a b s t r a c tThis study evaluates the knowledge, attitude and practices (KAP) of food handlers working in restaurants in Kuala Pilah, Malaysia. Data were collected in 2010 involving 64 food handlers. The results show that the food handlers have excellent knowledge and attitude, and good practices toward food hygiene with mean score (SD) of 83.98 (13.26), 82.8 (10.94) and 77.04 (14.98), respectively. There is significant correlation between educational level and attitude (p ¼ .008), knowledge and attitude (p .001), knowledge and practice (p ¼ .007) and attitude and practice (p ¼ .041). Even though the result shows satisfactory KAP levels of the food handlers, some aspects on hygiene measures like refreezing food item, clean working area and wearing of jewelry and watch need to be emphasized.

This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs) among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female) aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6%) had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6%) by the students, while chlamydia (26%) and trichomoniasis (21.0%) were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values < 0.05). Most of them (88.8%) were aware that STD screening was important while use of condoms was protective (63.8%). The majority of them strongly felt that treatment should be sought immediately if they (85.5%) and their partners (87.4%) have symptoms. Among the sexually-active students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24–30 years old (an odds ratio (AOR) = 0.57, 95% confidence interval (CI) = 0.377–0.859) and faculty type (AOR = 5.69, 95% CI = 4.019–8.057) were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented.

BackgroundIn Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia.MethodsThe questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).ResultsThe development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model.ConclusionsBased on the IRT analysis and factor analytic evidence, the knowledge and attitude sections of the KABP questionnaire on leptospirosis were psychometrically valid. However, the psychometric properties of the belief section were unsatisfactory, despite being revised after the initial validation study. Further development of this section is warranted in future studies.

BackgroundLeptospirosis is a zoonotic disease associated with occupations which exposed workers to environments contaminated with urine of infected animals. The objective of this study was to determine the seroprevalence of leptospirosis among wet market workers in Kelantan.MethodsA cross sectional study was conducted in two main wet markets in Kelantan and 232 wet market workers were randomly selected. Blood samples were analysed for microscopic agglutination test (MAT) against 20 live leptospirosis reference serovars. MAT titres of 1:100 or more were considered as seropositive.ResultsIt was found that the overall seroprevalence for leptospirosis among the respondents was 33.6% (95% CI = 27.5, 39.7). The samples were tested positive against serovars Melaka (IMR LEP 1), Terengganu (IMR LEP 115), Sarawak (IMR LEP 175), Copenhageni (IMR LEP 803/11), Hardjobovis (IMR LEP 27), Australis, Autumnalis, Bataviae, Canicola, Grippotyphosa, Hardjoprajitno, Icterohaemorrhagiae, Javanica, Pyrogenes, Terrasovi, Djasiman, Patoc and Pomona. The predominant serovars was Autumnalis (18.2%).ConclusionWet markets workers were at risk for leptospirosis infection evidenced by high seroprevalence of leptospirosis in this study. Further research need to be conducted to determine factors that favours infection in this groups.

Introduction. Municipal service workers have been found to have an occupational risk of leptospirosis. Study among municipality workers shows high seropositivity of leptospiral antibodies detected among town cleaners and garbage collectors.Objective. Aims of this study were to determine seroprevalence of leptospiral antibodies and distribution of serovars detected in samples among municipal service workers.Methodology. Cross-sectional study involved 89 municipal service workers in Selangor. Blood samples were taken and serological test was done using MAT following standard procedures.Results. Seropositivity of leptospiral antibodies among municipal service workers was 34.8%. Serovars identified were strains ofSarawak, Copenhageni, Hardjobovis, Lai, Bataviae, Patoc, Celledoni, Hardjoprajitno, Tarrasovi, andPomona. There were 31 workers with positive leptospiral antibodies. All of them were frequently exposed towards leptospirosis. Significant associations have been reported between seropositivity of leptospiral antibodies with job category (P=0.021) and worker’s nationality (P=0.014) among municipal service workers.Conclusion. High seropositivity of leptospiral antibodies detected among municipal service workers which was associated with job category and nationality of workers. The significant findings from this study suggest that health education programs and safe work practice should be considered to prevent leptospirosis among municipal service workers in future.

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew “rat-urine disease” as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222–0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204–2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239–0.665), income (AOR = 1.58, 95% CI = 1.041–2.385) and education type (AOR = 3.69, 95% CI = 1.237–10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613–7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

Polycystic ovary syndrome is a multifactorial condition associated with reproductive and endocrine organs and might cause infertility and metabolic abnormalities in childbearing age. PCOS seems to be a multifactorial disorder resulting from the combination of several genetic and environmental factors. Little research has been conducted to date on the impact of polymorphisms in infertility. We aim to review the appearance of polymorphisms in females of diverse ethnicities and their effect on infertility in the population with polycystic ovary syndrome. There have been numerous reports of the importance of the steroidogenesis pathway and genetic variants in PCOS pathogenesis. The most important genes that play a role in the aetiology of PCOS are CYP11A1, CYP17A1, and CYP19A1. We evaluated the occurrence of polymorphisms in various ethnicities in the CYP11A1, CYP17A1, and CYP19A1 genes and their efficacy on increasing PCOS risk with infertility. Our findings revealed that polymorphisms in various ethnicities are associated with the risk of PCOS with infertility. Although conflicting results regarding CYP11A1, CYP17A1, and CYP19A1 polymorphisms and their influence on PCOS with infertility have been reported in a small number of papers, the authors feel this may be attributable to the sample size and ethnic composition of the examined populations. In conclusion, our study strongly suggests that the CYP11A1, CYP17A1, and CYP19A1 genes might significantly enhance the probability of developing PCOS with infertility.

Background. Heat stress disorders may cause negative health outcome and subsequent productivity reduction especially in those who work under direct sunlight for an extended number of hours. Objective. This study assessed the impact of heat on the health and productivity among maize farmers in a hot tropical country. Methods. A cross-sectional study was conducted among 396 maize farmers, randomly selected across Gombe province, Nigeria. The wet bulb globe temperature monitor (WBGT) Model QuesTemp036 was used in determining the heat index. Health was determined using a validated questionnaire, while productivity was determined by recording work output based on the number of ridges cultivated during the working hours. Results. The farms recorded mean heat index with standard deviation (SD) of 31.56 (2.19) and 34.08 (1.54) in the hours of 9 am to 12 pm and 12–3 pm respectively, which exceeded the threshold level set by the ACGIH. Heavy sweating (93.2%), tiredness (48.5%), dizziness (34.1%), and headache (40.4%) were experienced by the respondents almost on daily basis. The finding further showed a significant difference in the farmers’ productivity during the three time duration of the work day (p<0.001). The productivity was significantly higher between the hours of 6–9 am (p<0.001) and 12–3 pm (p<0.001), compared to the hours of 9 am to 12 pm (p<0.001). The factors that significantly predict the productivity outcome include temperature (p<0.001), gender (p<0.001), age (p=0.033), and BMI (p=0.008). Conclusion. The farmers were frequently experiencing heat exhaustion which decreased their productivity.