is low despite its known health benefits. This study aims to determine the prevalence of intention to breastfeed among pregnant mothers, the prevalence of exclusive breastfeeding practice after delivery, and factors associated with exclusive breastfeeding practice.MethodsThis was a prospective cohort study. All pregnant women at 36 weeks gestation or above from 17 antenatal health clinics in an urban district were invited to participate in the study. A self-administered questionnaire was used, encompassing sociodemographic, breastfeeding knowledge, attitude, and intention towards the practice of breastfeeding. The participants were followed up one month post-natal for their practice of breastfeeding via telephone or during their post-natal follow-up appointment.Results483 pregnant mothers participated in the study initially. 462 (95.7%) were contactable after one month. 99.4% (459/462) of participants intended to breastfeed. 65.4% (302/462) of participants practiced exclusive breastfeeding. There was no significant association between intention and practice of exclusive breastfeeding. Multiple logistic regression analysis shows, pregnant mothers with high breastfeeding knowledge (AOR = 1.138; 95% CI 1.008–1.284) and Malay ethnicity (AOR = 2.031; 95% CI 1.066–3.868) were more likely to breastfeed their infant exclusively.ConclusionsPrevalence of exclusive breastfeeding practice at one month in the studied district was 65.4%. Malay mothers and mothers with high breastfeeding knowledge were more likely to breastfeed exclusively. Thus, we recommend targeted intervention towards non-Malay mothers and increasing breastfeeding knowledge to all pregnant mothers.

Seroepidemiological survey of the prevalence of Helicobacter pylori infection in Sabah, Malaysia

Gastric cancer is an important cause of mortality in Sabah, Malaysia, but the prevalence of Helicobacter pylori infection in this state is unknown. Serology is an important tool for the surveillance of H. pylori infection. The objective of this study was to determine the prevalence of H. pylori infection by serology, and to provide information for policy discussions on H. pylori control programmes in Sabah. This cross-sectional study analysed serum samples collected from blood donors in a hospital in Kota Kinabalu, Sabah. H. pylori antibody concentration was measured using a commercially available kit. The prevalence of H. pylori was 28.4% (204/718), and the infection rate was highest in subjects aged 30-39 years. Men were more likely to be infected than women. The H. pylori infection rate was highest among those of Kadazan (19.1%) ethnicity, followed by Dusun (15.7%), Bajau (14.7%) and Rungus (10.8%). Binary logistic regression analysis indicated that Chinese (P=0.026) and Malay (P=0.035) ethnicities were protective against H. pylori infection compared with other ethnicities. The seropositivity rate of H. pylori in this study was similar to the overall seropositivity rate in Malaysia; however, Chinese and Malay ethnicities were found to be protective against H. pylori infection.

COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study.

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO).Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test.Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00–3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28–0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29–9.70).Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Political support in an ethnically divided society: a case study of Malaysia

ABSTRACT Many studies have identified ethnic divisions as an obstacle to successful democratization. The present study examines political attitudes among ethnic majority Malays and two minority communities, Chinese and Indians, in Malaysia, a country which took a step toward democratization with a change of national government in 2018, yet seems to have reverted to single-party dominance. Utilizing survey data from 2006 to 2019, we compare attitudes at four levels of political support among the three ethnic communities: rejection of authoritarian regimes, confidence in public institutions, engagement in channels of political participation, and national pride. The availability of data collected after 2018 allows us to detect changes following the country’s first national-level power alternation. Empirical analysis reveals that in recent years the Chinese are significantly more likely to reject non-democratic regime alternatives to democracy compared with the ethnic majority Malays. Moreover, the Chinese community's long-held distrust in the government, parliament, judiciary and civil service has faded by 2019, suggesting a change of attitude brought by the 2018 election. On the other hand, while all three ethnic groups express some degree of national pride in the surveys, ethnic minorities are less likely to be very proud of being Malaysian compared with ethnic Malays.

Characteristics of eye injuries, medical cost and return-to-work status among industrial workers: a retrospective study

ObjectiveThe aim of this study is to determine the characteristics of eye injuries, medical costs and return-to-work status among industrial workers to provide better vision rehabilitative services.SettingNationwide data from the...

Allogeneic Hematopoietic Stem Cell Transplantation in Severe Aplastic Anemia: A Single Centre Experience in Malaysia.

Hematopoietic stem cell transplantation (HSCT) provides curative therapy in almost 90% of patients with severe aplastic anemia (SAA). Older age, long duration of disease with consequent heavy exposure to transfusion, and active infection at the time of HSCT have a negative influence on the outcomes, causing graft failure (GF) and graft versus host disease (GVHD). To describe the outcomes of all patients with SAA who received hematopoietic stem cell transplantation at a tertiary center in Malaysia. We included a 20 y cohort of patients who underwent transplantation from January 1, 1999 to December 31, 2019. Data were obtained from electronic medical records. Demographics, clinical characteristics, and treatment outcomes were analyzed using descriptive statistics. Overall survival (OS) was analyzed using Kaplan-Meier curves. All analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 25. Eighty patients were analyzed. The median age at diagnosis was 19 years, and 59% patients were male (n = 47). Malay ethnicity was the highest (52.5%), followed by Chinese (20.0%) and Native Sabah (15.0%). The median duration from diagnosis to transplantation was 13.5 weeks. A majority of patients received Cy-ATG conditioning (n = 51, 63.8%). Forty-one patients (51.2%) used peripheral blood as stem cell source, 36 patients (45.0%) used granulocyte colony stimulating factor (G-CSF) primed marrow graft and 3 patients (3.8%) used both. The mean nucleated mononuclear cell and CD34 cell doses were 4.7 ± 1.7 × 108/kg and 4.6 ± 1.9 × 106/kg, respectively. Median engraftment for WBCs and platelets was 14 and 15 days, respectively. There was no difference in WBC and platelet engraftment in patients who received peripheral blood stem cell transplantation or bone marrow transplant. At a median follow-up of 54 months, 49 patients (61.3%) achieved complete remission and 8 patients (10.0%) achieved partial remission. The estimated 5 y OS was 63% and higher among those who received HSCT within 3 months of diagnosis. Twenty-two patients (27.5%) died within 100 d of transplantation, and a majority of these died due to pre-engraftment death. Our study found that patients who received early allogeneic transplantation for SAA had better outcomes. Pre-engraftment failure was the major cause of transplant-related mortality within 100 d. Further studies are required to identify the factors responsible for delaying transplantation to improve treatment outcomes.

Autoimmune Haemolytic Anaemia: A cross sectional study in a Tertiary Haematological Centre

Autoimmune haemolytic anaemia (AIHA) is a group of disorders wherein autoantibody causes decompensated acquired haemolysis. There has been no epidemiological study of autoimmune haemolytic anaemia (AIHA) in Malaysia. This study retrospectively analysed the epidemiology of AIHA including Evan’s Syndrome in a Tertiary Haematology Centre in Malaysia. Patients diagnosed with AIHA and Evan’s Syndrome at 18 years old and above between 1 January 1994 to 1 October 2020 at the out-patient Haematology Clinic of Hospital Raja Permaisuri Bainun, Ipoh were selected. Patients’ information was retrieved from the outpatient clinic records. A total of 71 patients were included of which predominantly female. The mean age for both genders were comparable. Ethnic stratification revealed AIHA was higher in Malays followed by Chinese and Indian. Warm AIHA was most prevalent at 40.8%, compared to cold AIHA and Evan’s Syndrome (both 23.9%), and mixed AIHA (11.3%). Primary was more common than secondary AIHA followed by Evan’s Syndrome. Approximately half of the secondary AIHA and secondary Evan’s Syndrome were due to SLE. Overall, 67.6% of patients received corticosteroid only and 28.2% combined with immunosuppressant. Individuals at higher age and females have higher risk of developing AIHA and Evan’s Syndrome. The highest prevalence was seen among the Malay ethnic. Primary warm AIHA is the most common type and majority of Evan’s syndrome are secondary to autoimmune diseases.

Prevalence, characteristics, and predictors of healthcare workers with COVID-19 infection in an urban district in Malaysia.

Introductionhealthcare workers (HCWs) are at high risk of acquiring COVID-19 occupational transmission and subsequently, exposing patients and others. This study aimed to determine the prevalence and examine the characteristics and predictors of HCWs with COVID-19 infection in a Malaysian district.Methodsthis is a cross-sectional study of HCWs working at Cheras District Health Office, with COVID-19 infection from 1st January to 31st October 2021. Data was obtained from the Occupational Safety and Health Unit which included variables of basic sociodemography, type of disease acquisition; healthcare-acquired (HA) or community-acquired (CA), and management outcome. Data was analysed descriptively and cases with type of disease acquisition were compared using logistic regression.Resultsthe prevalence of HCWs with COVID-19 was 17.4%. Majority aged 30-39, female gender and Malay ethnicity (51.7%, 60% and 91.7% respectively). Main comorbidities included hypertension (3.3%), diabetes mellitus (3.3%), both hypertension and diabetes mellitus (2.5%) and obesity (4.2%). Smokers, pregnant mothers and non-immunized made up only small proportions (4.2%, 4.2%, and 4% respectively). Paramedics were the most infected proportion (68.4%). About one third of cases managed COVID-19 patients directly (37.5%). Similar proportion had HA infection (29.2%). Smaller proportion (12.8%) needed hospitalization. The early source of infection was HA (January-April). Later, the trend shifted towards CA (May-October). Male gender (OR 3.22, 95% CI = 1.43 - 7.29, p<0.05), smoker (OR 10.84, 95% CI = 1.17 - 100.77, p<0.05), and those who manage COVID-19 cases were more likely to acquire occupational COVID-19 infection (OR 2.28, 95% CI = 1.02 - 5.09, p<0.05).Conclusioncontinuous occupational infectious disease control measures is necessary to reduce the disease burden. Future research on HCWs with COVID-19 infection with larger scale is recommended to determine the final model for predictors of infection.