Vaccinations were considered to be among the most effective way in preventing further COVID-19 transmission. To date, the manufactures of vaccines were in the third phase of clinical trial studies. However, the extent to which the publics are able to pay and willing to pay for this vaccine remains unclear. This study aimed to evaluate the ability to pay (ATP) and willingness to pay (WTP) for COVID-19 vaccination in Malaysia. A cross sectional study was conducted among 67 staff of a public university in Nilai, Negeri Sembilan. The ATP and WTP were obtained through an open and close-ended method via either face-to-face interview or telephone-based interview. For the open-ended method, the mean (SD) ATP and WTP values recorded were USD 52.35 (620.83) and USD 52.08 (620.82) respectively. As for the close-ended, the mean (SD) ATP and WTP values recorded were USD 52.08 (620.82) and USD 32.38 (147.97) respectively. Through closed-ended method, lower ATP and WTP values were recorded compared with open-ended method, as the respondents are able to negotiate through a bidding process to get the best price of vaccine. Female, Malay, married, permanent staff and respondents with side-income respondents recorded higher ATP and WTP values in open-ended method. Nevertheless, except for the side-income, other factors in this study were not statistically significant. Findings from this study could facilitate government to set appropriate market price to ensure the affordability of COVID-19 vaccine and improve its accessibility so that a big proportion of the people will be vaccinated and protected from this disease.

COVID-19 infection resulted in significant economic implications to patients as well as a considerable financial burden to the general population for preventive measures. A descriptive study was conducted among staff at one of the public universities in Malaysia to estimate the monthly out-of-pocket expenditures for preventive measures used for COVID-19 infection. The study tool includes questions on household out-of-pocket expenditure and the measurements of the impact of the expenditure on household income. It was found that the average cumulative monthly expenditures related to the preventive measures were US$ 45.90 (Ringgit Malaysia 187.77), which was 4.3% of the household income. The highest expenditures were for traditional and complementary medicine followed by nutraceutical/supplements and disposable facemask. 8% of the households in this study incurred more than ten per cents of their monthly household income for expenditures related to COVID-19 preventive measures. Several households are experiencing substantial financial implications for preventive measures related to COVID-19 infection. This study highlights the out-of-pocket expenditures incurred for preventive measures were substantial for certain households. Effective initiatives from the government on providing subsidized protective personal equipment and a cost-sharing approach could help to alleviate the household financial burden.

Introduction Several countries have started mass vaccination programs to halt the spread of the COVID-19 pandemic. With an R naught value of 2 to 3, about 70% of the population needs to be immunized to achieve herd immunity. This study aimed to investigate the reasons for acceptance or refusal of COVID-19 vaccines among the Malaysian population. Methodology An exploratory, descriptive qualitative design was performed. The cross-sectional survey used a non-probability convenient sampling technique to recruit the respondents, who were required to answer an open-ended question: Either "If you are willing to get the vaccine, please state your reason" or "If you are not willing to get vaccinated, please state your reason." The survey also included questions on demography such as age, gender, and place of residence. According to the Health Belief Model, the data was transcribed, translated, and analyzed: perceived susceptibility, perceived severity, perceived barrier, and cues for action. Results A total of 1091 respondents who completed the online survey comprised 685 (62.8%) females, 406 (37.2%) males, with a mean age of 38.16 (SD = 16.44). The majority (81.1%) were willing to get vaccinated. Thematic analysis showed that most respondents perceived that the vaccine is safe, effective, protective and will provide herd immunity. Barriers to vaccination include unknown long-term side effects, rapid vaccine production, inadequate information and concerns regarding halal status. Cues to vaccination included individual desire, social responsibility, economic concerns and wait-and-see behavior. Conclusions The public should be well informed about the vaccine, its efficacy, side effects, and halal status to increase vaccine acceptability and achieve herd immunity.

Introduction: Swimming pools pose significant public health risks due to chemical and microbiological contaminants. This study focuses on evaluating the prevalence of faecal coliform, Escherichia coli, and Pseudomonas aeruginosa, while also assessing physicochemical parameters in residential swimming pools located in Ampang, Selangor, Malaysia. Materials and methods: Water samples were collected 20cm below the pool surface, preserved in 500ml sterile containers, and transported to the laboratory in iceboxes. Physicochemical analyses, including pH and residual chlorine, were performed. Microbiological examination utilized standard multiple tube fermentation and membrane filtration techniques. Results: Thirty-three swimming pools participated in the study. Physicochemical parameters revealed a mean pH of 5.8±1.2 and residual chlorine of 1.2±1.24/L. Notably, 66.7% of tested pools exhibited pH levels outside the acceptable range (7.0 to 7.9), and 75.7% had residual chlorine values below the standard level (0-0.5mg/L). Microbial analysis indicated a prevalence of 24.2% for faecal coliform, 15.1% for E. coli, and 9.1% for P. aeruginosa. Conclusion: This study highlights prevalent issues in residential swimming pools, including low pH levels, insufficient residual chlorine, and the presence of microbial contaminants. The findings underscore the need for proactive measures to enhance water quality management in domestic pools, ensuring the safety of users. Ongoing vigilance and maintenance practices, particularly monitoring pH and chlorine concentrations, are crucial to mitigate potential health hazards associated with swimming pool water. Implementing stringent protocols and regular inspections by relevant authorities can contribute to maintaining optimal pool conditions and safeguarding public health.

There is a growing interest on research related to health-seeking behaviours. However, there are minimal studies in Malaysia which focus on this issue. This paper aimed to determine the health-seeking behaviours among the Malay population and its association based on the localities of the urban and rural population. To achieve this purpose, a cross-sectional survey was conducted using face-to-face interview method. A total of 480 respondents participated in this survey with the majority (57.7%) of them were from a rural area. Among all the subjects, 4.9% and 5.4% of urban and rural participants respectively, did not seek treatment when they were sick. The reasons being are they chose to ignore the pain (80%), time-consumption (8%), and they do not believe in modern treatments (8%). A higher number of rural participants chose public healthcare facilities compared to urban (82.3% vs 72.6%, p<0.001), whereas a higher number of urban participants chose private healthcare facilities in contrast to rural participants (25.3% vs 16.4%, p<0.001). For participants with chronic diseases, 5.3% did not go for followup, 91.2% rely on healthcare staffs for information on the diseases, and 18.9% took traditional or supplementary medicine. Majority of the participants are in agreement that the accessibility to public healthcare facilities in terms of distance, transportation and operational time, as well as the services to get treatments, were good. Overall, majority of the respondents prefer to seek treatments from public healthcare facilities followed by private facilities and pharmacies. However, there is a small number of participants who did not seek for treatments, including those with chronic diseases. Further studies shall be conducted to explore the barriers to seeking treatments in this population.

This study aimed to explore the socio-demographic characteristics, mental health status, and perceived causes of pandemic fatigue with COVID-19 pandemic fatigue among the general population of Malaysia. The data was collected online during the transition from the COVID-19 pandemic phase to the endemic phase in Malaysia from 1 to 30 April 2022. Sociodemographic data, Depression Anxiety Stress Scale-21 (DASS-21), perceived causes of pandemic fatigue, and the Fatigue Assessment Scale (FAS) were included in the survey. The chi-square test and a simplelogistic regression analysis were used to identify predictors of pandemic fatigue. The completed survey (N = 775) included individuals aged 18 years or above [mean 31.98 (SD = 12.16)] from all states in Malaysia. Pandemic fatigue prevalence was 54.2%. Severe to extremely severe depression, anxiety, and stress symptoms were detected in 11.2%, 14.9%, and 9.1% of the participants, respectively. Younger age, non-Malay ethnicity, living alone, and higher income categories were significantly higher in the fatigued group. Higher DASS-21 scores on all domains were associated with higher FAS scores. Meanwhile, high scores for perceived tiredness from complying with the COVID-19 Standard Operating Procedure (SOP), perceived risk of infection from COVID-19, perceived hardship due to the pandemic, perceived public complacency during the pandemic, and perceived changes due to the pandemic were associated with a higher FAS score. This study provides valuable information for policymakers and mental health professionals worldwide on pandemic fatigue and its associated factors, including mental health status in Malaysia.

Globally, the minority indigenous peoples have a lower health status when compared with national populations. The Orang Asli who are indigenous peoples of Peninsular Malaysia, also poses a significant challenge towards the handling of diseases. The present study sought to synthesise a coherent explanation of health-seeking behaviour among Orang Asli using a mixed-method research approach. A cross-sectional survey was conducted among 324 adult Orang Asli living in the rural district of Jelebu, in the Peninsular Malaysian state of Negeri Sembilan who conformed to the inclusion criteria. Then, 16 participants were interviewed to obtain an in-depth insight regarding their health-seeking behaviour. The findings showed that the majority of the Orang Asli utilized modern healthcare facilities and the respondents reported that the accessibility, services and medicines provided by the government were excellent. Meanwhile, 40.7% of the respondents relied on both traditional and modern treatments. The key determinants of the modern health-seeking behaviours among the Orang Asli in this study were satisfaction on modern health, barriers in getting health services, acceptance and attitude, and traditional medicine utilisation. Government, institutions and healthcare facilities have a role in ensuring that the vulnerable Orang Asli population is not left behind in receiving essential information on diseases associated with chronic and infectious diseases, including the current COVID-19 pandemic, as their action of seeking treatment remains complex and multi-layered.

Introduction: Orang Asli (OA) in Malaysia is considered vulnerable to social, economic and legal abuse. The increase in prevalence of Non-Communicable Diseases (NCDs) among OA was reported due to their lifestyle changes. Our study aimed to determine the level of knowledge on NCDs among OA community and its’ association with demographic factors. Methods: A cross-sectional study by face-to-face interview was conducted among consented adult OA in Jelebu, Negeri Sembilan using a validated questionnaire. Their knowledge on risk factors, complications and treatment of cardiovascular diseases, diabetes mellitus, and chronic obstructive pulmonary diseases was asked. Respective thresholds and ranges for poor, moderate and good categories were set as 0-15, 15–21 and 21- 28. Mann-Whitney and Kruskal-Wallis test was used to test the association between the demographic profile and knowledge score since the data was not normally distributed. Results: A total of 325 respondents with mean age 39.94 (±13.196) ranged from 18 to 83-year-old participated in this study. Majority were females (71.1%) with primary education (39.1%) and mean household income of RM 615.47 (± 446.79). Their mean knowledge score was 12.82 (±9.671). Majority of them had poor knowledge (51.7%). The respondents with higher education background had significantly better knowledge score compared to lower education background (p <0.001). Conclusion: Study shows that the level of knowledge on NCDs among OA is low and associated with level of education. Effective health intervention programs among OA can be one of the strategic methods to increase their knowledge on NCDs and eventually their health.

Background: Coronavirus disease 2019 or COVID-19 is caused by a newly discovered coronavirus, SARS-CoV-2. The Malaysian government has planned to procure COVID-19 vaccine through multiple agencies and companies in order to vaccinate at least 70% of the population. This study aimed to determine the knowledge, acceptance and perception of Malaysian adults regarding the COVID-19 vaccine. Methodology: An online survey was conducted for two weeks in December 2020. A bilingual, semi-structured questionnaire was set up using Google Forms and the generated link was shared on social media (i.e., Facebook and WhatsApp). The questionnaire consisted of questions on knowledge, acceptance and perception of COVID-19 vaccine. The association between demographic factors with scores on knowledge about COVID-19 vaccine were analysed using the Mann-Whitney test for two categorical variables, and the Kruskal-Wallis test used for more than two categorical variables. Results: A total of 1406 respondents participated, with the mean age of 37.07 years (SD = 16.05) years, and among them 926 (65.9%) were female. Sixty two percent of respondents had poor knowledge about COVID-19 vaccine (mean knowledge score 4.65; SD = 2.32) and 64.5% were willing to get a COVID-19 vaccine. High knowledge scores associated with higher education background, higher-income category and living with who is at higher risk of getting severe COVID-19. They were more likely to be willing to get vaccinated if they were in a lower age group, have higher education levels and were female. Conclusion: Even though knowledge about vaccine COVID-19 is inadequate, the majority of the respondents were willing to get vaccinated. This finding can help the Ministry of Health plan for future efforts to increase vaccine uptake that may eventually lead to herd immunity against COVID-19.

The study evaluates the prevalence, knowledge, attitude, and practices of non-communicable diseases (NCDs) among adult Orang Asli and Malay ethnicity in Negeri Sembilan, Malaysia. This cross-sectional study involving 634 respondents aged 18 years and above of Orang Asli (51.3%) and Malays (48.7%) from the rural villages. Structured interview questionnaire for disease history and KAP level conducted. Weight, height, waist circumference, blood pressure, and blood glucose levels then measured. Prevalence of NCDs was higher among Malays compared to Orang Asli with hypertension (35.0% vs 14.8%), hypercholesterolemia (31.1% vs 5.2%), and diabetes mellitus (16.2% vs 4.3%), respectively. Malays also had a higher percentage of being abdominal obese (70.6% vs 59.7%) and increased blood pressure (54.4% vs 29.8%). Multivariate analysis indicates hypercholesterolemia [OR=6.035 (95%CI: 3.150,11.561)], abdominal obesity [aOR= 1.807 (95%CI: 1.065, 3.067)], and increased in blood pressure [aOR= 2.359 (95%C1: 1.619,3.437)] have a significant relation with Malay ethnicity. For Orang Asli, 51.7% had poor knowledge, 72.3% had a good attitude, and 16.0% had a good practice. Knowledge and attitude scores were significantly less among Orang Asli with no significant difference for practice compared to the Malays. The prevalence of NCDs among the Malays is alarmingly high, with an increasing trend among Orang Asli, which needs immediate attention. The NCDs and obesity were significant among Malays but also showed a worrying trend in the Orang Asli as the good practice on a healthy life-style was low in both ethnicities. Thus, proper education and promotion regarding NCDs needed for diseases screening and prevention.

Metabolic syndrome is a cluster of conditions that increase the risk of developing chronic diseases. This paper aims to assess the data on metabolic syndrome among indigenous Orang Asli in Malaysia. Searches were carried out using electronic databases of CINAHL, Medline, PubMed, and Scopus using predefined keywords. Cross-sectional studies of metabolic syndrome using any clinical diagnosis criteria among adult Orang Asli in Peninsular Malaysia included. Fifteen studies with these criteria were selected, five with metabolic syndrome studies. The general prevalence (weighted mean) of metabolic syndrome in Orang Asli was 26.3% (range: 12.0–39.8). Metabolic syndrome was more frequent in females (30.0%) than in males (19.3%). The most common components of metabolic syndrome were low HDL-C levels (41.0%) and hypertension (33.7%). For abdominal obesity, high triglycerides, and abnormal glycemia, the prevalence was; 24.6%, 21.5%, and 14.0%, respectively. Conclusively, the present systematic review brings us closer to an understanding of the prevalence of metabolic syndrome among this vulnerable population. The methodological differences among the studies published limit a joint analysis of their results. Nevertheless, finding from this review shows their high prevalence of the metabolic syndrome is comparable with other ethnic groups in Malaysia that requires immediate attention from all related parties.

Aims: This study aimed at exploring the self-perception of Orang Asli (OA) from the Temuan tribe in Jelebu by using the Global Self-rated Oral Health (GSROH) and General Oral Health Assessment Index (GOHAI). Materials and Methods: It was a cross-sectional study involving a two-stage sampling to select the district and villages. A total of 325 participants were selected based on convenience sampling. Results: Almost half of the participants rated their oral health as poor or average. The mean GOHAI score was 52.96 (±7.749), ranging from 29 to 60. The GOHAI score was statistically significantly lower for female gender (P = 0.025), lower education level (P = 0.001), and elderly (P = 0.001). The GSROH score was also statistically significant with GOHAI score (P = 0.001). Conclusions: A limited number of studies were conducted in this area, particularly in the vulnerable population of OA. Our study found that half of the OA living in the fringe had a poor GOHAI score. It is, therefore, suggested that potential study and intervention programs concentrate on the low GOHAI score group; the male, lower educational context, and the elderly.

Introduction: Maintaining high levels of vaccinations is important for public health success in any vaccination planning. Success requires a better understanding of the public’s perceptions of diseases and consequent decisions about vaccinations. This study aims to gather exploratory qualitative data on public opinion on the Malaysian Government’s COVID-19 immunization campaigns. Methods: Open-ended question on Google Form was advertised online between 2 to 17 December 2020. The questionnaire form was deactivated when saturation has been reached. The free text questions were analysed by qualitative thematic analysis by all authors on a Microsoft Excel spreadsheet. Results: Six hundred and sixty-one participants replied to the online questionnaire. Four themes emerged from the thematic analysis on suggestions for future National COVID-19 Immunisation Program. First, COVID-19 vaccine administration policy; secondly, knowledge dissemination and plan to address obstacles of public acceptances towards the vaccine proactively; thirdly, better implementation programs by the government and fourthly, using local research expertise for vaccine development and alternative medicines. Participants believe all this are essential in increasing their trust and uptake for the government’s future national COVID-19 Immunisation Program. Conclusion: This study highlights the suggestions made by the public for the Malaysian Government. These findings will help develop education and intervention strategies for new vaccine introduction to combat the COVID-19 pandemic in Malaysia.

Objectives: This study aimed to synthesise a coherent explanation risks and health behaviours on non-communicable diseases (NCDs) among the Orang Asli (OA) using three methodologies, namely 1) systematic review (SR): to systematically review the prevalence of behavioural and metabolic risks of NCDs among adults Orang Asli, 2) quantitative research: to determine the prevalence of major NCDs and its risk factors, knowledge, attitudes, practices towards NCDs and health-seeking behaviours, and 3) qualitative study: to provide a deeper explanation and understanding of the quantitative results. Methods: A SR was conducted on four electronic databases. Eligible studies were screened, selected and reviewed and summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Then, a mixed-method sequential explanatory study was employed. In the quantitative phase, a cross-sectional survey via face to face interview was conducted among the adults Orang Asli (n = 325) in Jelebu, Negeri Sembilan. Subsequently, the qualitative phase was conducted via in-depth interviews among 16 adults Orang Asli. The study was conducted from January 2018 to April 2019. Multiple logistic regression analysis was used to analyse quantitative data. Content analysis was applied to analyse the qualitative data. Results: Out of 1632 studies potentially relevant to behavioural risks, only 12 met the inclusion criteria. Among 170 studies that were potentially relevant to metabolic risk, only 16 were eligible for inclusion. The results from the SR revealed a high prevalence of behavioural and metabolic risk factors of NCDs among Orang Asli in Malaysia. Findings from quantitative research showed that the highest number of NCDs are self-reported hypertension (14.8%), followed by hypercholesterolemia (5.2%) and Diabetes mellitus (4.3%). Only 28.0%, 48.9% and 19.4% had good KAP category, respectively. In health-seeking behaviours, 59.3% seek modern treatment, while 40.7% use both modern and traditional treatment. Multivariate regression analysis showed that hypertension, hypercholesterolemia and Diabetes mellitus were significantly associated with the age group 40 years above. While hypertension inversely associated with non-smoker. Hypercholesterolemia had a significantly higher practices scores towards NCDs. Diabetes mellitus was significantly associated with low physical activity. Female, non-hardcore poverty group and alcohol drinker was significantly associated with abdominal obesity. The age group of 40 years and above, low vegetable intake, abdominal obesity and increased blood glucose were significantly associated with raised blood pressure group. The poorer level of knowledge of NCDs is related to lower education level, hardcore poverty group, physically inactive and inadequate vegetable intake. Low levels of attitude were also associated with alcohol consumers, physically inactive and inadequate vegetable intake group. The qualitative themes derived from this research include development and life transitions, knowledge and perception of NCDs, health effects of NCDs risk factors, barriers to preventing behavioural factors, utilisation of modern medicine and healthcare facilities, and traditional medicines. We found that low knowledge, negative attitude, obstacles towards healthy lifestyles, and barriers in accessing healthcare facilities were the main issues to tackle NCDs among Orang Asli. Conclusion: The results of the study found that the prevalence rate of NCDs and their risk are high among the Orang Asli communities. This provides a worrying benchmark for their future health status. The implementation of the strategy should emphasize the importance of early screening, education and awareness programs as well as intervention programs aimed at reducing the behavioural and metabolic risks of NCDs, increasing the level of knowledge, attitudes and practices towards NCDs as well as addressing misconceptions and perceptions in the communities.

Clinical training may expose medical and nursing students to workplace hazards comparable to those encountered by healthcare workers (HCWs). This study was designed to investigate the prevalence of latent tuberculosis infection (LTBI) and associated risk factors among medical and nursing students. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a systematic review was conducted utilising four electronic databases to appraise and synthesise the literature on LTBI which used the tuberculin skin test (TST) and the blood interferon-gamma release assay (IGRA). Results: Original articles published in the English language between 2010 and 2020 were included, yielding 14 relevant articles. The average prevalence of LTBI in high-burden countries was 38.2% for TST and 20.6% for the IGRA test. According to TST and IGRA findings, the average prevalence of LTBI in nations with an intermediate burden was 16.7% and 4.7 %, respectively. The average prevalence was 2.8% and 1.1% from the TST and IGRA tests for low-burden countries, respectively. A greater risk of LTBI was shown to be related with an increase in age among postgraduate medical school students, a history of Bacillus Calmette-Guerin (BCG) vaccination, origin from high-risk tuberculosis (TB) countries, increased hours of hospital exposure, a history of contact with TB cases, a high body mass index, older age group students, and a lower TB knowledge score. Conclusion: The available evidence from this review emphasised the importance of developing and implementing efficient and cost-effective TB infection-control programmes, particularly in high-burden countries and amongst students at risk.

Vaccine hesitancy has been around since the introduction of smallpox vaccine. Vaccine hesitancy has become more intense due to the rise of vaccine information in social media and mass adult vaccination during COVID-19 pandemic. This study investigated knowledge, perception, and reasons for rejection of the COVID-19 vaccine among Malaysian adults who refused to get free COVID-19 vaccination.