Background Typhoid fever causes global morbidity and mortality and is a significant health burden, particularly in low- and middle-income countries. The direct fecal-oral route is the main transmission mode, but indirect environmental transmission could occur, particularly in urban settings. This study aimed to investigate the burden and trend of typhoid fever, reporting the coverage system between government and private practice and pattern of multidrug-resistant (MDR) typhoid cases in the urban Klang Valley area from 2011 to 2015. Methods The data from a cross-sectional study retrieved from the e-Notifikasi System, a national reporting system for communicable diseases provided by the Disease Control Division, Ministry of Health Malaysia and secondary data of all the typhoid cases were obtained from the public and private hospitals and laboratories in Klang Valley. Descriptive analysis was performed to examine the sociodemographic characteristics, spatial mapping was conducted to examine trends, and the crude incidence rates of confirmed typhoid cases and percentage of reporting coverage were calculated. Significant differences between MDR and non-MDR Salmonella typhi were determined in the patient’s sociodemographic characteristics, which were analyzed using χ2 test. P values < 0.05 were considered statistically significant. Results In total, 507 typhoid fever cases were reported in Klang Valley; however, only 265 cases were confirmed by culture tests. The crude incidence rates of confirmed cases were between 0.5 to 0.7 but peaked at 1.42 per 100,000 population in 2015. Most typhoid fever cases were observed among men (55.6%), individuals aged 21 to 30 years (27.6%), Malaysians (86.3%) and individuals of Malay ethnicity (52.1%). The reporting coverage of confirmed cases was 78.9% and non-reporting coverage of unconfirmed typhoid cases was 79.5%. The predictive value positive (PVP) was 89.3, and 7.5% were detected as MDR Salmonella typhi. Statistical significance was found in gender, citizenship and ethnicity regarding MDR Salmonella typhi (p = 0.004, p = 0.008 and p = 0.034, respectively). Conclusions The local transmission of typhoid is still prevalent in the Klang Valley despite rapid urbanization and development in recent years. These findings are essential for policy makers to plan and implement focused and effective preventative activities to curb typhoid infection in urban areas.

Background Dengue virus (DENV) is spreading to parts of the world where it had not been previously reported. Increased international travel has led to intercontinental importation of dengue by visitors returning from countries in sub-Saharan Africa. Although dengue is well documented in the rain forest region of Nigeria, there is a dearth of information in the Guinea Savannah region, which is a major transit point for local and international visitors in the most populous nation in Africa. We provide preliminary evidence of dengue activity in the Guinea Savannah and highlight the risk factors. Methods Blood was collected from a cross-section of 200 patients attending four hospitals in Anyigba, Kogi State. Anti-dengue antibody was identified using DENV immunoglobulin G (IgG) immunoassays. Questionnaires were used to obtain sociodemographic variables and risk factors. Data were analysed with SPSS version 16.0 for Windows. Results Forty-two (20.5%) participants had anti-DENV IgG antibodies. Persons within the 45–59 y age group were more seropositive, with a rate of 35%. Males were more seropositive compared with females. Marriage, formal education, involvement in business activities and the presence of grasses around homes were associated with higher IgG seropositivity. The presence of open water containers around human dwellings and a lack of mosquito net use are predisposing factors. Conclusions This study identified past exposure to DENV among people in Anyigba, located in the Guinea Savannah region. Proper diagnosis of febrile episodes is required to improve case management and curtail off-target treatment. The high rate of previous exposure of patients to dengue indicates the need to strengthen vector control and dengue surveillance programs.

IntroductionDengue is among the most important mosquito-borne diseases, with more than half of the world’s population at risk of infection in dengue endemic countries. Environmental management, which includes any activities that involve environmental modification, environmental manipulation and changes to human behaviour have been used to mitigate the risk of dengue transmission. In this protocol, we will integrate the data from various sources to assess the overall effect of environmental management on the incidence of dengue and other entomological indices.Methods and analysesWe will conduct a systematic review of intervention that assess the effect of environmental management on the incidence of dengue and/or entomological indices. We will include any studies that include intervention through environmental management for dengue control, involving environmental modification, environmental manipulation and changes to human behaviour. A comprehensive search will be performed in electronic databases PUBMED, CENTRAL, SCOPUS, Web of Science and relevant research websites such as PROPSERO, WHO ICTRP and ClinicalTrials.gov to identify studies that meet our inclusion criteria. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic reviews and Meta-Analysis. Titles, abstract, keywords for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using quality assessment tool for studies with diverse design and Cochrane risk of bias tool. The characteristics of the selected articles will be described based on the study design, types of intervention and outcomes of the study in various countries. These include the types of environmental management intervention methods and the effectiveness of the intervention in reducing dengue cases or incidence and impact on entomological indices.Ethics and disseminationWe will register this systematic review with the National Medical Research Register, Ministry of Health Malaysia. This protocol also had been registered with the PROSPERO. No ethical approval is necessary, as there will be no collection of primary data. The results will be disseminated though a peer-reviewed publication and conference presentation.Trial registration numberCRD42018092189.

Aim Physical inactivity in older adults is linked to increased risk of chronic diseases, disability and various poor health outcomes. As the aging population rises, the prevalence of diseases associated with aging also increases. Regular physical activity in older adults is important to improve overall health and promote healthy aging. This study aimed to determine the prevalence and factors associated with physical inactivity among older adults in Malaysia. Methods This study was based on 3969 Malaysian older adults aged ≥60 years who completed the physical activity module in the National Health and Morbidity Survey 2018, a population‐based cross‐sectional survey. Physical activity was measured using the Global Physical Activity Questionnaire through a face‐to‐face interview. Participants were classified as physically active or inactive. Associations between physical inactivity, sociodemographic characteristics and a range of selected independent variables were examined using multivariable logistic regression. Results Overall, three out of 10 (29.8%) Malaysian older adults were physically inactive. Results of multivariable analysis showed that older age group (≥80 years), of Bumiputera Sarawak ethnicity, unemployed/retirees/homemakers, functional limitation, diabetes mellitus and dementia were significantly associated with a higher risk of physical inactivity. Women, with secondary education level and good social support were less likely to be physically inactive. Conclusions The present study reported the status of physical inactivity among older adults in Malaysia. There is the need to design effective public health programs and interventions to promote active living and healthy aging among Malaysian older adults, particularly in those at‐risk older population subgroups. Geriatr Gerontol Int 2020; 20: 49–56.

Aim Studies on the influence of social support on activity limitation among older persons remain limited. A better understanding of this relationship will help with resource planning and policy making aimed to reduce burden of care. The objective of this study was to assess the influence of social support on limitation in daily living among older persons in Malaysia. Methods Data from the National Health and Morbidity Survey 2018, a nation‐wide, cross‐sectional survey using a two‐stage stratified sampling design, were analyzed. A representative sample of individuals aged ≥60 years identified through national sampling frames throughout Malaysia was included. Face‐to‐face interviews were conducted using validated questionnaires on activities of daily living (ADL) and instrumental ADL (IADL). Social support was measured using the Duke Social Support Index. Results The overall prevalence of the presence of any limitations in ADL and IADL was 17.0% and 42.9% respectively. Overall prevalence of the older persons with low to fair social support was 30.8% and high to very high social support was 69.2%. Logistic regression analysis identified the following factors as being associated with limitations in ADL and IADL: being female, of older age, having a monthly income

IntroductionLeptospirosis is the most common zoonotic disease that causes morbidity and mortality worldwide. The disease can cause sporadic epidemics and recent epidemics have become more apparent in urban localities. There is lack of documented evidence on the specific risk factors of leptospirosis infection among the urbanites, thereby impeding initiatives for prevention in urban settings. We aim to systematically search published articles and synthesise evidence on the risk factors associated with leptospirosis infection among the susceptible populations in urban localities, particularly to identify the risk factors of non-recreational leptospirosis infection.Methods and analysisWe will conduct a systematic review of observational studies that investigated environmental risk factors of leptospirosis in urban localities. The search will be performed for any eligible articles from selected electronic databases from 1970 until May 2018. The study will include any studies that investigated risk factors of confirmed leptospirosis cases who acquired the infection in urban locality, particularly exposures from the non-recreational and non-water-related activities. Study selection and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Meta-Analysis of Observational Studies in Epidemiology guideline. All data will be extracted using a standardised data extraction form and quality of the studies will be assessed using the Newcastle-Ottawa Scale guideline. Descriptive and meta-analysis will be performed by calculating the standardised median ORs and risk ratios for types of the non-recreational risk factors stratified by social, living conditions and environmental exposures, types of reservoirs and transmissions and types of activities and employments associated with leptospirosis infection in urban locality.Ethics and disseminationNo primary data will be collected thus no formal ethical approval is required. The results will be disseminated though a peer-reviewed publication and conference presentation.PROSPERO registration numberCRD42018090820.

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