Supplement Issue Research Articles

Evaluation on Triaging Pathway Strategy Guidelines for Cases with Elipidae Bite during COVID-19 Pandemic at Emergency Department

Introduction: Emergency departments (ED) typically practice a triage system to classify patients into priority levels. A triage system is commonly used in crowded emergency rooms to determine which patient should be seen and treated immediately.Objective: The objective of this study was to evaluate the effectiveness of triaging pathway guidelines for critical cases seen in the Emergency Department during the COVID-19 outbreak.Case Presentation: Emergency Department, Taiping Hospital is practicing a triaging system which consists of two divisions; cases with respiratory symptoms (SARI) and cases without symptoms of respiratory impairment (non-SARI). A patient with snake bite was presented at the Emergency Department, Taiping Hospital with symptoms of numbness at the site of the bite and a complaint of difficulty to open the eyes, while tachycardia was noted. However, no shortness of breath or difficulty in breathing was reported. COVID-19 rapid screening was done and the patient was treated under Red Zone (non-SARI). Luckily, the patient survived and was stable with no reaction observed after treated with Neuro Polyvalent Antivenom 50ml in 500ml normal saline over one hour.Conclusion: The available patient triaging pathway strategy guideline was effectively practiced by paramedics when managing critical cases at the Emergency Department during COVID-19 outbreak. Other emergency departments are advised to practice effective and appropriate triaging pathway strategy guidelines to save patients’ lives.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S15

The Importance of Clinical History Taking when Assessing Patient Suspected Positive COVID-19

Introduction: COVID-19 pandemic is an on-going devastating global event. It starts from December 2019 and is yet to resolve. To date, there are more than 25 million people diagnosed and 850 thousand deaths with COVID-19 (CDC, 2020). Healthcare services throughout the world are facing immense challenges. History taking has been inevitably the most emphasized tool in approaching all patients. However, the usefulness of medical history strongly depends on the patient’s story offered. Incorrect or hidden history may not only bring wrong diagnosis but endanger health care personnel.Objectives: This case series is aimed to describe the importance of clinical history-taking in assessing patients associated with COVID-19 symptoms or history.Methods: Assessment through interview method in taking patient history was used. The focus of history taking was related to health and COVID-19 history. The data collected is a type of secondary data from medical reports of patients who come to receive medical services at the Emergency and Trauma Department, General Public Hospital Taiping, Perak. A total of three cases are taken using the purposive sampling technique. Data is analysed and presented in the form of qualitative data.Results: This study found that the clinical history taking through interview method has successfully identified three patients with positive COVID-19 through assessment conducted.Conclusion: Therefore, the study proved that effective history taking implemented by paramedics was able to identify patients with positive COVID-19 and to plan an appropriate management and help them get discharged without complications. All physicians and other health care practitioners in the Emergency Department or in the clinical ward are also advised to be more competent by increasing their level of knowledge and skills related to assessing patients through effective clinical history taking.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S13

Vaccination Knowledge and Perception among Pharmacy Undergraduates in a Northern Public University in Malaysia

Introduction: Worldwide, pharmacists are one of the advocates and practitioners which are commonly overlooked in improving vaccine hesitancy.Objectives: The aim of this study is to explore the vaccination knowledge and perception level as well as the sources of information sought, to support the importance in including the topic within the existing pharmacy curriculum.Methods: A cross sectional study using a validated and tested 43-itemed questionnaire were conducted among pharmacy students in USM. It included 4 domains of demographic data, knowledge on vaccination, perception towards vaccination and source of information on vaccination. Scoring and grouping of knowledge and perception level is based on modified Bloom’s cut-off point. A confidence interval of 95%, p value ≤ 0.05. Chi-square, ANOVA and the Kruskal-Wallis test were considered for the analysis of data.Results: Among 478 eligible pharmacy undergraduates, 311 (65%) participated and completed the questionnaire with a majority of female’s respondents (76.5%). Nearly 72.1% of the students had fair level of knowledge and 90% had good perception level towards vaccination. Online resource shown to be the favourable source of information onvaccination(84.2%). Furthermore, there was a statistically significant knowledge difference across the age, study year and races, (p=.02), (p<0.05) and (p<0.05) respectively. On the other hand, the level of perception shown to have a significant association with nationality (p=0.016), gender (p=0.049) and race(p=0.002).Conclusion: Majority of the students were shown to have fair knowledge and good perception towards vaccination, suggesting the need of implementing vaccination content delivery in the existing curricula to ensure better understanding and practice towards vaccination advocacy.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S28

Forum Panelist 1: COVID-19 Response: BBNGO ‘crossing’ the nationality borders

The Movement Control Order (MCO) due to the COVID-19 Pandemic implemented on18 March 2020 for Malaysia and the closing of the borders between Malaysia and Thailand caused a lot of strain on the Thai citizens working in Malaysia. Many of them were unable to do their usual job especially in the restaurants all over Malaysia.Efforts were taken by the NGOs and its sponsors in Thailand to relieve the Thai citizens’ suffering. On the 13th of April an agreement was signed between the Thai Islamic Medical Association of Thailand and ‘PertubuhanGabunganBantuanBencana NGO’ Malaysia (BBNGO) to support the Thai citizens in their daily life due to the difficulties during the MCO. Majority of those affected were the restaurant workers.According to reports there were about 40,000 Thai workers in Malaysia, most of whom worked in restaurants. On 18th April 2020 The Malaysian-Thai border was opened limitedly via five checkpoints, only 350 Thai citizens were allowed to cross each day. By early May 2020 more than 7,200 Thais have crossed the border including 2,100 who entered illegally by foot or small boats.Through the agreement between TIMA and BBNGO more than 400 packs of food supply were delivered to the Thai citizens mainly in Kelantan, Terengganu, Pahang, Penang, Perlis and Kedah. Information about their addresses and phone numbers were provided. Some were delivered direct to their homes while in some areas, they were asked to collect supplies from the nearby sundry shops. Knowing the difficulty of movement between districts during the MCO, the help of local NGOs was very much needed. The ‘Pertubuhan Ikram Malaysia’ (through its Yayasan Ikram/I-Bantu), having branches in many districts of Malaysia became our main partner. The SOPs were maintained during the deliveries. Due to our good, continuous cooperation and relationship since our engagement in the 2014 flood in Kelantan and the 2016/17 flood in Southern Thailand, we have managed to implement several humanitarian missions and social activities with the Thai Islamic Medical Association and its partners. Other BBNGO activities during the MCO include aid for the university students, fresh cooked food for the front-liners, preparation of PPEs, food supply for the poor and needy.COVID-19, you are a blessing in disguise; you bring our hearts together may it be citizens or non-citizens, people of all races and religion. May Allah blessthe human race and its submission to God.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S6

Knowledge of Postnatal Care among Confinement Ladies in Malaysia during COVID-19 Pandemic: A Pilot Study

Objective: This study aims to evaluate the knowledge of postnatal care among confinement ladies in Malaysia and assess the effectiveness of an intervention workshop.Methods: A quasi-experimental study was conducted among 65 confinement ladies residing in East Coast Malaysia. Among them, 36 ladies were purposely selected to participate in a workshop, while 29 ladies were selected using a snowball sampling method to be in the control group. A validated Malay translation of Knowledge on Postnatal Care for Mothers and Care of the Newborn Questionnaire was used. Data were analysed using IBM SPSS Statistics (Version 25). Multiple logistic regression was employed to determine factors associated with baseline knowledge. Repeated measure ANCOVA was used to measure the effectiveness of the intervention workshop.Results: Overall, the mean (SD) age of the respondents was 46.23 (8.49) with mean (SD) number of children of 4.0 (2.0) and working experience as confinement ladies of 36.0 months (20.24). Majority (77.1%) were married, from B40 group (91.4%) and received at least secondary education (77.1%). Confinement ladies who received secondary and tertiary education were found to have higher knowledge scores compared to those with primary education (p=0.026 and p=0.049 respectively). There was a significant increase in knowledge of postnatal care scores in those attending the postnatal care workshop (p <0.001)Conclusion: Education level plays an important role in determining the level of knowledge of a confinement lady. The workshop conducted was effective in improving the postnatal care knowledge among confinement ladies. Hence, more interventional programs should be held in the future.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S22

Second Wave of COVID-19 Pandemic in Malaysia and the Impact on Nuclear Cardiology Services: An Institutional Experience

Introduction: Nuclear cardiology applying radioactive tracer and hybrid imaging techniques are able to provide information needed to detect and evaluate ischaemic heart diseases. In our centre, nuclear cardiology services involving stress and rest myocardial perfusion scans and viability studies contribute about 40% of overall scan workload. The second wave of COVID- 19 pandemic in Malaysia announced by the end of February 2020 has affected nuclear cardiology services.Objectives: Our aims were to determine the impact of COVID-19 pandemic second wave on the nuclear cardiology imaging studies performed as well as to ascertain crucial institutional experience especially unavoidable problem and adjustment during the period.Methods: A review of Technetium-99m tetrofosmin radiopharmaceutical dispensing data and scan records for 1st February to 31st August 2019 and 2020 was conducted at Nuclear Medicine Department, Hospital Kuala Lumpur. Figures were compiled and statistical analysis done. Survey and focus discussion conducted involving nuclear medicine physicians, pharmacists and physic officers to identify the main difficulty faced and most important Job-adapting measure taken.Results: A total of 1109 cardiac radiopharmaceutical doses dispensed during the studied period but were less when compared to 1342 doses dispensed last year. Significant reduction was noted in April and May 2020 with only 69 and 67 cases respectively in comparison with monthly average of 192 cases in 2019. Although some scan appointments were postponed to avoid the usual waiting area congestions, the main difficulty faced was Technetium-99m generator supply disruption with limited production in Europe and international transportation restriction. Implementing infection control standard operating procedure (SOP) instructions as part of routine work practice with emphasis of time, distance and shielding concept was the most important Job-adapting measure.Conclusion: Nuclear cardiology services were affected by the second wave of COVID-19 pandemic locally. Main problem ascertained was disruption of radioactive supply. Most important adjustment was infection control SOP implementation.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S25

Medical Problems Among Rohingya Refugees and Medications Prescribed During IMARET Clinic Visits in Kelantan

Introduction: For years, thousands of the Rohingya have fled Myanmar to reside in different states in Malaysia. Without any legal status, they have limited access to government medical and healthcare facilities. This is because Malaysia is not a State party to the 1951 Refugee Convention and its 1967 Protocol. IMAM Response and Relief Team (IMARET), a medical NGO, has organized charity clinics for this minority group to provide basic medical aids. Objectives: To identify common medical problems and medications prescribed during IMARET charity clinics in Kelantan. Methods: This was a cross-sectional study among Rohingya refugees attending IMARET charity clinics in Kelantan from June 2017 until May 2018. Data was collected from a medical clerking sheet. Medical problems were classified using ICD-10 classification, while medications prescribed were classified according to the first level of ATC code. Data were analysed using SPSS Version 24.0. Results: From 315 patients attended the clinic, most of the patients are of male gender (n=232, 73.1%). Mean age of the patients was 21.9 + 13.6 years (range: 1 – 75). Patients attended either one of the clinic locations; Tanah Merah (n=153, 48.5%), PengkalanChepa (n=78, 24.8%), and Kok Lanas (n=84, 26.6%). Most common medical problems observed were related to musculoskeletal system (n=104, 19.9%), mostly involving myalgia (n=96, 30.5%). Other common problems involved respiratory system (n=94, 18.0%), digestive system (n=68, 13.0%), and skin problems (n=57, 10.9%). Medications used for gastrointestinal disorders were mostly being prescribed in the clinics (n=179, 56.8%), followed by medications used for nervous system (n=114, 36.2%) and respiratory system (n=97, 30.8%). Most frequently prescribed medications include paracetamol, diclofenac, chlorpheniramine and multivitamins. Conclusion: Common medical problems observed among Rohingya refugees include myalgia, respiratory diseases and gastrointestinal problems. Therefore, medications used to treat these problems were shown to be frequently prescribed during clinics.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S26

The Use of Magnetic Resonance Imaging in Managing Intra-Abdominal Pregnancy

Introduction: Most pregnant women will experience a normal pregnancy process. However, there are some complications that may occur during pregnancy, including intra-abdominal pregnancy. Intra-abdominal pregnancy, or pregnancy outside of the uterus, are commonly reported besides abortion, pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM). Thesecomplications are believed to be the main cause of maternal and perinatal death. Therefore, the use of appropriate diagnostic imaging inthe management of obstetric cases should be focused.Objective: This case study intended to evaluate the use of magnetic resonance imaging (MRI) in managing intra-abdominal pregnancy.Case Presentation: The study focused on one case with intra-abdominal pregnancy which continued into the second trimester. A 30-year-old woman, G2 P0+1 at 12-13 weeks’ gestation was presented to a public hospital complaining of recurrent epigastric pain with no history of vaginal bleeding. An MRI was performed and the mother was identified as having an intraabdominal pregnancy. Urgent laparotomy was done. Intraoperative finding noted hematoperitoneum with active bleeding seen from the placenta that adhered to the omentum. Partial omentectomy was done. The foetus in about 14 week’s gestation was seen and removed. Case studies have proven that the option to perform an MRI on a suspected intra-abdominal pregnancy can help provide information to establish an accurate diagnosis and appropriate patient care management.Conclusion: The use of MRI is highly recommended for all cases that are expected to experience intra-abdominal pregnancy as it will save the patient as well as avoiding obstetric complications.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S16

Home Medication Review by Hospital Tuanku Fauziah: Carers’ Perspectives

Introduction: Home Medications Review (HMR) is a continuation of patient care from health facilities to their home to assess patients’ pharmacotherapy by a multidisciplinary team. Bedridden patients were the main group who received this service. To improve the provision of HMR, we need to understand carers’ viewpoints of the current service.Objectives: To explore the carers’ perspectives of HMR conducted by the medical outreach team (MOT) of Hospital Tuanku Fauziah. Methods: This is a qualitative study conducted among carers who were involved in the HMR programme for more than six months. Subjects were recruited by purposive sampling from August 2019 to December 2019. In-depth interviews were audio-recorded at patients’ homes until data saturation and transcribed verbatim. The transcripts then underwent thematic data analysis.Results: Nine carers were interviewed. All participants had a limited understanding of HMR since they were not properly counselled prior to admission to the programme. The convenience of not having to go to the hospital was perceived as the major benefit of the programme. Healthcare providers were welcomed during each visit. Recognising allied health professionals in the MOT possesses a problem for some carers. There was a concern about having to collect newly add-on medications from the hospital. Some participants suggested increasing the frequency of visits and hope for more financial aids.Conclusion: This study proved that carers’ understanding of HMR was generally poor. All carers were satisfied with the current HMR programme provided by the MOT. However, several aspects of our HMR need to be improved. Despite the COVID-19 situation that puts HMR onhold and telemedicine have been adapted, HMR is here to stay in the post-COVID-19 era. This is supported by studies conducted in the pre-COVID-19 era that HMR is more beneficial than telemedicine due to the personal touch of face-to-face encounters.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S24

Forum Panelist 4: COVID-19 Response: Speaking for the Unspoken for

The COVID-19 pandemic has brought about unparalleled changes in all our lives, on an individual, societal and global level that it draws us into a necessary reflection of how we have lived our lives as an individual, a community and ashumankind. As health practitioners, we need to appraise our ways of working and have the courage to speak and call for the change we want to see. A time for an honest examination of policies of exclusion and marginalization of any sections of populations, and consequences of such policies in the face of a pandemic. A time for health professionals and those who speak for the unspoken to rise to the forefront with the right intention at heart, to set the right knowledge to action in moving towards a more inclusive and resilient health system. If we continue in our old ways, the lesson will be lost on us and this may be the pandemic that deepens the divide, which will be to our own detriment. Balancing the priorities in public health, and the politico-socio-economic priorities of a nation, what path would best address these priorities? As there are challenges, there are opportunities to have inclusive policies, coordinated health programming, with collaborative efforts in strengthening preparedness and response mechanisms, engaging the public, civil society, academia, international organizations and private sectors.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S9

The Impact of Proper PPE Protocol in A Highly Community Spread of Infectious COVID-19 in Semporna

Introduction: The district of Semporna, Sabah was majorly hit by the third wave surge of COVID-19 in September 2020. At the peak of the crisis, services in Semporna Hospital were paralyzed with 40 healthcare workers (HCW) found to be COVID-19 positive; contributing to 14% of the total manpower.Objectives: Due to the immediate crisis, the main priority was to control the spread of COVID- 19 amongst the Semporna Hospital HCWs. This was important to curb direct infection from handling suspected patients seeking treatment in Semporna Hospital. Based on the hospital capabilities and resources, a comprehensive modified protocol was needed to control the situation.Methods: Semporna Hospital pandemic emergency task force was established with the presence of multi department and specialties. Multiple issues were raised and attended to, especially; issue of preparedness, low PPE stock and Emergency Department infrastructure.Results: The number of Semporna Hospital HCWs infected with COVID-19 was minimal after the initial disaster. Emergency Department infrastructure was improvised, workflow processes modified, HCW protection education prioritized and complete PPE sets were stocked up. All these efforts were under the strict supervision of the infectious control unit. The presence of multiple units of Powered Air-Purifying Respirator (PAPR) completed our adherence to the Ministry of Health (MOH) guidelines in managing the highly infectious level 4 patients for aerosolized generating procedures (AGP).Conclusion: This achievement can be used as a preparedness reference for other non-specialist district hospitals in Malaysia.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S21

Bridging the Gap between Medical Students and the Deaf-Mute Population

Introduction: Deafness is the inability to hear or impaired hearing. In 2018, more than 40,000 Malaysians were registered with hearing loss. Sign languages use visualization and facial expression to convey conversational meaning. However not many healthcare workers are able to converse in sign language thus hampering effective communication with deaf patientsObjective: To evaluate the effectiveness of sign language in increasing awareness amongst medical students on healthcare access difficulties faced by the deaf.Methods: Four medical students underwent sign language classes at the Malaysian Federation of Deaf before being formally assessed and certified by an instructor. A video on common questions used in the clinical setting using sign language was then developed and shown to a cohort of 224 medical students in UiTM. Awareness on the importance of sign language amongst the cohort was surveyed before and after watching the video. The four medical students were also assessed on their awareness and communication proficiency before and after attending classes. Post- and pre-test responses were analysed using Wilcoxon signed rank test and paired sample T-test.Results: The number of students who were aware of the importance of sign language in the clinical setting increased from 39.7% (N=89) to 98.2% (N=220) after watching the video. The four medical students’ post-test scores also increased significantly after attending sign language classes (Mean +2.43, p<0.01). Significant improvement in basic knowledge of sign language and ability to demonstrate signs such as self-introduction and gathering medical history were observed (p=0.046). In totality, awareness of the challenges faced by deaf-mute patients when communicating with healthcare workers increased significantly (p=0.046).Conclusion: Sign language is essential in improving communication between deaf patients and healthcare workers. It is therefore imperative that healthcare personnel gain basic skills in sign language to improve communication and provide better medical services to the deaf community.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S11

Forum Panelist 3: MyCARE: The Humanitarian Responses as an NGO towards Pandemic COVID-19 in Malaysia

COVID-19 pandemic becomes the major disaster happening through out every part of the world and change every single sector, including the humanitarian perspective. As the COVID-19 has spread, government worldwide restrict the movement of people, interruption on activists to deliver assistances, logistics challenge and hampering humanitarian responses. This article makes HUMANITARIAN CARE MALAYSIA BERHAD (MyCARE) as an example of a local Malaysian NGO in providing humanitarian assistance during the periods in the pandemic. MyCARE is a Non-Profit Organization (NPO) registered with the Companies Commission of Malaysia (SSM) [Reg. No: 729288-P], the member of South East Asia Humanitarian Communities (SEAHUM) and existing special consultative member of United Nations Economic and Social Council (ECOSOC).MyCARE’s humanitarian relief network covers South East Asia Archipelago including the Philippines, Cambodia, Southern Thailand and Vietnam; war-torn countries in the Middle East such as Palestine, Syria, Lebanon and Iraq; the stateless and displaced Rohingya people, as well as disaster-stricken areas regardless of racial and religious boundaries. MyCARE is also active in Malaysia in providing temporary shelters, rebuilding homes and provision of fresh water in the flood-stricken areas.This article wishes to share the humanitarian works by MyCARE, in which major assistance has been provided to a major natural hazard be affected during the COVID-19 pandemic in Malaysia, and urgent needs for countries such as Gaza and well as the Rohingya Refugee Camp in Cox’s Bazar, Bangladesh as the largest refugee camp in the world.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S8

Final Year 5 Students’ Exit Evaluation of the Asia Metropolitan University MBBS Program

Introduction: An exit evaluation study by the final year graduating students was done Just prior to the completion of the third batch of the MBBS program at Asia Metropolitan University (AMU).Objective: (1) To determine whether the MBBS program had enabled the students to (a)attain the eight Program Learning outcomes (PLO); (b)to achieve the eight major competency areas expected upon completion of the program; and (2) To look into the strengths and weaknesses of the program from the graduating final year students’ perspectives.Methods: A descriptive study was done among 18 medical students who were doing senior clerkship posting. A self-administered questionnaire including one open ended question was used for the study. Informed consent was obtained from the participants, assuring them on confidentiality. Data gathered were analysed using SPSS version 23.Results: Most of the students (77%) feel that the program had enabled them to attain each one of the eight Program Learning Outcomes(PLO); between 60-78% achieved competencies in each one of the eight major areas expected at the end of course. The strengths included experienced lecturers, smooth implementation of the program, well designed curriculum while weakness was deficiency in clinical skills, training facilities, number of lecturers, case mix and adequacy of clinical exposure. The weaknesses include readiness to be a self-directed learner.Conclusion: Majority of the students attained each of the eight (PLO) competencies. The strengths were identified and discussed. The study has paved the way for a more detailed indepth study with more samples among the future graduating batches.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S12

Latest Evidence on Non-Communicable Disease Management (NCD) during COVID-19 Pandemic

The year 2020 has been dominated by a communicable disease which most did not see coming and are ill- prepared to handle. While daily headlines the world over are dominated by new cases and death from COVID-19, other major health issues must not take a back seat. As of 30thNovember this year, 357 people have died of COVID-19 in Malaysia,while close to 15,000 Malaysians died of Ischemic Heart Disease (IHD) alone. With IHD and cerebrovascular accident (CVA) being the number 1 and number 3 causes of death (15% and 8% of all death, respectively) our focus on COVID-19 must not distract us from the ‘elephant in the room’. Evidence from UK showed that while hospitalization due to acute myocardial infarction (AMI) has significantly decreased by 50%, out of hospital cardiac arrest has significantly increased by 56%; and in hospital mortality from AMI has increased by at least 35% during the pandemic. Patients are shying away from coming for scheduled follow ups, and there has been a reduction in guideline recommended care for NCD. This is confounded by early scare which suggested that treatment of risk factors for NCDs, especially for hypertension, dyslipidemia, and diabetes, may increase susceptibility to and worsen prognosis for patients with COVID-19. Since COVID-19 is a new entity, latest evidence generated are mainly from observational studies with few clinical trials with the exception of vaccine trials. What do we know about management of NCD in the COVID-era?Since the discovery that SARS-COV-2 virus attached itself to the ACE2 receptors before entering cells, alarm bells were sounded that patients treated with RAAS inhibitors may be susceptible to and have worse prognosis. Withup to 60% of hypertensiveworldwide taking this class of drugs, the concern is understandable. Reassuringly, 6 observational studies from 4 countries and 1 RCT from a 5th country showed this not to be true. Studies from China and Italy showed that those on RAAS inhibitors have better prognosis and this has triggered an RCT which hypothesized that pre-treatment with angiotensin receptor blockers may be beneficial in preventing pulmonary damage in these patients. Another RCT is looking at recombinant human ACE2 as treatment for patients with COVID-19. In diabetic patients, an observational study from New York showed those on statin has reduced mortality compared to non-user and in a large UK based primary care setting there was no increased risk of COVID-19 among patients prescribed SGLT2 inhibitors. The SGLT2 inhibitors have been proven to improve clinical outcome including mortality in diabetics and could be safely used to treat patients during the pandemic. Based on a nationwide retrospective cohort in the UK, overall mortality was higher for diabetics admitted to ICU or HDU and with greatest mortality impact in younger patients.The next few months will see more prospective intervention studies publishedaddressing the various unanswered questions. It is worth remembering that substandard care is responsible for upto 84% of CV death. Hence, we shouldnot let our guards down with NCDs even when the world’s attention is focused on COVID-19.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S10

Educating Children and the New Norm

The lockdown from March to November 2020 in its various forms have seriously impacted education of children, both nationally and internationally. In Malaysia; more than 1 million students were affected and 100,000 teachers and 20,438 members of school support staff were forced to stay at home. UNICEF noted that 24 million children around the world will drop out and students from vulnerable communities will be particularly and failed to return to class. This has forced almost all education providers to switch the education deliveries online. While some of the more established educational institutions which are more prepared than others, sailed plainly through this switch, a sizable majority found this switch a devastating blow to the delivery of education especially to children. The Parent Group for Education, Malaysia reported that 66% Malaysian children do not have good internet connectivity at home and the Ministry of Education also reported that 37% do not own devices for online learning. The outcome of these is almost predictable. 20% children were discovered to have lost interest in schoolwork and become demotivated while 7% have indeed dropped out from school. Although most children are no stranger to handphones and other devices, the use of these for education is daunting. For the first 10 weeks of the MCO, online teaching is noted to be adhoc, random, unstructured and even non-existent. Timetable was created in May but not strictly adhered to by teachers who are not familiar with technology. The Ministry of Education set up a free portal such as www.eduwebtv.moe.edu.my and the Digital Educational Learning Initiative Malaysia (DELIMA) as immediate mitigation. The future and the new norm for education is predictable and we have no choice. Online education delivery has to be strengthened by firm efforts to boost connectivity. School digital packages should consist of laptops or tablets, with video cams, telecommunication towers, especially in the rural areas must be built urgently. Mini and micro credentialing of children and teachers must be held to train them on the basics of online teaching, while more immersive applications are being prepared. We have little choice.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S4

The Effectiveness of Sexual Reproductive Health (SRH) Programme Among Adolescents in Cheras, Malaysia

Introduction: In Malaysia, the rate of adolescents involved in sexual activities has increased and starts at an earlier age. Data from NHMS 2017 showed that 7.3% among surveyed 13 to 17 years-old adolescents have already had sex. The rate of teenage pregnancies is also increasing at 3.7-3.9% between the years 2009 until 2011. Therefore, an effective SRH Programme should be conducted in schools to equip them with adequate knowledge regarding this subject.Methods: A cross-sectional questionnaire survey was conducted among 145 randomly selected secondary school students aged 13 to 15 years old, attending the SRH Programme in a secondary school in Cheras, Selangor, Malaysia. The objective of this programme is to deliver knowledge and promote awareness among adolescents regarding SRH. The programme consists of intervention using adolescent-friendly module and games. A pre- and post-test were given to the participants to evaluate the effectiveness of the programme using the validated SRH questionnaire (Malay version). The questionnaire consists of fourteen and six items for knowledge and attitude, respectively.Results: The result showed an increase in the mean knowledge score (±SD) after the SRH Programme at the school from 7.25 ± 2.44 for pre-test to 9.70 ± 3.17 for post-test. The mean difference in pre- and post-test was 2.45 (95% CI: 2.02, 2.87) and was statistically significant (p<0.001). In terms of attitudes, the majority of the students felt that they have enough knowledge to make a gooddecision regarding sexual reproductive health issues after the SRH programme. However, there was only a small increment with regards to their attitudes on assertiveness.Conclusion: This study demonstrated an increase in the level of knowledge among adolescents in Cheras after the SRH programme using the adolescent-friendly module and games. However, there is no significant change in attitude among adolescents regarding SRH.Future SRH programmes need to be done regularly to instil positive attitudes among adolescents in dealing withsexual reproductive dilemmas.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S20

Barriers to Physical Activity Among Pregnant Women During Pregnancy

Introduction: Co-morbidities such as obesity, gestational diabetes and pregnancy induced hypertension during pregnancy can be dangerous to the mother and foetus. Regular physical activity during pregnancy not only maintains maternal and foetal wellbeing, but it also maintains physical fitness and brings various health benefits. However, many women reduce their physical activity levels during pregnancy.Objectives: Thus, this study aimed to identify the barriers that could prevent pregnant mothers from doing physical activities.Methods: This is a cross-sectional study involving 168 pregnant women aged 18 to 35 years between gestational age 12 to 35 weeks in a primary health clinic in Kuantan, Pahang. Their socio-demographic characteristics were recorded, and barriers for physical activity assessed through a set of pre-tested questionnaire.Descriptive statisticswere used to describe the sociodemographiccharacteristics and the barriers.Results: The mean (SD) age was 28.0 (3.6) and majority of them were of Malay ethnicity from B40 group. Two thirds (74.4%) had tertiary education and 66.7% were working mothers. More than half (53.0%) of the participants wereoverweight and obese.Moreover, 58% of the participants had leg cramp and 63.1% felt fatigue. Almost 80.4% had backache and 46.4% had epigastric discomfort.Conclusion: Barriers such as leg cramp, backache, fatigue and epigastric discomfort could prevent pregnant women from conducting physical activities. Opportunistic recommendation by physician and concerns on the physical activity should be addressed.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S23

Turkish School Libraries

This paper focuses on school libraries in Turkey. It is a general outlook on K-12 education and how the community perceives the school library. A short history of school libraries and the problems they face will be described. Is a school library part of the education or is it a supplementary issue? How do librarians view the issue? How does the Ministry of Education see the centers? The current trends in Turkish school librarianship: what is the near future of the library media centers and how will the learning-commons strategy affect them? The Turkish government is about to release a new version of Intellectual Property Rights. School librarians and all educators should stress the importance and the necessary practices in order to go hand in hand with the global world.

Memories from the margins: violence and counter-narratives � introduction

This supplementary issue looks at how informal, often unrecognised, memory practices are used to deal with the legacy of violent conflict as a way to heal trauma, demand justice, and build sustainable peace. By drawing on case studies from Bosnia and Herzegovina, Colombia, India, Lebanon, Northern Ireland, Rwanda, Sri Lanka, Syria, and Vietnam, the articles examine informal practices of memorialisation that challenge amnesia and hegemonic discourses of conflict by creating spaces for dialogue and exchange.