Background: We reviewed studies on the prevalence of Chlamydia infection as a risk factor for developing cervical cancer in a meta-analysis studies published in that subject area. Methods: Cochrane Library and PubMed databases were systematically searched for articles (observational and randomized controlled trials) published from 2008-2018. A meta-analysis of studies was performed to analyse the association between chlamydia infection and cervical cancer. Results: Five articles were included in the final analysis (N=5271). All five articles were case-control studies, of which three studies sampled from population-based registries. All studies involved with sexually active women with minimum 15 years old. Three studies reported the association of C. trachomatis infection cervical cancers, two other studies reported C. trachomatis-HPV co-infection in association with cervical cancer. Result showed C. trachomatis has an overall prevalence of 31.9%, pooled OR 1.96, 95% CI 1.05 to 3.67, OR 2.13, 95% CI 1.78 to 2.54 among cervical cancer. There was a mild publication bias detected at 3.0 effect estimation. Heterogeneity detected from clinical and methodological diversities particularly from C. trachomatis-HPV co-infection subgroup analysis, including sampling bias, geographical strain diversity, and different outcome endpoint measured. Conclusion: C. trachomatis infection was significantly associated with the development of cervical cancer. Co-infection of C. trachomatis-HPV with cervical cancer is plausibly sound but temporality of C. trachomatis-HPV with the development of cervical cancer need to be proven in future prospective cohort studies.

Taboos and traditions refer to myths and non-scientific practices held by people across the world. A variety of taboos are practiced worldwide (including those relating to food, religious, and sexual beliefs), including in Malaysia. Most of the taboos that concern the postpartum period are related to postpartum physiological, emotional, and family dynamic changes. The aim of this systematic review is to explore the traditions and taboos practised among postpartum mothers in Malaysia, and to consider the purpose and health impact of their practice. A systematic search of journals in Malaysia was conducted using eight major databases: Scopus, Ovid Medline, Science Direct, SAGE, PubMed, Wiley Online Library, Google Scholar, and EBSCOhost. Articles from all journals published between 2013 and 2018 were assessed through the PRISMA checklist. From 17,945 papers screened, seven papers were selected for critical analysis using the Mixed Methods Appraisal Tool (2018). It was found that in Malaysia, certain postpartum traditions, including food taboos and behavioural and physical restrictions were conducted with the aim of maintaining the well-being of mother and baby, and to improve the healing process. Some of the practices were found to be irrelevant, whilst others had beneficial health impacts. Based on this review, the practice of certain taboos and traditions during the postpartum period was found to have both advantages and disadvantages. A rational approach is needed to weigh the practice against maternal safety and health. Thus, healthcare personnel should be sensitive to the role of taboos and traditions in the postpartum care of patients. The practice of traditions and taboos should be monitored for safe practice, along with a need for communitybased education to avoid any unwanted issues as a result of its practice.

PurposeThis study aims to validate the English version of a WHO-adapted questionnaire: Zika infection awareness/knowledge questionnaire using a unique dual-approach validation model.Design/methodology/approachA cross-sectional pilot study of 30 adult respondents in Malaysia completed the self-administered questionnaire on knowledge and perception to Zika infection. Construct validity was assessed by exploratory factor analysis (EFA) of SPSS and Rasch partial credit. Reliability is tested using pKR20 and Cronbach’s alpha.FindingsKnowledge construct was unidimensional, good model fit, easy to endorse and well discriminative. Five-rating Likert scale for perception domain was appropriate. Knowledge domain should be separated into 6 level of difficulties. Perception domain should remain as one construct. Knowledge domain was highly reliability (pKR20 = 0.96), perception domain was fairly reliable (Cronbach’s alpha = 0.641). Respondent's ability to answer knowledge domain and perception domain were separated into 3 and 4 levels.Research limitations/implicationsSmall sample size may affect factor analysis.Practical implicationsThe questionnaire has good psychometric properties to measure the knowledge and perception of Zika infection among Malaysian community.Social implicationsThe questionnaire helped to gauge knowledge and perception of the general community in Malaysia to aid preparation of health education tool for Zika infection.Originality/valueThis paper validated questionnaire with two biostatistical software programs in bidirectional approach – items difficulty and respondents' ability – is the first field test of WHO questionnaire among general population in Southeast Asia.

Zika virus (ZIKV) has had a history in Malaysia since its first isolation in 1966. However, it is believed that the immunity status among forest fringe communities has been underreported. We conducted cross-sectional surveillance of forest fringe communities from 10 Orang Asli villages and their peripheral communities in Perak, Pahang, and Sabah in Malaysia. A total of 706 samples were collected from 2019 to 2020 and screened for ZIKV exposure using an anti-ZIKV IgG ELISA kit. A neutralization assay against ZIKV was used to confirm the reactive samples. The seroprevalence results reported from the study of this population in Malaysia were 21.0% (n = 148, 95% CI, 0.183–0.273) after confirmation with a foci reduction neutralization test. The presence of neutralizing antibodies provides evidence that the studied forest fringe communities in Malaysia have been exposed to ZIKV. Multivariate analysis showed that those older than 44 years and those with an education below the university level had been exposed significantly to ZIKV. In addition, higher seropositivity rates to ZIKV were also reported among secondary school students from Bentong (Pahang) and residents from Segaliud (Sabah). No associations were identified between Zika seropositivity and gender, household size, house radius to the jungle, and income level. The presence of neutralizing antibodies against ZIKV among the study population might indicate that the causative pathogen had already circulated widely in forest fringe regions. Intervention for vector control, protection from mosquito bites, and awareness improvement should be encouraged in this population.

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