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MALAYSIAN JOURNAL OF PUBLIC HEALTH MEDICINE ISSN: 1675-0306 Volume 13 (Supplement 2) 2013 Official Publication of the MALAYSIAN PUBLIC HEALTH PHYSICIANS’ ASSOCIATION 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 MJPHM Official Journal of Malaysian Public Health Specialist Association EDITORIAL BOARD Chief Editor Prof. Dato’ Dr. Syed Mohamed Aljunid (United Nations University – International Institute for Global Health) Deputy Chief Editor Assoc. Prof. Dr. Sharifa Ezat Wan Puteh (Universiti Kebangsaan Malaysia) Members: Assoc. Prof. Sharifah Zainiyah Syed Yahya Dr. Lokman Hakim Sulaiman Assoc. Prof. Dr Retneswari Masilamani Assoc. Prof. Dr. Mohamed Rusli Abdullah Assoc. Prof. Dr Saperi Sulong Assoc. Prof. Dr Maznah Dahlui Dr. Roslan Johari Dr. Othman Warijo Dr. Norfazilah Ahmad Dr. Amrizal Muhd Nur University Putra Malaysia Ministry of Health Malaysia University Malaya University Sains Malaysia University Kebangsaan Malaysia University Malaya Ministry of Health Malaysia Ministry of Health Malaysia University Kebangsaan Malaysia United Nations University–International Institute for Global Health (UNU-IIGH) Chief Editor Malaysian Journal of Public Health Medicine (MJPHM) United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia ISSN: 1675–0306 The Malaysian Journal of Public Health Medicine is published twice a year Copyright reserved @ 2001 Malaysian Public Health Physicians’ Association Secretariate Address: The Secretariate United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia Tel: 03-91715394 Faks: 03-91715402 Email: [email protected] 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 MJPHM Official Journal of Malaysian Public Health Specialist Association 7thNATIONAL PUBLIC HEALTH CONFERENCE 2013 11 – 13thNOVEMBER 2013 CONCORDE HOTEL SHAH ALAM, SELANGOR Organized by Ministry of Health Malaysia & The Malaysian public health physicians’ association In collaboration with Public Health Department of: (UKM, UM, USM, UPM, UiTM, IMU, UPNM, UMS, UNISZA, USIM, UNIMAS, UIA) Academy of Medicine of Malaysia, Malaysian Association of Health Education Officer Angkatan Tentera Malaysia EDITORIAL BOARD CHAIRMAN: DR. TAHIR BIN ARIS SECRETARY: SALSABILAH BINTI MOHAMAD MUKHTAR MEMBERS: DR. ROSLINAH ALI, MOH DR. NIK JASMIN NIK MAHIR, MOH DATIN DR SITI HANIZA MAHMUD, MOH DR FADZILAH KAMALUDIN, MOH DR NOR ASIAH MUHAMAD, MOH AP DR HEJAR ABDUL RAHMAN, UPM DR JAMAIYAH HANIFF, MOH PROF MADYA DR. MAZNAH DAHLUI, UM DR. MUHAMMAD FADHLI MOHD YUSOF,\ DR. NOR IZZAH BINTI HJ AHMAD SHAUKI DR MOHAMAD IKHSAN SELAMAT, UITM DR. OTHMAN WARIJO, MOH DR. NOOR ANI AHMAD, MOH DR. MOHD AZAHADI OMAR, MOH DR AMAL NASIR MUSTAPA, MOH DR RAFIZA SHAHARUDIN, MOH DR FATANAH ISMAIL, MOH DATIN DR. HJH NORIAH BIDIN, MOH DR. NOR FILZATUN BORHAN, MOH AP DR. JAMALUDDIN AB RAHMAN, IIUM DR. NIK NUR ELIZA BT MOHAMED 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 7TH NATIONAL PUBLIC HEALTH CONFERENCE The national public health conference was initiated in 1995 by the then Deputy Director General of Health (Public Health), YBhg Dato’ Dr Wan Mahmud Othman. The conference was organised in collaboration of the Ministry of Health and Malaysian Public Health Physicians Association (PPPKAM) with other public health related professional bodies as well as public health departments of the local medical faculties. The main objective of this conference is to gather public health professional from various sectors to discuss relevant public health issues and share experiences in order to upgrade and maintain their professionalism and the discipline of public health medicine. The 7th national public health conference is organized by Malaysian Public Health Physicians Association (Persatuan Pakar Perubatan Kesihatan Awam Malaysia) and the Ministry of Health Malaysia, co-organized by the public health departments of Universiti Kebangsaan Malaysia, Universiti Malaya, Universiti Sains Malaysia, Universiti Teknologi MARA, International Islamic University Of Malaysia and Universiti Pertahanan Nasional Malaysia in collaboration with the Collage of Public Health Medicine (Academy of Medicine, Malaysia) Objectives of this conference Enhance professionalism among Malaysian public health professionals through a strong understanding and knowledge transformation and update of the national health system and public health issues at local and international levels. To discuss the opportunities and challenges and the role of public health professionals in improving the fairness and efficiency of public health services in line with the country's health system transformation. Foster the spirit of cooperation of all public and private sectors from various fields and sectors of public health. Provide an opportunity for public health professionals to present and share research findings and their professional experience. 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Conference format The 7th National Public Health Conference is held on 11 - 13 November 2013 at Concorde Hotel, Shah Alam, Selangor and will be officiated by the Minister of Health, Malaysia, YB Datuk Seri Dr. S. Subramaniam. The conference theme is Public-Private Partnership towards Achieving Universal Health Coverage. Keynote address will be delivered by the Director General of Health, Malaysia, YBhg Datuk Dr. Noor Hisham bin Abdullah which will focus on the conference theme. Three plenary papers will be presented by distinguished speakers i.e. To’ Puan Dr. Safurah binti Jaafar (Director of Family Health Development Division, MOH), YBhg Datin Paduka Siti Sa’diah Shiekh Bakir (Corporate Advisor, KPJ Healthcare Berhad) and YBhg Datuk Dr. Lokman Hakim bin Sulaiman (Deputy Director General of Health [Public Health]). Six symposia will also be conducted besides 3 forums, 6 pre-conference seminar/workshops and scientific paper presentations (oral and poster); in total 100 scientific papers will be presented. The conference is expected to attract 400-500 participants consisting of public health physicians, medical doctors, health service managers, public health nurses, public health dental specialists, health educators, health inspectors and various other public health professionals from the Ministry of Health, institutions of higher learning, local authorities, private hospitals, armed-forces and private practices. 12 commercial booths on various health products will be displayed. PHC 2013 Secretariat November 2013 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 CONTENTS PAGES KEY-NOTE ADDRESS 1 PUBLIC-PRIVATE PARTNERSHIP TOWARDS ACHIEVING UNIVERSAL HEALTH COVERAGE YBhg. Datuk Dr. Noor Hisham bin Abdullah PLENARY PL 01 ROLE OF PUBLIC SECTOR IN ENCHANCING PUBLIC PRIVATE PARTNERSHIP TOWARDS ACHIEVING UNIVERSAL COVERAGE IN PUBLIC HEALTH 4 To' Puan Dr Safurah binti Jaafar PL 03 TRANSFORMING PUBLIC HEALTH TO MEET TODAY’S HEALTH THREATS 5 YBhg. Datuk Dr Lokman Hakim b. Sulaiman SYMPOSIUM 6 S1TAP1 QUALITY SERVICE DELIVERY YBhg.Tan Sri Dato Dr Abu Bakar bin Suleiman S1TAP3 OPTIMIZING HEALTH CARE RESOURCES FOR UNIVERSAL COVERAGE 7 Prof. Dato’ Dr. Syed Mohamed Aljunid S1TBP1 GOALS AND TARGETS FOR VACCINE PREVENTABLE DISEASES PROGRAMME 7 Dr. Rohani Jahis S1TBP2 PUBLIC-PRIVATE COLLABORATION IN PROMOTING VACCINE PREVENTABLE DISEASE PROGRAM 8 Mr. Sasitheran KK Nair S1TCP1 INFORMATION MANAGEMENT IN PUBLIC HEALTH 9 Prof. Madya Dr. Jamalludin bin Ab Rahman S1TCP2 HEALTH INFORMATICS 9 Dr. Ariffin Marzuki bin Mokhtar S1TCP3 BARRIERS TO INFORMATION TECHNOLOGY 10 Dr. Fadhlullah Suhaimi Abdul Malek S1TDP2 A CONTEMPORARY REVIEW OF RHEUMATIC HEART DISEASE REGISTRY IN A TERTIARY CENTER IN SABAH Dr. Narwani bt Hussin i 10 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TDP3 CHRONIC RHEUMATIC HEART DISEASE SECONDARY PROPHYLAXIS MONITORING IN PRIMARY CARE CLINIC: IS 80% ADHERENCE ACHIEVABLE? 11 Dr. Rumihati bt Abd Hamid S1TEP1 DO COMMUNITY – WIDE INTERVENTIONS INCREASE PHYSICAL ACTIVITY? 12 Prof. Philip R Baker S1TEP2 EVIDENCE OF EFFECTIVENESS: HIGH LEVEL SYNTHESIS OF RESEARCH TO PREVENT OBESITY ABD INCREASE PHYSICAL ACTIVITY IN CHILDREN 12 Prof. Philip R Baker S1TEP3 POPULATION BASED VERSUS TARGETED HIGH RISK POPULATION FOR CANCER SCREENING 13 Prof. Madya Dr. Nur Aishah bt Mohd Taib S1TFP1 CLIMATE CHANGE AND CLIMATE VARIABILITY AND ITS EFFECT ON CLIMATE SENSITIVE DISEASES 14 Dr. Muhammad Amir bin Kamaluddin S1TFP2 EFFECTS OF ELECTROMAGNETIC RADIATION FROM TELECOMMUNICATION TOWERS Prof. 14 Dr. Adlina Suleiman S1TFP3 SAFETY AND SECURITY OF NUCLEAR POWER PLANT 15 Prof. Emeritus Dato’ Dr. Noramly Muslim ORAL PRESENTATION Oral 01 OVERVIEW OF PLASMODIUM KNOWLESI MALARIAIN SELANGOR (2011-SEPTEMBER 2013) 16 Sharifah Malihah WM1, Venugopalan B1, Muhammad Afi S1 Oral 02 E. COLI FOOD POISONING OUTBREAK AMONG ATHLETE AT TELUK KEKE, MALAYSIA 2012 16 Liza AL, Razan S, Ummi Nadiah Y, Ismail I, Ahmad Nazri S, Rosli Y, Yusmaliza MY, Tg Johanoordin TZ, Intan Hawani AD, Wan Nur Farhana WA, Kamil SM, Mazlizaini G, Mohd J, Anwa S Oral 03 SHARING MEASLES ELIMINATION ACTIVITIES IN KUALA LANGAT DISTRICT 17 Lasa I, Shuaita MN, Anuratha S, Zabedah LS, Hasniza MR, Nurulizzah AK, Noraziani K Oral 04 ROLE OF TODDY DRINKS IN HEPATITIS A OUTBREAK: A MALAYSIAN EXPERIENCE 17 Ahmad Faudzi Y, Rusdi AR, Rohani J Oral 05 THE FIRST METHANOL POISONING OUTBREAK IN MALAYSIA - A MULTIAGENCY ROLES AND RESPONSIBILITIES COULD HALT THE ILLEGAL PRODUCTION OF ILLICIT ALCOHOL ACTIVITIES - SELANGOR 2013 HarishahT, J Norli , A Rosemawati, M Omar , K Fadzilah , Dr Raja A ii 18 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 06 AN OUTBREAK OF GASTROENTERITIS AMONG COMMANDO TRAINING RECRUITS IN SELANGOR, NOVEMBER 2011, WAS IT LEPTOSPIROSIS? 18 2 Harishah T, Rosemawati A, Fadzilah , Lasa , Siti Sabariah S ,Sazidah MK Oral 07 A PRELIMINARY STUDY OF INTESTINAL PARASITES PREVALENCE AND INTENSITY IN SOME SELECTED LOCAL GOVERNMENT AREAS OF ZAMFARA STATES, NORTH-WESTERN REGION OF NIGERIA 19 Oral 08 ORAL HEALTH RELATED QUALITY OF LIFE AND HEALTH RELATED QUALITY OF LIFE AMONG HIV PATIENTS IN KOTA BHARU 19 Mohammed K, Ikeh Eugene I2,Aziah I, Julia O,Fabiyi Joseph P, Mohamed Rusli A Mohamed NA, Yusoff A, Saddki N, Anilawati MJ Oral 09 KNOWLEDGE AND ATTITUDES OF ANTENATAL MOTHERS ON INFANT ORAL HEALTH 20 Mohd Hulaime MN, Zaim S, Mahmood Z, Saddki N Oral 10 ALCOHOL AND ITS CO MORBIDITIES AMONG ADOLESCENTS IN MALAYSIA; FINDINGS FROM GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY 2012 20 Mala AM, Hamizatul AH, Hatta M, Rozanim K, Yussof S, Chong ZL, Norhafizah S, Diana Y, Hashimah I, Gurpreet K Oral 11 SEXUAL ACTIVITY AMONG MALAYSIAN ADOLESCENTS: WHAT ARE THE RISK AND PROTECTIVE FACTORS? 21 Noor Ani A, S Maria A, Hasimah I, Norazilah MR, Nik Rubiah AR, Hamizatul Akmal AH, Tee GH, Norhafizah S, Diana M Oral 12 MENTAL HEALTH PROBLEMS AMONG STUDENTS OF SEKOLAH MENENGAH KEBANGSAAN METHODIST, NIBONG TEBAL, PULAU PINANG Rozaini MS , Thiruloga Guna Venthi K , Raveena Visha M , Fazilah Y Oral 13 UNDERSTANDINGS ADOLESCENTS EATING BEHAVIOUR IN MALAYSIA 21 22 Suhaila AG, NorhafizahS, Ahmad Ali Z, Azli B, Hatta M, Yeo PS Oral 14 PREVALENCE AND DETERMINANTS OF DIETARY SUPPLEMENTS USE AMONG ADOLESCENTS IN MALAYSIA 22 Yeo PS, Norhafizah S, Hatta M, Nor Azian MZ,Suhaila AG Oral 15 PHYSICAL ACTIVITY AND ASSOCIATION WITH NUTRITIONAL STATUS (BMI) AMONG MALAYSIAN ADOLESCENTS: FINDING FROM MALAYSIAN SCHOOL-BASED NUTRITION SURVEY, MSNS2012 Azli B, Ahmad Ali Z, Suhaila AG, Rashidah A, Balkish MN, Hatta AM, Chan YY, Mala M, Noor Ani A iii 23 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 16 BURDEN AND CORRELATES OF DEPRESSION AMONG ADOLESCENTS IN MALAYSIA 23 Jasvindar K,Gurpreet K, Balkish MN, Noor Ani MN, Helen Tee GH, Diana M, Cheong SM, Siti Fatimah MH, Fadli Y,Nurashikin I &Azriman R Oral 17 IDENTIFIED RESEARCH PRIORITY AREAS IN OCCUPATIONAL HEALTH FOR TENTH MALAYSIA PLAN (10MP) 23 Lasa I, Yahya B, Juliana SP, Gurdeesh K, Ridhuan MD, Hazrin H Oral 18 CORPORATE CULTURE IMPLEMANTATION AMONG HEALTHCARE PROVIDER IN MOH: WHERE ARE WE! 24 Dr. Nor Filzatun B, Noriah B, Roslinah A, Mohd Idris O, Roziana S, Fariz Sakina A, Aishah M Oral 19 THE ECONOMIC BURDEN OF OCCUPATIONAL NOISE INDUCED HEARING LOSS IN MANUFACTURING INDUSTRIES IN MALAYSIA 24 Noraita T, Jamal Hisham, Syed Aljunid Oral 20 ACTUAL COST OF DENTAL RESTORATIONS IN GOVERNMENT DENTAL CLINIC IN KELANTAN 25 Oral 21 EVALUATION OF ICPMS AND GFAAS FOR ANALYSES OF LEAD IN BLOOD 25 Abdullah MZ, Yusof A, Abd Rahman N, Sulong S, Mohd Nur A Rafiza S, Wan Nurul Farah WA, Yuvaneswary V, Mohd Fitri R, Mohd HairulHisam H & Muhammad Amir K Oral 22 CODING ERRORS OF DIAGNOSIS AND PROCEDURES CLASSIFICATION: IMPACT ON IMPLEMENTATION OF CASEMIX SYSTEM 26 SA Zafirah, Syed Aljunid, Sharifa Ezat WP, Amrizal MN Oral 23 WORKPLACE VIOLENCE AMONG HEALTHCARE WORKERS IN EMERGENCY DEPARTMENT, HOSPITAL UNIVERSITI SAINS MALAYSIA 26 Zulraini J, Zaliha , Aziah D, YN Azwany Oral 24 DETERMINANTS OF SICK LEAVE DURATION AND RETURN TO WORK POST-ACUTE CORONARY SYNDROME: A REVIEW OF THE LITERATURE 27 Oral 25 PUBLIC ACCEPTANCE TOWARDS SMOKE FREE INITIATIVES IN PERLIS 27 Sahrol Nizam Abu Bakar, Mohd Nazri Shafei, Norsa’adah Bachok, Zurkurnai Yusof, Mansor Yahya Zulhizzam A, Ghazali O, Kamariah H and Azmi A Oral 26 EFFECT OF ELECTRONIC MEDICAL RECORD UTILIZATION ON DEPRESSION, ANXIETY AND STRESS AMONG DOCTORS AND NURSES IN JOHOR Ahmad Fairuz M, Mohd Ismail I, Mohd Nazri S iv 28 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 27 FACTORS INFLUENCING HEALTH SEEKING BEHAVIOR AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN PRIMARY CARE SETTING 28 LL Low, SF Tong, WY Low Oral 28 THE IMPACT OF CIGARETTE PACKAGING AND HEALTH WARNINGS ON RISK PERCEPTION IN YOUNG CHILDREN IN RELATION TO THEIR PARENTS SMOKING STATUS 29 Siti Munira Y, Noridayu A, NurQaasimah M, Wan Nor Atiqah WM, Wan Muhammad Hafiz WJ, Mohd Hafiz MH2 Oral 29 KNOWLEDGE, ATTITUDE AND PRACTICE ON FAMILY PLANNING AMONG ORANG ASLI WOMEN IN ROMPIN DISTRICT, PAHANG 29 Aznita Iryany MN, Mohd Hashim MH Oral 30 SEXUAL AND REPRODUCTIVE HEALTH KNOWLEDGE OF PREMARITAL PREGNANT ADOLESENTS IN RAUDHATUS SAKINAH 30 A Safiya, Mohd Yusof Sidek, KI Musa Oral 31 CORRELATES OF CURRENT SMOKING AMONG ADOLESCENT SCHOOL CHILDREN 30 GH Tee, Gurpreet K, KH Lim, Muhammad Fadhli MY, Hamizatul Akmal AH, Hazrin H Oral 32 PREVALENCE AND PREDICTORS OF ILLICIT DRUG USE AMONG ADOLESCENTS IN MALAYSIA: GLOBAL SCHOOL HEALTH SURVEY SCHOOL-GOING 31 Mohamad Naim MR, Norhafizah S, Fadhli MY, Yusoff S, Lim KH, Norzawati Y, Noor Ani A Oral 33 ALEGIONELLA OUTBREAK AT A HOSPITAL IN KUALA LUMPUR 31 Rohani I, Thilaka C, Rosmawati A, Zakiah MY, Deenesh K, Ummi Kalthum S, Balachandran S Oral 34 A MEASLES OUTBREAK AT A PRIVATE WELFARE CENTRE IN KUALA LUMPUR, FEBRUARY 2012 31 Rohani I, Nurul Hafizah MY,Norhaida U, Sarah Hassan, Tarmizie N Oral 35 EPIDEMIOLOGICAL ANALYSIS OF TYPHOID FEVER IN SELANGOR FROM A RETRIEVED REGISTRY 2013 32 Mas Norehan A ,Harishah T ,Wan Nor Fareeda W.Y , Mohmad Farhan K Oral 36 DENGUE VIRUS INFECTION AMONG FOREIGNERS IN KUALA LUMPUR AND PUTRAJAYA, 2010 TO 2012 32 Wong YM, Zainal Abidin AB Oral 37 QUIT SMOKING SERVICES IN KLANG HEALTH DISTRICT: FACTORS ASSOCIATED WITH FAILURE OF QUIT ATTEMPTS Ho BK, Nelli Y, Menaga M, Parimala D, Daisy V, Nor Izah D, Che Azlan S v 33 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 38 CERVICAL CANCER SCREENING COVERAGE AT HEALTH CLINICS, KUALA LUMPUR IN 2012 Shanthi V, Chia SY, Ummi Kalthom S Oral 39 A CROSS SECTIONAL STUDY ON PREVALENCE, KNOWLEDGE AND PRACTICE ON DIABETES IN A VILLAGE IN KINTA DISTRICT, PERAK 33 34 Davinder S, Sandheep S, MM Soe Oral 40 EARLY DETECTION OF AIRFLOW OBSTRUCTION IN A POPULATION EXPOSED TO OCCUPATIONAL LUNG CARCINOGENS 34 Fauziah N, Booton R, Barber PV, T Frank, F.de Vocht,, Povey AC Oral 41 PREVALENCE AND FACTORS ASSOCIATED WITH OVERWEIGHT AMONG ADOLESCENTS 34 Rampal L, Garba JA, Hejar AR, Salmiah MS Oral 42 MAJOR DIETARY INTAKE AMONG ADOLESCENTS AND THEIR ASSOCIATION WITH OVERWEIGHT 35 Rampal L, Garba JA, Hejar AR, Salmiah MS Oral 43 BULLYING AND ITS ASSOCIATED FACTORS AMONG SCHOOL ADOLESCENTS IN MALAYSIA 35 Diana M,Rosnah R, Siti Fatimah MH,Riyanti S, NurShahida AA, MohdHazrin H, HamizatulAkmal AH, Cheong SM, Noor Safiza MN Oral 44 NUTRITIONAL STATUS AND BODY WEIGHT PERCEPTION AMONG ADOLESCENTS IN MALAYSIA 36 Ahmad Ali Z, Suhaila AG, Azli B, Norhafizah S, Cheong SM, Noor Ani A, Balkish MN, Mala M Oral 45 AWARENESS ON COMMON EYE DISEASES AND BARRIERS TO EYE CARE AMONG JAKUN SUBETHNIC COMMUNITY OF ORANG ASLI (INDIGENOUS PEOPLE) IN KUANTAN, MALAYSIA 36 Azuwan M, Sheeladevi S, Williams JD Oral 46 OCCUPATIONAL AND ENVIRONMENTAL CHARACTERISTICS AMONG SEROPOSITIVE TOWN SERVICE WORKERS FOR LEPTOSPIROSIS IN KELANTAN, MALAYSIA 37 Mohamad Azfar Z, Aziah D, Mohd Nazri S, Mohamed Rusli A, Maizurah O, Zahiruddin WM, Nor Azwany Y, Nabilah I, Siti Asma’ H, Mohd Nikman A Oral 47 IMPLEMENTATION OF WEB-BASED GEOGRAPHICAL INFORMATION SYSTEM (GIS) APPLICATION FOR MAPPING OF HEALTH FACILITIES, SERVICES AND PROVIDERS IN MALAYSIA 37 Hazrin H, Tahir A, Fadhli Y Oral 48 VALIDITY AND RELIABILITY OF THE MALAY VERSION OF THE STROKE KNOWLEDGE, ATTITUDE AND PRACTICE QUESTIONNAIRE Noriah M, Mohd Ismail I, Norsa’adah B vi 38 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 POSTER PRESENTATION Poster 01 THE PRIVATE HAEMODIALYSIS CENTRE FINANCIAL ARRANGEMENTS IN MALAYSIA: AN EXPLORATORY STUDY 39 Adilius M, Siti Haniza M Poster 02 LEPTOSPIROSIS IN TERENGGANU, MALAYSIA 2010 – 2012. 39 Liza AL, Ummi Nadiah Y, Ismail I, Ahmad Nazri S, Yusmaliza MY, Wan Nur Farhana WA, Kamil SM, Mazlizaini G, Mohd J, Anwa S Poster 03 STUDIES ON MALAYSIAN HEALTHCARE SYSTEM: LISTENING TO THE PEOPLE'S VOICE 40 Najwa M , Hasmuny O , Nordin S , Siti Sa’adiah HN Poster 04 DEPRESSION AND RESILIENCE IN RELATION TO ACADEMIC PERFORMANCE AMONG MEDICAL STUDENTS IN A PUBLIC UNIVERSITY 40 Siti Munira Y, Nurhuda I, Nor Aini MN, Imran Z, Muhammad Ammar AR, Elisa Shafura S, Fatheen Atheerah AR, „Aisyatul Najiha H Poster 05 REFERRAL PATTERN OF PRIMARY CARE PROVIDERS IN THE MALAYSIAN PUBLIC HEALTHCARE SYSTEM 40 Ang KT, Ho BK, Mimi O, Salmah N, Salmiah MS, Magesiwaran M, Noridah MS Poster 06 HOW WELL DO WE KNOW OUR PARTNERS? 41 Siti Haniza M, Adilius M, Sarah J, Sai Gaayathri S, Wan Shihabuddin WM, Look CH, Halim AH, Rozita Halina TH, Nordin S Poster 07 FACTORS ASSOCIATED WITH NO ANTENATAL BOOKING AMONG PREGNANT WOMEN WITH HIV IN SELANGOR 41 Dr Fazlina Mohamed Yusoff, Dr Ho Bee Kiau, Dr Salmiah Sharif, Dr Vickneswari Ayadurai , Dr. Noranizah Muzaid, , Dr Masitah Mohamad, Dr. Rosnah Mat Isa Poster 08 COST OF OPERATING KLINIK 1MALAYSIA (K1M) WITH A MEDICAL OFFICER 42 Mazura M & Ramli Z Poster 09 PERINATAL MORTALITY REVIEW: OPPORTUNITY FOR INTERVENTION IN KUALA LANGAT DISTRICT 42 Noraziani K, Lasa I, Shuaita MN, Siti Harirotul A, Nor Azila MI Poster 10 MANAGING ACUTE DIARRHOEAL DISEASES AMONG UNIVERSITY STUDENTS USING SYNDROMIC NOTIFICATION APPROACH Noraliza NM, Fazar AJ, Maryam AG, Rohani I vii 43 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 11 1MALAYSIA MOBILE CLINICS – AN INNOVATION TOWARDS UNIVERSAL PRIMARY HEALTH CARE COVERAGE IN MALAYSIA 43 Poster 12 ACCESS OF ANTENATAL HEALTHCARE AMONG NON-CITIZENS AT GOVERNMENT MATERNAL & CHILD HEALTH (MCH) CLINICS, FEDERAL TERRITORY OF KUALA LUMPUR IN 2012 44 Poster 13 DENGUE CASES IN SEPANG, SELANGOR OVER 5 YEARS – A REVIEW 44 , Kawselyah Juval, Kamaliah Mohamad Noh, Noridah Mohd Salleh, Rachel Koshy Muhamad Nazimim Chia SY, Shanthi V, Balachandran S1 Ruhaini I, Fariza F, Meftahuddin T, Latifah M, Mohd Zahrulnizam S Poster 14 TRADITIONAL POSTPARTUM PRACTICES AMONG MALAYSIAN MOTHERS: A REVIEW 45 Fariza F, Shamsuddin K, Sharifa Ezat WP Poster 15 INVESTIGATING SUSPECTED LEPTOSPIROSIS DEATH IN A DETENTION CENTRE (DTS) 45 Rahimah N, Othman BW, Norerwana M, Azlinda H, Ruzaimy AR Poster 16 INVESTIGATING LEGIONELLOSIS: NEED FOR A PROPER COMPREHENSIVE GUIDELINES 45 Othman BW, Lily Rmz, Imran A, Saman Mb Poster 17 SUSCEPTIBILITY TO SEVERE DENGUE INFECTIONS IN AN URBAN DISTRICT IN MALAYSIA: A CASE CONTROL STUDY 46 Siti Munira Yasin, Ariza Zakaria, Ruziyah Omar, Rozlan Ishak, Aminuddin Makpol, Siti Zakiah Mesbah, Azura Abul Hasan Ashari Poster 18 TREND OF MATERNAL MORTALITY IN FEDERAL TERRITORY OF KUALA LUMPUR FROM 2008 TO 2012 46 Noriah H, Noorzila I Poster 19 A URTI OUTBREAK AT A GOVERNMENT SCHOOL IN KUALA LUMPUR 47 Asyraf Z, Haliza AM, Mokhtar O, Rohani I Poster 20 ACUTE DIARRHEA AND HYGIENE PRACTICE AMONG WOMEN WHO MANAGE HOMES AT KUALA TERENGGANU DISTRICT 47 Azmawati MN, Dalila M Poster 21 THE WILLINGNESS TO PAY FOR DRUGS AMONG SELANGOR STATE POPULATION , 48 , Siti Nurul Akma A, Sharifa Ezat WP Azimatun Noor A Ramli Z, Ruhaini I Poster 22 LEVEL OF CATASTROPHIC HEALTH EXPENDITURE AND ITS INFLUENCING FACTORS AMONG INPATIENTS ADMITTED TO HOSPITAL KUALA LUMPUR Yang Rashidi A, Azimatun Noor A, Shamsul Azhar S viii 48 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 23 HIGH PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS AMONG COMMUNITY LEADERS IN KELANTAN 49 Zulraini J, AA Ismail, YN Azwany, Tengku MA, Ismail MS Poster 24 DO PATIENTS ADMITTED WITH DENGUE FEVER HAVE A COMPLETE DIAGNOSIS AND ENOUGH FLUID? 49 Norfarahdina R, Nurulraziquin MJ, Nurain MN Poster 25 REDUCING THE OCCURRENCE OF DENGUE FEVER IN PPA DESA REJANG SETAPAK THROUGH INTEGRATED VECTOR MANAGEMENT (IVM) APPROACH, 2013-2014 50 Poster 26 DIETARY FACTORS INFLUENCING O6-ALKYLGUANINE-DNA ALKYLTRANSFERASE (MGMT) ACTIVITY IN PATIENTS ATTENDING A BRONCHOSCOPY CLINIC 50 Zainal Abidin AB, Dahlia B, Zakiah Y, Khadijah K Fauziah N, O’Donnell PNS, Barber PV, Booton R ,Billson H, Derbyshire E, Margison GP, Povey AC Poster 27 MALNUTRITION AND ITS RISK FACTORS AMONG HOSPITALISED PATIENTS AT KUALA LUMPUR GENERAL HOSPITAL 51 Nor Azian MZ, Suzana S, Romzi A, Azahadi O Poster 28 SEXUAL RISK BEHAVIOR: TEENS’ EXPERIENCES 51 Hatta M., Fadzilah K., Balkish MN., Faizah P., Norzawati Y., Yussof S., Hazrin H. Poster 29 THE ASSOCIATION OF PORNOGRAPHY EXPOSURE WITH ADOLESCENTS’ SEXUAL BEHAVIOR 52 Hazrin H, Hatta M, Norzawati Y, Faizah P, Yussof M, Fadzilah K Poster 30 SUSCEPTIBILITY TO INITIATE SMOKING AMONG SECONDARY SCHOOL NON-SMOKERS IN MALAYSIA 52 Lim KH, Hasimah I, Helen Tee GH, Gurpreet K, Jasvindar K, Lim KK Poster 31 VIOLENCE RELATED BEHAVIOURS AMONG ADOLESCENTS IN MALAYSIA; A CROSS SECTIONAL SURVEY AMONG SECONDARY SCHOOL STUDENTS 53 Nur Shahida AA, Diana M, Siti Fatimah MH, Rosnah R,Mohd Hazrin H Poster 32 SUICIDAL BEHAVIOURS AMONG MALAYSIAN ADOLESCENTS: WHAT’S THE CURRENT SITUATION? 53 Noor Ani A, Cheong SM,Azriman R, Nurashikin, Mala M, Fadhli MY, Siti Fatimah, Gurpreet K, Noor Safiza MN Poster 33 PHYSICALLY ACTIVE ADOLESCENTS: WHAT ARE THE PREDICTORS? Chan YY, Lim KK, Teh CH, Azahadi O, Azli B, Hamizatul Akmal AH, Norhafizah S, Leni T, Noor Ani A ix Tee GH, 54 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 34 WHAT PARENTS AND SCHOOLS CAN DO TO BUILD PROTECTIVE FACTORS AMONG ADOLESCENTS? 54 Noor Safiza MN, Nik Rubiah NR, Norzawati Y , Diana M, Leni T , Afiq A , Noor Ani A Poster 35 ADOLESCENTS BREAKFAST HABITS IN MALAYSIA: MALAYSIA SCHOOL BASED NUTRITION SURVEY 2012 55 Suhaila AG, Hafizah Mohd Shahril, Ahmad Ali Z, Azli B, Hatta M, Yeo Pei Sien Poster 36 ORAL HEALTH PRACTICES AMONG ADOLESCENTS IN MALAYSIA 55 Riyanti S, Yaw SL, Nurrul A, Khairiyah AM, Balkish MN, Yeo PS Poster 37 ALCOHOL CONSUMPTION AMONG ADOLESCENTS IN MALAYSIA 55 Hamizatul Akmal AH, Hatta M, Mala M, Rozanim K, Yusoff S, Chong ZL Poster 38 ADOLESCENTS IN MALAYSIA: IS ANXIETY ASSOCIATED WITH SOCIO-DEMOGRAPHIC, MENTAL HEALTH, ENVIRONMENTAL, AND NUTRITIONAL FACTORS? Cheong SM, Jasvindar K, Balkish MN, Dr. Noor Ani A, Gurpreet K, Helen Tee Guat Hiong, Azriman R, Nurashikin I, Diana Mahat, Siti Fatimah MH, Leni T, Suhaila AG x 56 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 DIRECTOR GENERAL’S KEYNOTE PUBLIC-PRIVATE PARTNERSHIP TOWARDS ACHIEVING UNIVERSAL HEALTH COVERAGE YBhg. Datuk Dr. Noor Hisham bin Abdullah Director General of Health Ministry of Health Malaysia Ladies and Gentlemen, I would like to express my gratitude to the organising committee of the National Public Health Conference 2013. It is an honour for me to present the keynote speech for this conference with the theme: Public-Private Partnership towards Achieving Universal Health Coverage. The Malaysian healthcare system consists of the public and private sector which provide healthcare services from the primary care to to the tertiary care services at hospital level which consist of promotive, preventive, curative, rehabilitative and palliative care .According to 2013 Health Facts published by the Heath Informatics Centre of Planning Division, there are 6675 registered private medical clinics in contrary to only 2856 public health and community clinics. There are 209 registered private hospitals as compared to 140 public hospitals in Malaysia. Thus, it is suffice to say that there is plenty of resource in the private sector and relative heavy burden of public sector with less resource but more workload. It is therefore logical to think of Public-Private Partnership (PPP) as a partnership in bringing together available resources for the common goal of improving the health of a population based on the mutually agreed roles and principles. The Organisation for Economic Co-operation and Development (OECD) defines the partnership as a long term agreement between the government and a private partner whereby the private partner delivers and funds public services using a capital asset, sharing the associated risks. Universal Health Coverage (UNIVERSAL HEALTH COVERAGE) as expounded by the World Health organization in 2005, envisages a situation where there is access to appropriate promotive, preventive, curative and rehabilitative health services for those who need them at an affordable cost. Since then, it has gained increased recognition as a framework for embracing various global health priorities. In 2008, this was further reinforced by International Labour organisation (ILO) that defines it as the effective access to affordable health care and financial protection in case of sickness. Ladies and Gentlemen, Going back to the theme of our conference, Public-Private Partnershiptowards achieving UNIVERSAL HEALTH COVERAGE is all about the collaboration and sharing responsibilities between public and private sectors which can bring about synergetical positive effects on the efficiency, equity and quality of health care services. I would like to quotepart of the opening speech given by the ex-Director General of WHO, Dr Margaret Chan during the launch of the World Health Report 2010. „The World Health Report is designed to encourage every country in the world to adopt at least some policies that will extend coverage to more people, and reduce the number of people who risk financial ruin when they fall ill. All countries, at all stages of development, can take immediate steps to move towards universal coverage and to maintain their achievements. Countries that adopt the right policies can achieve vastly improved service coverage and protection against financial risks for any given level of expenditure.‟ South Korea has successfully attained the universal coverage of its population. Only within a span of 12 years after the introduction of social health insurance, South Korea has achieved the full coverage of its entire population in 1989. All health insurance programme and insurance societies had been merged into one single payer since the year 2000. 1 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Ladies and Gentlemen, How does Malaysia fare in providing Universal Health Coverage to its people? A case study report published in the Biomedical Centre of Public Health Journal in 2012 reported that Malaysia did well with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, tax-based financing system that fundamentally poses as a national risk pooled scheme for the population. This was based on the 4 indicators under the WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) which was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population. Even though we are on the right track, nevertheless, there‟re always rooms for improvement. In the present day, the majority of primary care consultations are paid out-of-pocket with private physicians but free or highly-subsidized care of reasonable quality is available throughout the country at public healthcare facilities. The majority of Malaysians still seek treatment at government hospitals which provide highlysubsidized general wards. Thus, the PUBLIC-PRIVATE PARTNERSHIP can act as a tool to further enhance accessibility, provide higher quality service and promote equity in delivering the desired optimum healthcare service for the public. Let us look at the pros of the PUBLIC-PRIVATE PARTNERSHIP first. First of all, it contributes in reducing fiscal pressures of governments to reallocate resources. It also enables private providers both non-profit or for profit oriented play an important role in social service provision and fostering of voluntary engagement of private sectors. PUBLIC-PRIVATE PARTNERSHIP also enhances the efficiency of public service delivery by reducing bureaucracy. In addition, improving access through increased private sector provision and government‟s commitment to universal and equitable health coverage is reaffirmed. Although PUBLIC-PRIVATE PARTNERSHIP can promote universal health coverage, there‟s also the downside of it. For example, increase transaction costs, e.g. for negotiating and monitoring can be transpired into increased healthcare costs thus leads to Increased inequity in access and use of health care. Secondly, introduction of contact may lead to lack of co-ordination within the broader public health system, brain drain and drive scarce resources into a particular allocation. Moreover, private providers may take advantage of patients by supplying more health care than is required and providing low-quality health care. Ladies and Gentlemen, Towards realization of the Government Transformation Program and holding steadfast to the motto “1Malaysia: People First, Achievement Now”, the MINISTRY OF HEALTHMinistry of Health strives to provide the highest quality and yet affordable healthcare service in Malaysia. As Malaysia‟s plan of transformation towards achieving high-income status and global competitiveness, there are 12 National Key Economic Area (NKEA) were chosen to lead the country‟s economic growth. The example of the entry point projects (EPP) of the NKEA Healthcare, the government has introduced the compulsory private health insurance for foreign workers. Since 2011, the Government has introduced a compulsory low premium private health insurance scheme for foreign workers. With an annual premium of RM120, foreign workers have access for hospitalisation and medical coverage for all sickness and injuries requiring admission into Ministry of Health hospitals for up to a total coverage of RM10,000 per annum. If the treatment charges exceed RM10,000.00, the additional charges will be borne by the worker or the employer.This is an excellent example of the collaboration between the public and private sector in improving health coverage for the foreign workers in Malaysia. To date, Ministry of Health has embarked upon several Partnership with the private sectors. Examples of the current Partnership between MINISTRY OF HEALTHMinistry of Health and the private sectors are the outsourcing medical services e.g. Cancer treatment, imaging, lab, surgery, palliative care and hospital support services e.g. linen & laundry, clinical waste management, cleaning, maintenance, food catering, security. These Partnership not only benefit the healthcare provision, in addition, it also enhances the national economy by generating wealth, contributing to economical activities and providing jobs to many. In the field of ICT, the MINISTRY OF HEALTHMinistry of Health has had the private sector expert ICT support for the Health Information Management System (HIMS) and Total Hospital Information System (THIS) projects. In terms of developing new physical facilities, we partnered up with the private sector which builds and maintains the facilities. The advantage from this arrangement is that the MINISTRY OF HEALTH is able to concentrate its resources in the core business in healthcare delivery and utilises the private sector in managing the non-clinical related fields. 2 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 In hastening development, but at the same time without too much financial initial commitment, the MINISTRY OF HEALTH rents the Women and Child Hospital infrastructurefrom the private sector which then transfers the ownership to government. This is not new as the similar concept was used for the development of the Federal government complexes in Putrajaya. In the example of land swap agreement with the private developer, the existing MINISTRY OF HEALTH institutions on the prized, high-valued commercial land such as the National Institutes for Health Complex in Bangsar (IHM, IKU & IPTK) will be moved to the 1NIH research complex once the developerhas completed the new complex. Ladies and Gentlemen, The MINISTRY OF HEALTH has continuously worked tirelessly to enhance our healthcare service delivery. The MINISTRY OF HEALTH is collaborating with several private training colleges which train medical students, nurses and allied health workers which whom to be employed at the public facilities upon graduation. In the implementation of the methadone programme, MINISTRY OF HEALTH and the 21 authorized private clinics are collaborating in which government, through the MINISTRY OF HEALTH has provided the methadone (free-of-charge) F.O.C. while the clients will pay the private GP consultation fees when using the service.With the collaboration of Pos Malaysia, the MINISTRY OF HEALTH has initiated the „Pharmacy Home Delivery‟ service which enables patients to receive their medical prescriptions via PosLaju at a minimal charge. In terms of human resource, locum arrangements have been made where public doctors are able to provide their services in the private facilities. Vice versa, the MINISTRY OF HEALTH has also contracted private doctors in Primary Healthcare clinics and hospital on session‟s basis and at the traditional and complementary care (TCM) point of care. Looking at the successful and promising outcomes from the existing public-private Partnership, the MINISTRY OF HEALTH is in the midst of planning for several potential future Partnership with the private sector. For examples, the public-private collaboration in managing patients with chronic diseases (HPT & DM) in the public clinics who are outsourced to private general practitionersis being looked at. In addition, integrated health care system of public and private sectors providers as a component of the health system transformation plan is currently being studied. There is no “one size fits all” solution for governance and management structures that is conducive to attaining UNIVERSAL HEALTH COVERAGE. Nevertheless, in the context of our society, if well designed and implemented in stages, PUBLIC-PRIVATE PARTNERSHIP is an innovative mechanism that benefits the society in general. Ladies and Gentlemen, In conclusion, PUBLIC-PRIVATE PARTNERSHIP will allow government and non governmental bodies to achieve efficiency by risk sharing and shouldering the responsibilities. This can also allows private sector a chance to bring on board new innovation and to contribute towards construction, operation, maintenance of public infrastructure. With that, I thank you. 3 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 PL-01 ROLE OF PUBLIC SECTOR IN ENHANCING PUBLIC-PRIVATE PARTNERSHIP TOWARDS ACHIEVING UNIVERSAL COVERAGE IN HEALTH To’ Puan Dr Safurah Bt Jaafar Director Family Health Development Division Ministry of Health Malaysia There has been recent surge in many countries to take on the path towards Universal Health Coverage. From Thailand to Nigeria, or Ghana to the Obama administration, many of them are in different phases making efforts implementing different universal health coverage schemes, marking a rise in interest and political will for universal health coverage. The core initiatives in health have seen a moved from not just diseases and prevention but looking inwardly more into sustainability and strengthening of their health system. UHC, as defined by the World Bank, refers to health systems providing both access to health services and financial protection which includes avoiding out-of-pocket payments that reduce the affordability of services, and ideally some compensation for productivity loss due to illness The debate continues, what is the best model and what models are appropriate for a given country with their various predisposition. Most of these models however focus on the role of the public sector health services for the provision of healthcare to all citizens covered under UHC. The questions on the role of the private sector in such predominantly public domain platform have received many competing views. The most common stand on the public-private partnerships is an optimistic one, ie: PPPs promote sharing of risks, stimulate additional private resources and avoid crowding out and foster innovation that can help reduce costs and improve efficiency. In many liberalized economy, private-sector agents such as provider groups or insurance bodies, do play important roles within the health system. They have substantial standing, have power and have the influence on the development of relevant policy changes. However, in economies that have been dominated by government investment and action, the private sector as a whole is generally are much smaller. Even if those countries which are currently liberalizing, the private sector is likely to play only a small role within the health system and its policy formulation, confining to probably just the provision of care. 4 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 PL-03 TRANSFORMING PUBLIC HEALTH TO MEET TODAY’S HEALTH THREATS YBhg. Datuk Dr Lokman Hakim b. Sulaiman Deputy Director General of Health (Public Health) Ministry of Health Malaysia World Health Organisation (WHO) recently reported that the greatest threat to public health is not infectious diseases but non-communicable diseases (NCDs). The recent Health Minister‟s Retreat articulated an overarching goal for the nation‟s health: ‘towards communitycare and self-care through empowerment and partnership thus ensuring a healthy Malaysian at every stage of life’. To achieve this goal will require a strong and vital healthcare system. Our healthcare system is going through a transformation process that will allow universal health coverage. There is a need to create more integrated approaches to prevention, primary care and overall health delivery system that is more efficient and effective. This will require public health professionals to reassess their role in relationship to the larger healthcare system of which public-private will be an integral part along with non-profit and for profit organisations in the community. Responding to this shift requires a different approach in both the health care and community settings. Public healthcare providers need to embrace new tools and train or retain their workforce with new skills in order to lead a „health for all policies‟ approach that addresses the social determinants of health. Changing circumstances require public health officials to be deft and flexible – in the face of current financially austere times. They are required to possess a vast array of knowledge, skills and attitudes to be effective providers of healthcare i.e. developing effective evidence based public health policies, effective communication, mobilizing the community and forging partnership, cultivating leadership, management and business skills. They need to be more engaged and visible in building partnerships. National efforts towards universal health coverage create a timely opportunity to realign primary care services in ways not previously possible. As a „health in all policies‟ approach becomes more accepted and the definition of health and its determinants broadened, it will be important to recognize that not all public health activities or functions must run/organised by MOH or using MOH‟s budget. In conclusion, public health healthcare providers are currently doing things well under constraint circumstances. As the health landscape in Malaysia continues to change, public health providers need to be sensitive to the changing public health threats and be equipped to provide the leadership and expertise. We need to build on the current successful accomplishments while at the same time develop new skills and strategies for creating a comprehensive and integrated public health programs to achieve better health outcomes within communities and population. 5 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TAP1 QUALITY SERVICE DELIVERY YBhg.Tan Sri Dato Dr Abu Bakar bin Suleiman President International Medical University (IMU) Bukit Jalil The goal of universal health coverage is to ensure people obtain the health services needed without suffering financial hardship when paying for them. Universal health coverage can occur in a setting of a strong, efficient, well run health system supported by a system of health financing. There must be access to essential medicine and technologies, with a sufficient capacity of well trained, motivated health work force. It must be supported by health information and other resources, and there must be a sound governance system that emphasizes patient safety and quality improvement in health services delivery. While Malaysians would claim to have universal access to healthcare, what is the actual quality of our “universal health coverage”? Do we have data to evaluate this? What is the quality of access to healthcare, and how equitable is it? The concerns with equity must surely be evaluated, carefully, especially when out-of-pocket spending on healthcare is at such a high level in our country. This cannot be good for our concern about equity in healthcare coverage. Porter had observed that the American Health Care System is fragmented, fractured, inefficient and had made recommendations on transforming the healthcare system to a system that achieves universal coverage, and is a value-based system for patients. Berwick‟s “triple aim” relating to care, health and costs are important initiatives in the healthcare transformation process in the USA, and is relevant in other countries as well. These approaches, recent experiences and sentiments that had influenced health policy will be discussed. The barriers between public and private sectors in healthcare is artificial and creates inefficiencies and will continue because of inadequate attention, time and effort spent on proper development of health policies in the country. The challenges facing Malaysia in healthcare is broadly similar to that faced by many countries. The need for initiatives to transform the healthcare system in Malaysia is compelling if we are to reduce the wastage, improve efficiency, productivity and quality of healthcare delivery. It is never too late to start, but initiatives for improvement must be backed by evidence. 6 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TAP3 OPTIMIZING HEALTH CARE RESOURCES FOR UNIVERSAL COVERAGE Prof. Dato’ Dr. Syed Mohamed Aljunid UNU-International Institute for Global Health Health expenditure has been showing an increasing trend globally in the last three decades. Rise in prevalence of chronic non-communicable diseases, aged population, and increasing demand for specialised care and uncontrolled infusion of new technology in healthcare are among the factors causing raise in the overall health spending. However in many developing countries, the total health expenditure remains below 5% of GDP. With universal coverage as the new health system objectives, health policy makers may have to make unpopular decisions to use the limited resources available to spread the services to every individual in the population. Social health insurance (SHI) programme will become the main source of funding for universal coverage. Comprehensive strategies covering both supply and demand side should be developed in order to optimise the limited resources. The demand side strategy should include the effective use of health promotion and preventive services to promote health and well being of the population. Benefit package of SHI should cover only proven cost-effective interventions to ensure value for money spend. The supply side measures should cover efforts to promote efficient use of resources by health providers. Providers in SHI should be reimbursed based on prospective payment methods such as capitation and casemix system. Incentives and disincentives should be built in SHI programme to encourage efficiency and quality. Pay-for-performance methods should be developed and implemented in larger scale to provide incentives for efficient practice and to control moral hazards of providers. In conclusion, with limited resources allocated for health care, it is unlikely that the current health spending is sustainable in long term. There is an urgent need for policy makers especially in developing countries to address this crucial issue. S1TBP1 GOALS AND TARGETS FOR VACCINE PREVENTABLE DISEASES PROGRAMME Dr. Rohani Jahis Head of The Vaccine Prevention Of Disease/Food & Water Borne Ministry of Health Malaysia Vaccination is known as the most effective means of controlling infectious diseases. It provides longer term protection. Generally, the immunization program aim is to reduce the mortality and morbidity due to vaccine preventable diseases (VPD). Each VPD has its goal and targets set by national stakeholders and World Health Organisation (WHO) that need to be achieved by all member countries. The program is monitored and strengthened through regular evaluation. At present, the goals for most VPD have been achieved except measles elimination. The achievement of these goals requires commitment and collaboration of various parties including the general public, synergise with strong advocacy. The challenge is to ensure our people accept the immunization programme without hesitancy and come forward for the services. 7 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TBP2 PUBLIC-PRIVATE COLLABORATION IN PROMOTING VACCINE PREVENTABLE DISEASE PROGRAM Mr. Sasitheran KK Nair Health Education Officer, Health Education Division, Ministry of Health Malaysia Introduction: Public-Private Partnerships have become an accepted norm in various sectors in most of the developed countries. Malaysia, under the leadership of Prime Minister, Dato' Sri Najib had set up The Public Private Partnership Unit to steer private sector participation and stimulate private sector investment through publicprivate partnership (PPP) in the national development agenda. The partnership ventures allows for sharing of costs and optimization of resources and facilities. Thus, the establishment of Immunise4Life Programmes (IFL) too is based on the principles of PPP and also in line with the Ottawa Charter (1986) on health promotion through community strengthening. Two NGOs in collaboration with four major private companies has partnered with the Ministry of Health in promoting the immunisation programme. Method: The Smart partnership between MOH, the NGOs and private companies was established with the intention to increase awareness of vaccine-preventable diseases and their respective vaccine solutions, counter anti-vaccine lobby, promote full compliance with the MOH Expanded Programme on Immunisation (EPI) for children, while advocating optional vaccines for wider protection, promote general and gender-specific vaccination for adult individuals, advocate immunisation of foreign workers & personnel in selected industries. This programme is structure into Core Programme and Ancillary campaigns. The core programme covers all immunisable diseases and all participating companies contribute to the operational fund. The ancillary allows opportunity individual participation to emphasise selected areas of interest. This allows competition based on first-come, first-served basis. Thus, IFL promotes a platform for healthy partnership and as well as competition under the supervision and guidance of MOH. Results : This programme has so far succeeded in establishing a dedicated website to promote immunization through videos (15 public service announcements, 21 doctor talks) and 36 articles, produced (printed) 10,000 copies of booklets. All the videos and the booklets are uploaded for public use on www.immunise4life.my. Those who contributed to the videos, includes the Director General of Health, MOH, specialists from government and private sector, and as well as celebrities. The establishment of the website has resulted in an increase of buzz among the public, especially the netizens. Many are sharing experiences, opinions and seeking advice from experts in the social media. The queries are a sign that many in the public are not fully aware of immunisation and the benefits. The experts wish to help the public make informed decisions on immunisation for themselves and their loved ones. Discussion: This partnership complements and promotes compliance with the MOH‟s Expanded Programme on Immunisation (EPI) for children, while advocating optional vaccines for wider protection as well as providing a platform for the public to seek further information to make informed decision on immunization. This partnership strategy does not financially burden the MOH; instead the pooled sponsorship by the participating companies has financed the production of the videos, articles, booklets and other educational materials amounting to almost half a million Ringgit Malaysia in the first year, and the total saving of the tax payers‟ money for 3 years is estimated to be around RM2million. Keywords: partnership, IFL, immunization 8 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TCP1 INFORMATION MANAGEMENT IN PUBLIC HEALTH Prof. Madya Dr. Jamalludin bin Ab Rahman Department of Commuity Medicine IIUM Kuantan Efficient and reliable management of information is critical to the success of any organisation. Public health generates a lot of data and in return requires a lot of information to monitor and measure its purpose and function in the population. The development of good information management system starts form identifying organisations‟ own needs and direction. Well defined data structure and properly planed method of data collection are essential. This paper will discuss all these matters and proposed general guidelines of how to achieve it. S1TCP2 HEALTH INFORMATICS Dr. Ariffin Marzuki bin Mokhtar National Heart Institute of Malaysia Health informatics is the science behind the convergence of Information Technology, Healthcare and Business that allows health professionals to provide higher quality care, promote wellness and protect patient safety. It manages all aspects of effective and efficient planning, collection, organization, implementation, analysis and use of date to create information within a healthcare system. This will connect the healthcare world to information it needs while always looking for a better way to promote wellness, provide higher quality care and protect patient safety. There are six (6) domains of Health informatics function and ten (10) subspecialties that include Public Health Informatics (PHI) and Health Information Management. The Public Health is modeled as a complex adaptive system that has an approach in response to a problem and interventions of the causal pathway of disease are explained as a business process that will generate data. Health Informatics role in managing information for public health intervention starts at the process of collecting, collating and aggregating data, followed by analysis of data to meaningful information, so that knowledge and wisdom can be attained with regard to the outcome of the public health intervention. These meaningful information and knowledge can be used to achieve the fundamental mission of public health to promote physical and mental health and prevent disease, injury and disability to realize the vision of healthy people in healthy communities .The role of Public Health Informatics are to systematically apply information and computer science and technology to public health practice, research and learning. The challenges for public health informatics are in developing coherent, integrated national public health systems, developing closer integration of public health and clinical care; and addressing the pervasive concerns about the effects of information technology on confidentiality and privacy. The consensus for the challenges are to enhance communication and information sharing within the PHI community; to improve the consistency of PHI through common health terminologies, rigorous evaluation methodologies, and competency based training, and; to promote effective co-ordination and leadership that will champion and drive the field forward. 9 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TCP3 BARRIERS TO INFORMATION TECHNOLOGY Dr. Fadhlullah Suhaimi Abdul Malek Performance Management and Delivery Unit (PEMANDU), The expectations of consumers (patients) have been shaped by the advent of technology advancement and its adoption into the daily lives. This very change imposes greater demand on the healthcare system. Definition of universal health coverage is impacted by the market, depending on supplier or demand driven in perspective. The paper provides a view of the behavioral change in light of technology, where the new demands will come from, where everything is now an ASAP-syndrome. This behavioural change will further be affected and cemented by the trends in technology. In crafting the behavioural and technology scenario, an attempt is made to analyse the healthcare system and elucidate the barriers to information technology from a financial, policy and operational perspective. Concluding on how best to deal with such barriers both for healthcare providers in private and public. S1TDP2 A CONTEMPORARY REVIEW OF RHEUMATIC HEART DISEASE REGISTRY IN A TERTIARY CENTER IN SABAH Dr. Narwani bt Hussin Public Health Physician, Clinical Research Center, Hospital Queen Elizabeth II Rheumatic fever and Rheumatic Heart Disease (RHD) have been almost eradicated in areas with establish economies. However it is still endemic in developing countries & indigenous population in wealthy countries. There are between 15.6-19.6 million existing cases of RHD and there are around 282,000 new cases each year. An estimated 233,000 to 468,164 individuals die from RHD each year, and hundreds of thousands of people are disabled by this disease and its long-term complications. Malaysia has been lacking incomprehensive data on rheumatic heart disease patients. There is still no nationwide registry or nationwide survey on rheumatic heart disease has been implemented specifically in Sabah and generally for the whole Malaysia. The Cardiology Unit together with the Clinical Research Centre, Queen Elizabethll Hospital, Kota Kinabalu, Sabah has made an initiative and developed this small scale hospital based registry to assess the burden of rheumatic heart disease especially in terms of socio demographic profile of the patients involved, the severity of the disease, types of valve problem faced by patients and practice of secondary prophylaxis. The registry was first initiated in December 2010. We included all patients with a diagnosis of rheumatic heart disease who attended or referred to the Cardiology Clinic, Queen Elizabeth ll Hospital, Kota Kinabalu. Data were recorded using a data collection form designed by a team of cardiologist and medical officer. The variables included the socio demographic profile of the patients namely age, sex, home address and ethnicity. In addition, the current disease status, types of secondary prophylaxis medication, ECG changes and disease extent in term of valves abnormality were also obtained. A two and a half year review of patients registered under this registry from Dec 2010 to August 2013 revealed that a total of 593 rheumatic heart disease patients were been able to be registered. Amongst total of 593rheumatic heart disease patients, two-thirds were female (66.3%). Mean age was 42 year-old. 30.2% were newly diagnosed in this registration period. Half (52.0%) of them has severe valvular dysfunction during 10 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 registration. 33.9% received secondary antibiotic prophylaxis: 12.9% were on IM BenzathinePenicilin (IM Ben Pen) while the rest (21.0%) received oral antibiotic (either Oral Penicillin V or Erythromycin). However there was an increase in percentage of patients received secondary prophylaxis (both type – oral and IM) by year (23.2% in 2010, 74.4% in 2013 with p value < 0.001). For those who received no secondary prophylaxis, majority of them aged more than 40-year-old who was less vulnerableto recurrent RHD. With this knowledge, we hope to gain further insight into the problem and eventually create more awareness and advocacy to RHD. World Heart Federation has advocated Ministry of Health not to forget to include rheumatic heart disease prevention and control in the national Non Communicable Disease plan, in an effort to reach the goal of reducing mortality by 25% by 2025 - among individuals under the age of 25. S1TDP3 CHRONIC RHEUMATIC HEART DISEASE SECONDARY PROPHYLAXIS MONITORING IN PRIMARY CARE CLINIC: IS 80% ADHERENCE ACHIEVABLE? Dr. Rumihati bt Abd Hamid Klinik Kesihatan Putatan,Sabah Ministry of Health Malaysia Background: Chronic Rheumatic Heart Disease (CRHD) is still fairly common in Sabah. A registry audit done by Cardiac department of Queen Elizabeth Hospital in 2011 showed Putatan area is one of the highest prevalence of CRHD. Secondary prophylaxis plays an important role in decreasing the valvular damages and complications. Adherence to secondary prophylaxis had been shown to increase when patients are given personalized care and enrolled into recall systems in primary care whereby hospital being a place for education and establishment of secondary prophylaxis. Hence a primary-tertiary collaborative project between the Cardiology Department at the tertiary centre and Primary Health Clinic , had been initiated which involving a close monitoring of patients receiving secondary prophylaxis. Objectives: This study was conducted as to assess if good adherence to scheduled injections (target > 80 %) based on Australian Guidelines On Rheumatic Heart Disease is achievable with the personalized care and recall system in primary care setting. Methodology: All CRHD patients who attended Klinik Kesihatan Putatan for their secondary prophylaxis were registered and given monitoring book with the scheduled dates for injection. A monitoring tool was used to check whether the patient had their injection as scheduled. The patient will be called if they missed their injections. The study period was from April 2012 to January 2013. Results: A total of 11 patients were enrolled in the study. There were 9 female and 2 male. The age range from 14 to 39 years old. One patient changed back to oral antibiotic due to fear of injection. About 8 out of 10 patients had more than 80% adherence to appointment given for injection and the remaining 2 patients achieved between 70%-72 %. Conclusion: Personalized care in primary care setting may increase good adherence to secondary prophylaxis in CRHD. 11 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 S1TEP1 DO COMMUNITY – WIDE INTERVENTIONS INCREASE PHYSICAL ACTIVITY? Prof. Philip R Baker School of Public Health and Social Work Queensland University of Technology Brisbane, Australia Background: Not getting enough physical activity leads to poorer health. Regular physical activity can reduce the risk of chronic disease and improve one‟s health and well-being. The lack of physical activity is a common and growing problem in many countries. We sought to evaluate the effects of community wide, multi-strategic interventions upon the physical activity patterns of populations. Method: We undertook a Cochrane Systematic Review which included an extensive search of databases, including studies which met pre-determined criteria, and conducted independent risk of bias assessment and data extraction. Results: After the selection process, 25 studies were included in the review. The strategies varied by the number and type of components and their intensity. No studies were identified as low risk of bias. Sixteen studies were identified as having a high risk of bias and thus untrustworthy. Nine studies were of considered to have an unclear risk of bias and some studies held back data they collected. The effects reported were inconsistent across the studies and the measures. Some of the better designed studies showed no improvement in measures of physical activity. Interventions which have an environmental change component seemed to be a promising direction. Those interventions which were primarily a mass media campaign were less likely to be successful. Conclusions: Although numerous studies have been undertaken, there is considerable inconsistency in the findings of the available studies and this is confounded by serious methodological issues within the included studies. Simply combining interventions does not necessarily result in increased physical activity as many such studies, including some long term programs, failed to demonstrate efficacy. There is a clear need for well-designed studies and these studies should focus on the quality of measurement of physical activity. The review is currently being updated with newer studies. S1TEP2 EVIDENCE OF EFFECTIVENESS: HIGH LEVEL SYNTHESIS OF RESEARCH TO PREVENT OBESITY ABD INCREASE PHYSICAL ACTIVITY IN CHILDREN Prof. Philip R Baker School of Public Health and Social Work Queensland University of Technology Brisbane, Australia Background: Prevention of childhood obesity is a public health priority for Malaysia and many other countries. Physical activity for children is also decreasing at an alarming rate. Both conditions are associated with noncommunicable diseases and with significant morbidity and mortality in later life. Systematic reviews of public health interventions provide a useful summary to inform public health practice by combining the results of a range of research studies on a specific intervention into a single report. Systematic reviews are deemed most valuable for health program development and evidence based practice. Unfortunately, many policy makers and practitioners are simply unaware of the evidence: which strategies which are most likely to provide benefit; and which strategies are known to be harmful or useless. 12 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 This presentation provides a “birds eye” overview based upon recent (since 2007 to present) high quality systematic reviews of public health interventions. Method: HealthEvidece.org and the Cochrane Library were searched for systematic reviews which evaluated interventions targeting obesity prevention and increasing physical activity for children. The findings of the included reviews were themed and summarized. Results: Seven reviews were identified addressing obesity in the early years, and fifteen reviews addressing obesity more broadly in childhood. Additional reviews were identified aimed at increasing physical activity. The synthesis shows several strategies to be effective, however many popular strategies clearly are not. Several of the reviews were inconclusive due to an absence of robust primary studies. Amongst the findings, interventions undertaken in the school setting appear very promising. Conclusions: There is significant evidence from systematic reviews to guide public health practice and policy, and to inform future research. S1TEP3 POPULATION BASED VERSUS TARGETED HIGH RISK POPULATION FOR CANCER SCREENING Prof. Madya Dr. Nur Aishah bt Mohd Taib University of Malaya Breast cancer is a treatable cancer; worldwide about 1.6 million people are diagnosed with it each year and about 4 million lives with this cancer due to the high survival rates in the more developed world. In Malaysia about 4000 women are diagnosed in the Peninsular of Malaysia. It is the second cause of death in women after cardiovascular disease. In a low incidence country, how does one improve excellent outcomes that we know that can be achievable with early breast cancer. The ASR of breast cancer in Malaysia is 47.7 per 100000 as compared to rates in Australia of 115.5 per 100000. The relative survival of breast cancer for 2006 to 2010 was 89.1% in Australia. There are no published figures in Malaysia on relative survival to 5-year overall survival of 43.5 per cent in HKL for patients diagnosed in 2005-2009 and 75.4% in UMMC for patients diagnosed 1998-2002. The difference is due to early presentation. Early presentation and treatment are the best method to prevent this disease as most of the time there is no discernable risk factor. Risk factors that confer a high risk predisposition to breast cancer. The factors are older age, being female, having dense breasts, having past history of precursor lesions in the breast like ADH, LCIS and DCIS, having significant family history, fertility factors like early menarche, late menopause and nulliparity. Factors affecting outcomes of cancer include early stage at presentation and better treatments. There are many reasons why women present late. In a public health perspective the understanding of the breast cancer trajectory can be understood with the points of delay in breast cancer model. And to understand why individuals present late can be understood through the BCDE model, which include information on disease and treatments; having adequate resources ie. coping skills, support and finances and lastly what their role preference is when faced with symptoms or diagnosis ie whether they prefer to be autonomous or they need their significant others to make decisions for them. The literature on the efficacy of population screening with mammogram is now at the crossroads, where the effect of treatment have been attributed to be a main reason for improvement in survival since the introduction of better adjuvant therapies and also a smaller proportion is attributed to earlier presentation due to screening mammogram. A multi-prong strategy is required in Malaysia, and by using the PBCD model; the respective stakeholders could identify their roles. The public health perspective could focus on symptom recognition and navigating to diagnostic 13 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 centres. Planning health education materials with the use of the BCDE model; where information on the curability of breast cancer, good outcomes of treatment and the need to understand evidence based medicine in order to reduce the rampant use of alternative treatment. Recognising signs and symptoms of breast cancer and knowledge on navigating to diagnostic centres are important in the primary health care and primary care settings. The hospital perspective would be to improve the timeliness of diagnosis and treatment. Providing good counseling when recommending treatment is important. Using the BCDE model provides a framework on areas to be covered and awareness of the practitioner on the resources and the roles patients play in their decision making would help practitioners to effectively communicate with their patients. Identifying high risk women to enable early presentation would be to educate women on what is a significant family history, providing genetic services, providing quality mammogram services that are audited. Ensuring surgeons are educated on risk assessment and risk management of high risk individuals would be imperative. S1TFP1 CLIMATE CHANGE AND CLIMATE VARIABILITY AND ITS EFFECT ON CLIMATE SENSITIVE DISEASES Dr. Muhammad Amir bin Kamaluddin Head, Environmental Health Research Centre, Institute for Medical Research Ministry of Health Malaysia This paper described the relationship between weather, climate variability factors and climate change and focus on impact of climate sensitive diseases relevant to Malaysia. The climate sensitive diseases as reported in Malaysia‟s second national communication document (NC2: 2011) to United Nation Framework Convention on Climate Change (UNFCCC) include vector borne disease namely dengue, chikungunya and malaria; Food and waterborne disease include cholera and typhoid; Flooding has been associated with higher incidence of zoonotic diseases namely leptospirosis. Health issues are also influenced by climate change through the occurrence of more frequent extreme weather events leading to floods and heat waves. Sea-level rise and salt water intrusion is another observed event with climate change leading to changes in mangrove eco-health systems and spreading a bigger area for malaria vectors. The concept of climatological normals is introduced as a foundation to understand weather, climate variability and climate change. Temperature, precipitation and relative humidity are weather factors commonly used to show relationship with risk of diseases. Climate change is slow and gradual and impact of climate change on future projection of disease distribution, need to model disease trends to local regional climate change model. Climate change impact on climate sensitive diseases is important in formulating future health policies and plan resources. S1TFP2 EFFECTS OF ELECTROMAGNETIC RADIATION FROM TELECOMMUNICATION TOWERS Prof. Dr. Adlina Suleiman National Defence University of Malaysia There has been increasing public concern on the effects of electromagnetic radiation (EMR) from telecommunication towers (TELCO). These towers have been constructed in housing areas, school compounds, apartment and multi-storey shop-lot rooftops and within compounds of mosques throughout Malaysia and other countries. On 31st May 2011, the International Agency for Research on Cancer (IARC), a part of WHO designated 14 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 cell phones as "possible human carcinogen” [Class 2B]. They found evidence of increase in glioma and acoustic neuroma brain cancer for mobile phone. The health effects of EMR are best explained in a study by Hallberg and Oberfeld estimated that 50% of the public exposed to EMR would be sensitive to the radiation effects by 2017. The manifestation of this hypersensitivity would be health complains such as headaches, giddiness, nausea, skin rashes, feeling warm, depression, night sweats, memory loss, disturbances in menstruation and insomnia. This paper will discuss three unpublished studies on EMR and the health effects conducted in Malaysia since 2008. The author will discuss how the studies have evolved from epidemiological studies using questionnaires to the more complex blood studies and explain the reason for the change in methodology. The intention of this paper is not to dismantle TELCO towers in housing areas and on rooftops, instead it serves to create awareness on the health effects of EMR and to suggest a change in policy that would convince operators to reduce transmitted power from 20W/carrier to max. 1 -2 W in dense urban area or to observe a minimal distance of people from cellular phone base stations that is < 300 m.” S1TFP3 SAFETY AND SECURITY OF NUCLEAR POWER PLANT Prof. Emeritus Dato’ Dr. Noramly Muslim Department of Science & Technology National University of Malaysia The devastating earthquake followed by tsunami which resulted in multi-reactor damage in Fukushima will have significant impact on the use of nuclear energy, the future for nuclear industries and the global nuclear order. The impacts of Fukushima are still unfolding and may take a long time. Seriousefforts and resources have been invested to gain an understanding of what happened and why in the Fukushima Daiichi accident Currently, more than 430 nuclear power plants operate in 30 countries, providing approximately 16 percent of the world's total electricity. Fukushima accident has not stopped the pace of nuclear power plants under construction in China, India and Korea. Many more newcomers such as Vietnam, UAE, Turkey, Jordan, Bangladesh etc. are embarking on going nuclear. The future of nuclear power will depend on improved knowledge of safety, safeguards and security.The nuclear community has made significant progress in examining many Defense-in-Depths (DID) related safety matters, aimed at improving nuclear safety and security. National regulatory authorities need to strengthen and apply the DID concept to maximize the safety of power plants and periodic safety reviews should be carried out across the entire life cycle of the installations. There is a need to take full advantage of the IAEA review services, especially those related to siting, design and emergency preparedness. The IAEA, upon request, helps Member States enhance nuclear safety by facilitating development of international legal agreements, developing safety standards, offering international expert review and safety services as well as fostering scientific research, technical cooperation, information exchange and networkings. There is a real strong need for national regulators to improve nuclear safety at plants in light of the Fukushima Daiichi accident. Involvement of all stakeholders such as operators, regulators and industry are important. Currently in Malaysia the regulators are in the final stages of reviewing the Atomic Energy Act, the exiatingregulations thus ensuring compliance to all national and international safety norms, agreements, conventions and other safety and security initiatives. Malaysia is adhering to most of the international protocols, legal requirements and accepting training opportunities as mandated, or as recommended by international standards and the U.N. International Atomic Energy Agency. This supervision, training, advice and inspection from outside agencies will continue even after a Malaysian nuclear facility, or facilities, are built. It should be pointed that because of this guidance, advice and inspection, the nuclear power industry is in fact safer and less polluting than the burning of fossil fuel. 15 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 ORAL PRESENTATION Oral 02 Oral 01 E. COLI FOOD POISONING OUTBREAK AMONG ATHLETE AT TELUK KEKE, MALAYSIA 2012 OVERVIEW OF PLASMODIUM KNOWLESI MALARIAIN SELANGOR (2011-September 2013) Liza AL, Razan S, Ummi Nadiah Y, Ismail I, Ahmad Nazri S, Rosli Y, Yusmaliza MY, Tg Johanoordin TZ, Intan Hawani AD, Wan Nur Farhana WA, Kamil SM, Mazlizaini G, Mohd J, Anwa S Sharifah Malihah WM1, Venugopalan B1, Muhammad Afi S1 E.coli is a significant cause of bacterial diarrheal illness worldwide and transmitted by food or water contaminated with animal or human faeces. On October 14th, 2012 twenty participants of athlete of Perhentian Island were experiencing vomiting, diarrhea, abdominal pain, nausea and fever. An investigation was started to determine the source of infection and risk factors. Control and prevention measure was implemented to avoid subsequent similar outbreaks. A case-control study was designed. A case was defined as any athletes with vomiting, diarrhea, abdominal pain, nausea and fever that started on October 12th, 2012. Data on potential food taken were obtained by face-to-face interviews with athletes. Hazard analysis and critical control points (HACCP) was done. Environmental samples, water samples and food handlers hand swab samples were taken. Frequencies and OR were analyzed by SPSS version 15. Twenty (20) cases were compared with 60 controls. The major risk factor of food was taking dinner on October 13th with 6 out 9 items taken showed significant and the highest was shrimp curry (OR = 16.6; 95% CI (2.1 to 132.3). Source of water showed highly contaminated by coliform >181cfu/100ml. Based on HACCP source of infection also pointed to source of water. The Enterotoxigenic E.coli (ETEC) food poisoning outbreak was probably occurred due to ingested contaminated untreated water as the septic tanks are higher than water source and the distance is approximately 10 meters. The short term measurement was done to chlorinate the well. The long term measure is to chlorinate the well regularly for every 3 months until treated water supply had been in-place. 1 Vector Borne Disease Unit, Selangor Health State Department Plasmodium knowlesi malaria infection is now increasingly recognized as a potentially fatal zoonotic infection, particularly in South East Asia. In Malaysia, various research projects conducted analysing in depth issues in the states of Sarawak, Sabah and Pahang. However, none highlighted this emerging public health challenge of P.knowlesi infections in Selangorsince it was first reported officially in 2008. This study‟s objective is to describe the epidemiological characteristic and its distribution in Selangor, thus to recommend their prevention and control strategies. All malaria records, from district manual reports and VEKPRO online (January 2011 to September 2013) were reviewed at the Selangor Health State Department. Analysis was done using Microsoft Excel 2007 software and the on-line Google Map. In 2011, P.knowlesi contributed 22% of all local malaria cases and since then continues increasing up to 83% in September 2013. The districts currently reporting P.knowlesi are Hulu Selangor, followed by Gombak and Hulu Langat.Productive age between 35-39 years old were most affected with Malaysians accounted for 64% and males (88%) were predominant. Occupation wise, 37% were farmers and 12% were construction workers. All these patients were detected through passive case detection with majority (39%) reported cases involved residences close to jungle fringes, estates (14%) and eco resort (11%). Although Selangor is a mainly urbanized state, P.knowlesi malaria is currently becoming an emerging public health threat. More basic research on the disease epidemiology and entomological studies on the vectors are required for planning effective long term prevention and control strategies. Public awareness and active collaboration with related agencies such as the Wildlife Department, Forestry Department, District Land Offices, Local Governing Authorities and Eco-Tourist Site Operators will be important in establishing an effective surveillance and control system for P.knowlesi in Selangor. Keywords: well water, E.coli, athlete, Teluk Keke, case control Keywords: semian malaria, zoonotic 16 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 03 A community outbreak of hepatitis A occurred in Manjong District, Perak from 19th September to 10th October 2012. The outbreak started to surface when the Manjong District Health Department received a notification from Seri Manjung Hospital regarding 10 patients suspected to be Hepatitis A cases. The cases presented with signs and symptoms of Hepatitis A. Laboratory investigation on one of the serology samples were positive to HAV IgM. The objectives of this investigation were to identify the source of outbreak, to trace the possible mode of transmission and to suggest a control measure based on the outcome of the outbreak investigation. A case was defined as an acute illness with a discrete onset of symptoms and jaundice or elevated serum aminotransferase levels, from 1st September 2012 in Manjong District. A community-based case control study was designed where cases were those who fulfilled the above case definition while controls were their family member or co-worker without signs and symptoms and negative to laboratory results. Face to face interview using pre-tested questionnaire were used to collect the data. Univariate analysis was performed to test our hypothesis using odds ratio as a measure of association. Multiple logistic regression analysis was performed control the effect of confounder and effect modifier. Environment assessment were conducted by observing toddy processing, food premises, visiting patients in hospital and visit their houses. A total of 78 cases of hepatitis A (attack rate of 3.1/10,000 population) and 71 controls were enrolled into the study. Higher incidence was noted in Ayer Tawar (44.3%) and Sitiawan (42.6%). Most of the cases were Indians (5.1 per 1000 population), active age group (25-40 years), working as as labourer and lorry driver and belong to low income group. Based on the epidemic curve the possible time of exposure were between 33rd to 34th epidemiologic weeks (14th -25th August 2012). Univariate analysis showed that the association between cases and male, eating outside, eating sea food, drink alcohol and drink toddy were statistically significant (p < 0.5). Using multivariable logistic regression, we found that only male (Adjusted OR 8.366; 95% CI 1.38-50.81) and consumption of Toddy at the Sitiawan (Adjusted OR 2.46; 95% CI 1.03-5.87) were statistically significant. Environmental assessment showed that the Sitiawan and Seri Manjung toddy processing places were unhygienic, processed by Indian Indians and the well water was positive for coliform. None of environmental specimens were positive for HAV. Based on the statistical analysis and environmental assessment, it was possible conclude that toddy was the primary source of the outbreak. Today is a famous drink among Indian in Manjong. All Toddy preparation places were closed temporarily and disinfection activities were carried out. All the wells in the Toddy preparation places were sealed. Food premise inspection and Enforcement activities as well as health education activities were intensified. The need for Hepatitis A vaccination among the high risk groups should be seriously considered. SHARING MEASLES ELIMINATION ACTIVITIES IN KUALA LANGAT DISTRICT Lasa I, Shuaita MN, Anuratha S, Zabedah LS, Hasniza MR, Nurulizzah AK, Noraziani K Kuala Langat Health District Office, Ministry of Health Measles virus causes a highly contagious vaccinepreventable disease that can lead to death worldwide. The reporting of measles vaccination coverage nationally may not reflect the true situation in the different districts in Malaysia. There were occurrences of sporadic outbreaks in several districts in the state of Selangor, Malaysia, in 20112012 including Kuala Langat district, Selangor. Several control measures were initiated locally together with the strategies outlined in the state and national Measles Elimination Programme. The local strategies included improving measles immunisation coverage through optimising the home nursing services, home visits and outreach activities by the health care providers from the Maternal and Child Health (MCH) unit. These activities had complemented the control activities of the communicable disease done mainly by the Communicable Disease Control (CDC) unit in the district. Defaulters and missed opportunities were picked up and were given measles immunisation. The strong commitment and good networking between both the MCH and CDC units in the district had made the initiatives possible and as a result, the number of measles cases has reduced notably and the district is now experiencing zero measles for several months this year. Besides that, the immunisation coverage monitoring using the „Universal Child Immunisation‟ approach too was further strengthened in all Health Clinics in the district. Keywords: measles, immunisation, child health, home visit Oral 04 ROLE OF TODDY DRINKS IN HEPATITIS A OUTBREAK: A MALAYSIAN EXPERIENCE Ahmad Faudzi Y1, Rusdi AR2, Rohani J3 1 Institute for Medical Research, Malaysia Melaka Tengah District Health Department, Melaka, Malaysia 3 Surveillance Section, Ministry of Health, Malaysia 2 17 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Keywords: jaundice, hepatitis A, outbreaks, toddy of methanol poisoning will be produced shortly. All suspected cases should be notified immediately. State Health Department is working closely with other agencies in order to prevent future outbreak. Oral 5 THE FIRST METHANOL POISONING OUTBREAK IN MALAYSIA - A MULTIAGENCY ROLES AND RESPONSIBILITIES COULD HALT THE ILLEGAL PRODUCTION OF ILLICIT ALCOHOL ACTIVITIES SELANGOR 2013 Keywords: methanol, poisoning, outbreak HarishahT1, J Norli1 , A Rosemawati 2, M Omar2 , K Fadzilah2 , Dr Raja A3 Harishah T1, Rosemawati A2, Fadzilah K2, Lasa Siti Sabariah S3 ,Sazidah MK3 1Selangor State Health Department; 2Ministry of Health, Malaysia; 3 Pahang State Health Department 1 Oral 6 AN OUTBREAK OF GASTROENTERITIS AMONG COMMANDO TRAINING RECRUITS IN SELANGOR, NOVEMBER 2011, WAS IT LEPTOSPIROSIS? 3 , Selangor State Health Department Epidemic Intelligence Program (EIP) Malaysia, Ministry of Health Malaysia 3 Kuala Langat Health District Office 2 Methanol poisoning outbreak is rarely reported in Malaysia. On 13th March 2013, Emergency Unit of Serdang Hospital had notified three severe poisoning cases in a very critical condition, after consuming illicit alcohol. Immediate investigation was instituted to verify the agent, the source of outbreak and further intervention. Suspected persons andclosed contacts were interviewed and retrospective reviewed of hospital admission records from February until 15th July 2013. Confirmed methanol poisoning person was those with positive methanol detection in the blood or their drinks. Intensive search of suspected alcohol products and sampling activities were performed at manufacturing, selling, and drinking sites involving multiple agencies.A total of 41 cases-patients detected within 5 months period. All of them were male with mean age of 33.2 (7.0 SD) years old and majority latent period were within 48 hours (29.3%). Eighty percent (80.9%) were Myanmarese, 7.3% Nepalese and 12.2% Malaysian. About 69.5% had central nervous symptoms, 65.9% had gastrointestinal symptoms, 33% had visual disturbances and 8.9% blindness. Median arterial pH and bicarbonate were 6.8(range 2.3-7.2) and 4.9(range 0.0-17.0) mmol/L respectively. Median blood methanol level was 5.8(range 0.090.0)mg/dL. They consumed cheap, illegal unregistered compounded hard liquor of imported brands. Out of 31 alcohol samples taken 15 (14.8%) were above WHO standard level for methanol and all found at illegal selling sites.More than hundreds premises were inspected and 10 were penalized due to nonconformities. Myanmarese was at risk of methanol poisoning in Selangor due to easy accessibility to adulterated cheap compounded hard liquor in illegal market. Massive health education with multiagency involvement managed to control the outbreak. Specific guidelines for management Leptospirosis outbreaks among military recruits are common due to their continuous exposure to risk environment. On 27th November 2011, Banting District Hospital had notified gastrointestinal tract illness among commando recruits while in their field training courses. An investigation was initiated immediately to identify the causative agent, sources and risk factors for infection. All trainees and trainers were interviewed using structured questionnaires. Confirmed case was defined as individual who had history of vomiting or diarrhoea with or without other symptoms and positive MAT (titre of 800) or PCR or ELISA tests (four fold rose in antibody titre). Univariate analysis was performed and risk factors was expressed in RR (95% confident interval, CI). Blood culture, stool and food samples were taken. Environmental examination and sampling were performed at different possible exposure sites. Out of 74 exposed trainees and trainers, 16 (21.6%) were confirmed with one death (CFR 6.3%). All of them were male trainees, Malays and median age was 21 (ranges 19-32) years old. Had contact with water (RR 10.00; CI: 2.42-41.38) and having open wound at upper or lower limb (RR 3.30; CI: 0.99-10.97) were associated with leptospirosis but later was not significant. Without frequent hand wash, it increased infection risk (RR 15.40; CI: 3.8-62.8).Taking prophylaxis showed no protective effect (RR 0.36; CI: 0.10-1.28). Environmental samples from 3 different sites were positive. Due to very nature of their training environment, commando recruits are easily susceptible to leptospirosis infection. Nonspecific illness caused delay in diagnosis and led to death. Health education was given to trainees regarding regular hand hygiene and good wound care. Close supervision by health personnel on prophylaxis compliancy had already started. 18 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Keywords: Leptospirosis, nonspecific illness, training environment, skin wound, water activity were found to be 15.2%,9.5%,7.8% and 7.1% respectively Intestinal parasites was found to be among the highest neglected tropical disease endemic in the area studied and has therefore constitute a major public health problem. Integrated control approach such as Deworming programme among school children, improvement of safe water supply, health facilities, Sanitation as well as health education are needed so as to reduce the rate of intestinal parasitic infection. Oral 07 A PRELIMINARY STUDY OF INTESTINAL PARASITES PREVALENCE AND INTENSITY IN SOME SELECTED LOCAL GOVERNMENT AREAS OF ZAMFARA STATES, NORTHWESTERN REGION OF NIGERIA Keywords: Prevalence, Zamfara state, Nigeria Intestinal Parasites, Oral 08 ORAL HEALTH RELATED QUALITY OF LIFE AND HEALTH RELATED QUALITY OF LIFE AMONG HIV PATIENTS IN KOTA BHARU Mohammed K,*1 Ikeh Eugene I,2,Aziah I, 3 Julia O,4,Fabiyi Joseph P5, Mohamed Rusli A1 1 Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, (USM), Kelantan 16150, Malaysia 2 Department of Medical Microbiology, Faculty of Medical Science, University of Jos, Plateau State, Nigeria.3Institute for Molecular Medicine, University Sains Malaysia(USM),Kelantan 16150 Malaysia. 4Department of Chemical Pathology, School of Medical Sciences, USM Kubang Kerian, Kelantan.5Department of Applied parasitology, Faculty of Veterinary Medicine, Usmanu Danfodiyo University,Sokoto Nigeria Mohamed NA, Yusoff A, Saddki N, Anilawati MJ School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Oral health problems are common in people living with HIV/AIDS (PLWHA), and these problems can have significant impact on the general well-being of individuals affected. This study aimed to determine self-reported oral health problems, oral healthrelated quality of life (OHRQOL), health-related quality of life (HRQOL) and the association between OHRQOL and HRQOL in PLWHA receiving medical care in Kota Bharu, Kelantan. This cross sectional study was done at the Infectious Disease Clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan. A total of 130 patients were included in this study. Self-reported validated questionnaires were used including the Malay version of the Oral Health Impact Profile (S-OHIP(M)) and the Malay version of Medical Outcomes Study Short Form (SF36) to measure the OHRQOL and HRQOL respectively. About half of the patients (51.5%) perceived their current oral health as good or very good although oral health problems were also commonly reported such as cavitated teeth (56.9%), toothache (27.7%) and gingival swelling (20.0%). The prevalence of impact due to oral health problems was 37.7% with a mean severity score 10.1 (S.D. 9.50). Psychological discomfort due to food getting stuck in between the teeth or dentures was the most prevalent impact (22.4%) followed by difficulty in chewing (13.9%), avoid eating certain food (13.8%), and discomfort during eating (13.0%). The mean SF-36 scores were 79.8 (S.D. 21.39) for physical functioning, 66.2 (S.D. 40.81) for rolephysical, 77.0 (S.D. 23.24) for bodily pain, 58.9 (S.D. 21.67) for general health, 66.9 (S.D. 20.97) for vitality, 78.5 (S.D. 21.17) for social functioning, In this cross sectional study, Intestinal parasitic infections is regarded as one of the major health related problems among the neglected diseases in tropical Africa, with the school aged children being the most affected. The diseases result in high morbidity and mortality among people living in suburban and rural areas where the only surface water bodies are the main source of water supply. Study aimed at determining prevalence and assessment of factors associated with intensity of intestinal parasitic infections in some selected local government areas of Zamfara State, Nigeria. Based on stool examination using parasitological techniques (Formol ether Concentration methods) of a single sample, the prevalence of intestinal parasites was established. Parasitological examination was carried out on stool samples from 606 participants whose ages range between 5 years to 30+. Data were entered and analysed using SPSS version 20.0 statistical software. In the analysis,pearson chi-square test was used. Sociodemographic, water contact pattern variables amongst others were tested for strength of relation with infection. Of the 606 participants, 61.7% were positive for intestinal parasitic infections. Males recorded 85.1% times higher prevalence than the females with 14.9%. Age groups between 10-14 years and 5-9 years showed Prevalence of 33.3% and 29.7% than the older aged group respectively. Prevalence and intensity of Entamoeba.coli, Hookworms, E.histolytica, and Ascaris lumbricoides 19 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 72.1 (S.D. 42.49) for role-emotional and 69.1(S.D. 18.34) for mental health. Significant negative correlations were observed between all S-OHIP(M) and SF-36 domains. In conclusion, oral health problems were common among PLWHA in this study. OHRQOL and HRQOL of the patients were significantly associated although not particularly affected. messages emphasis that can measures lesion. to antenatal mothers should not just oral hygiene but also on risk behaviours cause dental caries in children and to prevent initiation and progression of Keywords: Oral health related quality of life, health related quality of life, HIV, S-OHIP (M), Malay version of Medical Outcomes Study Short Form SF-36 Oral 10 Keywords: Early childhood mothers, infant oral health caries, antenatal ALCOHOL AND ITS CO MORBIDITIES AMONG ADOLESCENTS IN MALAYSIA; FINDINGS FROM GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY 2012 Oral 09 KNOWLEDGE AND ATTITUDES OF ANTENATAL MOTHERS ON INFANT ORAL HEALTH Mala AM1, Hamizatul AH1, Hatta M1, Rozanim K2, Yussof S1, Chong ZL1, Norhafizah S1, Diana Y1, Hashimah I1, Gurpreet K1 Mohd Hulaime MN, Zaim S, Mahmood Z, Saddki N School of Dental Sciences, Universiti Sains Malaysia.16150 Kubang Kerian, Kelantan 1 Institute for Public Health, Ministry of Health, Kuala Lumpur 2 Disease Control Division, Ministry of Health Malaysia Early childhood caries (ECC) is one of the most common, yet preventable diseases in young children. Considering the important role of mother in the life of a child, this study aimed to determine the knowledge and attitudes of antenatal mothers on infant oral health. This cross-sectional study used systematic random sampling to select 210 mothers attending the Obstetrics and Gynaecology Specialist clinic at Hospital Universiti Sains Malaysia for antenatal care. Participants took about 15 minutes to complete the questionnaire given. A self-administered questionnaire was used to obtain information on the variables of interest. All mothers were of Malay ethnic. The majorities of them were in their third trimester (63.3%) and most were multigravida (68.1%). Most mothers knew about the importance of brushing baby‟s teeth (100.0%), using fluoridated tooth paste (93.8%), and cleaning baby‟s mouth after each meal (90.5%). However, most mothers were not aware that tooth decay can affect infants (51.4%) and that it is necessary to fill cavities in baby teeth (53.4%). Regarding the mothers‟ attitude, although most mothers (85.7%) agreed that a child‟s teeth should be cleaned as soon as they appear, about half of them disagreed that tooth decay can be caused by transmission of bacteria from mother to baby through feeding utensils (53.9%), night-time breast/bottle feeding (41.0%), and frequent and prolonged daytime breast/bottle feeding (47.6%). In conclusion, although most antenatal mothers in this study knew the importance of keeping the child‟s mouth clean, they lacked the awareness that infants too can be affected by dental caries and carious baby teeth need to be restored. In addition, attitudes of some mothers on transmission and risk factors of dental caries were rather poor. Oral health education Alcohol use among adolescents has serious consequences on physiological, psychological and social functioning in oneself and others. It also clusters with other health risk behaviour such as smoking, physical fighting, injuries and sexual malpractice. This study aims to illustrate the prevalence of alcohol consumption and factors predicting of its use among adolescent in Malaysia. A nationwide cross-sectional study which employed 2 stage clustering sample involving 25,507 respondents from the Global School-based Student Health Survey (GSHS) 2012, was carried out among Malaysian secondary school respondents aged 12 to 17. The respondents were interviewed using selfadministered WHO structured questionnaires. The response rate for alcohol use was 88.8%. The prevalence of alcohol use was 8.9% (95% CI: 7.8110.07), more common in males 11.2% (95% CI: 9.8012.80), Chinese 23.4 (95% CI: 21.40- 25.50) and among form 4, 10.1 % (95% CI: 8.40 -12.20) and form 5, 11.1% (95% CI: 9.10-13.60). There was significant difference among current drinker by age, secondary academic classes, ethnicity and comorbidities. Among these school drinkers, 40.8% (95% CI: 37.6-44.0) were involved in fighting; 46.9 (95% CI: 43.8-50.1) in injury; 15.8% (95% CI: 13.218.8) in smoking; 14.2% (95% CI: 11.4-17.5) in sexual behaviours and 8.4% (95% CI: 6.5-10.9) in drug use. Multivariate logistic regression showed that the alcohol use among adolescents had a higher likelihood in fighting (aOR=1.50; 95% CI: 1.25-1.79), sexual behaviour (aOR=1.39; 95% CI: 1.07-1.81), getting injured (aOR=1.51; 95% CI: 1.30-1.77), current smoker (aOR=4.16; 95% CI: 3.07-5.64), and 20 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 current drug used (aOR= 3.10; 95% CI: 1.35-7.10). Strengthening alcohol policies and comprehensive interventions should be implemented to curb alcohol consumption among adolescents. Keyword: sexual activity; substance use; violence; peer support; family connectedness. Oral 12 Keywords: Alcohol, Adolescents, Students, Alcohol risk behavior MENTAL HEALTH PROBLEMS AMONG STUDENTS OF SEKOLAH MENENGAH KEBANGSAAN METHODIST, NIBONG TEBAL, PULAU PINANG Oral 11 SEXUAL ACTIVITY AMONG MALAYSIAN ADOLESCENTS: WHAT ARE THE RISK AND PROTECTIVE FACTORS? Rozaini MS1 , Thiruloga Guna Venthi K2 , Raveena Visha M2 , Fazilah Y2 1 Pejabat Kesihatan Daerah Seberang Perai Selatan, Nibong Tebal, Pulau Pinang 2 Unit Kesihatan Sekolah, Pejabat Kesihatan Daerah Seberang Perai Selatan, Nibong Tebal, Pulau Pinang Noor Ani A1, S Maria A1, Hasimah I1, Norazilah MR2, Nik Rubiah AR3, Hamizatul Akmal AH1, Tee GH1, Norhafizah S1, Diana M1 1Institute for Public Health, Ministry of Health Malaysia; 2Institute for Health Behavioural Research, Ministry of Health Malaysia; 3Family Health and Development Division, Ministry of Health Malaysia. There is an increasing awareness regarding the rise in mental health issues among adolescents and its implications. The current number of research in Malaysia addressing the prevalence of mental health issue among adolescents and its interventions are rather limited. The main aim of this study is to ascertain the prevalence of three main types of mental health disorders among students from a small town in the state of Penang and the efficacy of the interventions in the forms of counselling, pharmacotherapy and health education in school in helping students with mental health issues. A total of 260 students comprising of all Form Two and Form Four students at Sekolah Menengah Kebangsaan Methodist, Nibong Tebal, Pulau Pinang were screened using the DASS 21 questionnaire to assess Depression, Anxiety and Stress disorders. Response rate was 87.7%. The Pre-intervention screening results noted 25.4% (95% CI 19.7%, 31.1%) of the students had depressive symptoms; 28.1% (95% CI 22.2%, 33.9%) had anxiety symptoms; and 26.3% (95% CI 20.6%, 32.1%) had stress. Postintervention, repeat DASS scores in similar group of students showed prevalence‟s of 15.5% depression, 17.2% anxiety and 16.7% stress indicating some improvement in post intervention group. In conclusion, the increasing prevalence of mental health disorder among adolescents should be addressed via more targeted intervention programmes at schools to ensure significant impact in the outcome. Sexual activity at a young age predisposed adolescents to risky sexual behaviour and the possibility of involvement in other risky sexual behaviours later in life. The aim of this article is to identify risk and protective factors that are associated with sexual activity among Malaysian adolescents. Data from Malaysia Global Schoolbased Study 2012, a nation-wide study using twostage cluster sampling design involving 234 schools with 25,507 students Form 1 to Form 5, was analysed. A total of 23,645 students (response rate of 92.7%) responded to this topic using a selfadministered validated questionnaire. Multivariate analysis was used to assess the association between demographic, health-related behaviours and protective factors with sexual activity. The overall prevalence of reported sexual activity was 8.3% (95% Confidence Interval: 7.5-9.2). Binary logistic regression revealed that sexual activity was positively associated with current smoker [aOR: 1.64 (95% CI: 1.40-1.93)], ever drunk alcohol [aOR: 1.75 (95% CI: 1.39-2.20)], current drug used [aOR: 5.15 (95% CI: 3.43-7.75)], involvement in fight [aOR: 1.49 (95% CI: 1.32-1.68)], being bullied [aOR: 1.22 (95% CI: 1.06-1.39)], truancy [aOR: 1.26 (95% CI: 1.13-1.41)], and physically abused at home [aOR: 1.30 (95% CI: 1.10-1.54)]. Protective factors against sexual activity were having close friends [aOR: 0.62 (95% CI: 0.48-0.80)], supportive peers [aOR: 0.83 (95% CI: 0.74-0.93)], and parental connectedness [aOR: 0.78 (95% CI: 0.69-0.88)]. Efforts to curb unhealthy lifestyles (substance use) and violence (bullied, fight, abused), and promote protective factors (peers and family connectedness) should be the focus of all stakeholders. Keywords: Adolescents, Mental Health, Malaysia, Prevalence 21 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 13 Oral 14 UNDERSTANDINGS ADOLESCENTS EATING BEHAVIOUR IN MALAYSIA PREVALENCE AND DETERMINANTS OF DIETARY SUPPLEMENTS USE AMONG ADOLESCENTS IN MALAYSIA Suhaila AG1, NorhafizahS1, Ahmad Ali Z1, Azli B1, Hatta M1, Yeo PS1 Yeo PS1, Norhafizah S, 1Hatta M1, Nor Azian MZ1,Suhaila AG1 1 Institute for Public Health, Ministry of Health, Kuala Lumpur 1 Institute for Public Health, Ministry of Health The increase in the burden of chronic diseases linked to the nutrition transition is of growing concern nationwide and adolescents are at the forefront of these changes. The objective of this study is to understand adolescents with different socio-demographythrough their meal pattern andhabitual food intakes associate with nutritional status among adolescents. The data from Malaysia School based Nutrition Survey was analysed. This survey was a two-stage cluster sample design involving 40,011 of students from standard 4 until form 5 with 90.5% response rate. The result revealed that 77.8% of adolescents took three main meals daily, of which66.1%took three main mealswith two light meals in between. 50.7% consumed all five meals with a heavy meal taken after dinner. Multivariate analysis showed, of those who likely to skip breakfast were among older adolescent (aOR=2.59), Chinese (aOR=1.50), overweight (aOR=1.27) and obese (aOR=1.39). Skipped lunch was more likely among Indian (aOR=1.7), overweight (aOR=1.22) and obese (aOR=1.23). Skipped dinner was more likely among overweight (aOR=1.23) and obese (aOR=1.36) while it was less likely among girls (aOR=O.78) and Chinese (aOR=0.66). Taking fast food was more likely higher among girls (aOR=1.14) while it was less likely among obese (aOR=0.89). Those who take snack were more likely higher among female (aOR=1.20) and other ethnicity (aOR=1.82), while it was less likely among overweight (aOR=0.97). Results indicated that the top three popular food consumed daily were white rice, sugar and green leafy vegetables. Of all the food groups, vegetable and dairy products failed to meet the recommended mean servings by Malaysia Dietary Guidelines 2010. Therefore, there is a necessity to develop relevant intervention in order to inculcate healthy eating behaviour among adolescents. The use of supplements has increased recently in many countries, but the knowledge on the consumption of dietary supplements among adolescents in Malaysia is limited. This study aimed to determine the pattern of vitamin/mineral and food supplements use among Malaysian adolescents. Data from Malaysia School-based Nutrition Survey (MSNS 2012) conducted by Ministry of Health Malaysia was analyzed. It was a population based survey of Malaysian students. A-two stages stratified sampling based on school and class was used. Descriptive and multiple logistic regressions were used in the analysis. The prevalence of vitamin/ mineral supplements intake among adolescents were 54.1% (95% CI: 51.8-56.4), while 40.2% (95% CI: 38.1-42.4) of adolescents took food supplements. Higher proportion of the younger adolescents (10-12 years old) took the dietary supplements than the older one (13-17 years old). More boys [57.0% (95% CI: 53.4-59.3)] took vitamin/ mineral supplements compared to girls [51.1% (95% CI: 48.4-53.8)]. Similarly, male food supplement users [43.7% (95% CI: 41.5-46.0)] were more than female users [36.7% (95% CI: 34.3-39.1%)]. The most commonly vitamin/ mineral supplements been taken was vitamin C [72.4% (95% CI: 71.2-73.6)], followed by multivitamin [11.3% (95% CI: 10.5-12.2)] and iron [7.0% (95% CI: 6.4-7.7)]. Bee products was the most commonly food supplement been taken by the adolescents [25.9% (95% CI: 24.1-27.9)], followed by fish oil [23.2% (95% CI: 22.0-24.4)] and spirulina [16.2% (95% CI: 15.3-17.3)]. Three main reasons for taking dietary supplements were on parents‟ instruction, self-awareness and doctor‟s instruction. Regardless of sex, dietary supplements were taken most by those who thought they were severely underweight and underweight. Those who perceived themselves as overweight and obese were unlikely to take dietary supplements. These findings can be useful in developing health communications on the use of supplement among adolescents and their parents. Keywords: meal patterns, habitual food intakes, heavy meal, eating behaviours Keyword: Malaysia 22 Dietary supplements, adolescents, 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Jasvindar K1,Gurpreet K1, Balkish MN1, Noor Ani MN1, Helen Tee GH1, Diana M1, Cheong SM1, Siti Fatimah MH1,Fadli Y1,Nurashikin I 2&Azriman R 2 Oral 15 PHYSICAL ACTIVITY AND ASSOCIATION WITH NUTRITIONAL STATUS (BMI) AMONG MALAYSIAN ADOLESCENTS: FINDING FROM MALAYSIAN SCHOOL-BASED NUTRITION SURVEY, MSNS2012 1 Institute for Public Health; Ministry of Health Malaysia 2 Adolescents with mental health problems are worrisome as it propels into adulthood. A pilot study on depression among students conducted in 6 schools in Malaysia (2011) showed a prevalence of 14.1%. The objective of this study was to determine the prevalence and factors predicting depression among adolescents in Malaysia. Data from the National Health and Morbidity Survey 2012 (DASS 21) and Malaysian Global School Health Survey (GSHS) was analysed. This survey was a two-stage cluster sample design involving 28,741 (response rate of 89%) students from Form 1 to 5 from 234 government secondary schools throughout Malaysia. Students completed the self-administered DASS21 and GSHS questionnaires. The overall prevalence of depression was 17.7% (95% CI: 16.71-18.67), higher among female students (18.5%; 95% CI 17.5- 19.7) and Indians (30.0%; 95% CI: 26.7- 33.6). Multivariable logistic regression analysis revealed that females (aOR=1.23 ; 95% CI: 1.11- 1.37), Indians (aOR= 2.00 ; 95% CI: 1.63-2.44), adolescents who felt lonely most of the time/ always (aOR=2.99 ; 95% CI: 2.57-3.47) and considered attempting suicide during the past 12 months (aOR=2.63 ; 95% CI: 2.24-3.09); and with the following associated factors in the last 30 days, smoked cigarettes (aOR=1.42 ; 95% CI: 1.22- 1.67), drank at least one drink containing alcohol (aOR= 1.25 ; 95% CI: 1.061.46), ever used drugs (aOR= 1.85 ; 95% CI: 1.212.82), parents/guardians never/really knew what they were doing in free time (aOR=1.42 ; 95% CI: 1.29- 1.56), and ever been bullied (aOR=1.79 ; 95% CI: 1.60-1.99) were significantly associated with depression. Public health interventions should be developed at individual, family, school and community levels to address depression among adolescents. Azli B1, Ahmad Ali Z1, Suhaila AG1, Rashidah A1, Balkish MN1, Hatta AM1, Chan YY1, Mala M1, Noor Ani A1 1 Institute for Public Health, Ministry of Health Malaysia Physical activity is important component of healthy lifestyle and significantly benefit to health. The objective of this study is to determine the physical activity level among adolescents and associates with socio-demographic characteristics and nutrition status.A cross-sectional study was carried out nationwide among adolescents aged 10 to 17 years old involving 14,558 studentsfrom primary schools and 25,453 from secondary schools. A selfadministered Physical Activity Questionnaire for Older Children (PAQ-C)was used for Physical Activity Level (PAL). Weight and height were measured directly to compute body mass index (BMI) classification as recommended by WHO (2007). The mean score for the physical activity level for adolescents was 2.3 (95% CI: 2.3-2.3). The findings showed the boys were significantly activecompared to girls with mean score of 2.5 (95% CI: 2.4-2.5) and 2.1 (95% CI: 2.1-2.2) respectively.The prevalence of physically active adolescents was 42.7% (95% CI: 40.8-44.7), and according to states, WP Putrajaya was the highest [51.0% (95% CI: 42.9-59.1)].The five most popular physical activities during their spare time were walking for exercise, jogging/running, badminton, tagging and cycling.The adolescentswere physically activeduring weekend [2.7 (95% CI: 2.6-2.7)] compared to schooling days [2.3 (95% CI: 2.3-2.4)].In a nutshell, the inculcation of healthy eating habits and being physically active at early age are important approaches to prevent the occurrence of non-communicable diseases later in life. Keywords: DASS21 Depression, Adolescents, Students, Oral 17 IDENTIFIED RESEARCH PRIORITY AREAS IN OCCUPATIONAL HEALTH FOR TENTH MALAYSIA PLAN (10MP) Keywords: adolescent, BMI, physical activity level, weekend, schooling day Oral 16 Lasa I1, Yahya B2, Juliana SP2, Gurdeesh K2, Ridhuan MD2, Hazrin H2 BURDEN AND CORRELATES OF DEPRESSION AMONG ADOLESCENTS IN MALAYSIA 1 Kuala Langat District Health Office, Ministry of Health Malaysia. 2 Institute Kesihatan Umum, Ministry of Health Malaysia. 23 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Tenth Malaysia Plan (10MP) stresses on a healthy community and spells out strategies to achieve a high-income nation. In line with this plan, the Occupational Health Division in Institute for Public Health produced a document on Identifying Research Priority Areas (IRPA) in Occupational Health for the Tenth Malaysia Plan, in year 2009. A team consisting of thirty nine occupational health experts from all over the country in various disciplines was formed. A qualitative research using Delphi technique was adopted by the team members whereby two steps were taken. Step one includes identifying three broad research priority areas for occupational health research. Subsequently in the second step, the prepared lists were then reprioritized again by ranking them using six criteria which consist of „big impact on morbidity and mortality‟; „reinforcing literature resources‟; „demand from stakeholders‟; „data required as tools for policy makers‟; „evaluation of performance of service delivery‟; and „the feasibility, practicality, cost and time availability‟. There were 111 researched topics on occupational health identified in which finally grouped to another 19 broad research priority areas. The highest topic scored 982 and the least scored 825. Topic on „Healthy Workplace‟ scored the highest (982 score) followed by topic on „Environmental Health Disease‟ (955 score), „Stress at Work‟ (948 score) and „Accident while working and to and fro work‟ (940 score), „Occupational Lung Disease‟ (931 score) and „Musculoskeletal Disorders‟ (928 score). Based on the 6 criteria data required, the „tools for policy makers‟ ranked the top with 3651 scores and the least was the criteria on „evaluation of performance of service delivery‟ (2530 score). Findings from this IRPA serve as a reference documents by various other agencies. Therefore, it is recommended that National health Institute utilizes it as guidance before conducting research in this field. Corporate culture refers to the shared values, attitudes, standards, and beliefs that characterize members of an organization and define its nature. In a healthy culture, employees view themselves as part of a team and gain satisfaction from helping the overall organization succeed. Ministry of Health has started its culture building in 1990 whereby a committee for Corporate Culture was formed under the Director General of Health. In 1995, restructuring of the existing committee was done where an Advisory Committee and Working committee for the Corporate Culture was formed separately. In the same year, evaluation on the corporate culture values had been initiated under Intensification of Research in Priority Areas (IRPA). This cross-sectional study is the third of the series using self-administered questionnaires. Prior to this study, there have been three studies to evaluate its implementation. There are two types of respondents, where administered questionnaires were sent to all head of departments and all medical officers in public hospitals in Malaysia. Analyses were made using SPSS Version 17 & 20. About 84.8% (n= 3302) medical officers responded in this study. The study shows that at least 92.6% (n=2962) of the doctors perceived the three core values of the corporate culture had been implemented in their department. The study also showed a decrease about 3.9% compared to the last study conducted. However, 95.5% doctors implemented caring value in their daily routine. Medical officers were also asked to give their suggestion on how to generate a caring service among them. About half 50.4 (n=1478) of the doctors agreed on their heavy workload and suggested to reduce the workload of the doctors. Apart from increasing manpower, workload can also be reduced by reformatting the system and upgrading the doctor‟s competency. Keywords: corporate culture, corporate values, medical officers, public hospitals, caring, workload Keywords: Tenth Malaysia Plan, occupational health, occupational research, healthy workplace. Oral 19 Oral 18 THE ECONOMIC BURDEN OF OCCUPATIONAL NOISE INDUCED HEARING LOSS IN MANUFACTURING INDUSTRIES IN MALAYSIA CORPORATE CULTURE IMPLEMANTATION AMONG HEALTHCARE PROVIDER IN MOH: WHERE ARE WE! Noraita T1,2,, Jamal Hisham1, Syed Aljunid1 Dr. Nor Filzatun B1, Noriah B1, Roslinah A2, Mohd Idris O1, Roziana S1, Fariz Sakina A1, Aishah M3 1United Nation University International Institute for Global Health; 2Department of Occupational Safety and Health, Ministry of Human Resources Malaysia 1 Institute for Health Management, Ministry of Health 2 Institute for Health System Research, Ministry of Health 3 Malaysia National University (UKM) Occupational noise induced hearing loss (NIHL) were the most serious health effect resulting from the damage of the inner ear due to exposed to 24 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 excessive noise in the workplace. This study aimed to estimate the total disease burden to workers exposed to hazardous noise in manufacturing industries. We analyzed data from the Occupational Disease and Poisoning Data 2011, a cross-sectional population-based industrial survey with stratified sampling design involving a total of 310 respondents with NIHL at the mean age of 43 years whom almost 90% were men, working in 26 industries with noise exposure more than action level. The workers and safety and health practitioners were interviewed using standardized questionnaires. Annual total cost of NIHL from a societal perspective was RM32,500 per patient, with direct cost accounted for 14% and indirect cost 86%. The main components for direct medical cost, direct non-medical cost and indirect cost was treatment and rehabilitation (14%), transportation (0.2%) and productivity loss including benefit expenditures (84%) respectively. In multiple linear regression showed middle age, secondary education, longer employment and high salary were associated with higher total cost. In conclusion, this study shows that occupational noise induced hearing loss imposed a substantial amount of burden on workers, employers and government in Malaysia. As productivity loss and benefit expenditure by the government made up a large share of the economic burden, better awareness by having effective hearing loss prevention program are urgently needed. These findings could provide an economic burden-based model for occupational disease loss estimation among manufacturing industries. incurred and actual cost for dental restorations among adult patients in government primary oral healthcare clinics in Kelantan.A cross-sectional study was carried out in January to July 2013. Using simple random sampling of dental clinics which fulfilled pre-determined inclusion and exclusion criteria, 284 amalgam and composite restorations were recorded. The Direct-Activity-Based Costing (ABC) was calculated on each of dental restorations. Statistical data analyses used were the Mann-Whitney U and Kruskal-Wallis test via SPSS version 20.0. Results revealed that cost was significantly higher in composite resin restoration compared to amalgam at median RM14.27 (IQR 7.99), and median RM11.74 (IQR 6.77) respectively (p<0.001). In amalgam type of restorations, median(IQR) Class 2 [RM13.34 (7.68)] was significantly higher as compared to median Class 1 [RM10.81(5.21)] and Class 5 [RM10.61(5.16)] (p=0.01). In composite resin, no statistically differences were found between restorations of Class 1, 2, 3, 4 and 5 (p=0.1). However, the direct building, equipment and instrument, operational and maintenance as well as the labour cost were significantly different between composite resins of Class 2 and Class 5 (p=0.04). In conclusion, the cost in the provision of dental restoration in government dental clinic is higher as compared with the charges set in Fee Act 1951. Findings provide an added value in the evidences on the costing of primary oral health services in Malaysia. Keywords: noise induced hearing loss, manufacturing, economic burden, occupational Oral 21 Oral 20 EVALUATION OF ICPMS AND GFAAS FOR ANALYSES OF LEAD IN BLOOD Keywords: dental caries, dental restorations, direct-activity-based costing ACTUAL COST OF DENTAL RESTORATIONS IN GOVERNMENT DENTAL CLINIC IN KELANTAN Rafiza S, Wan Nurul Farah WA, Yuvaneswary V, Mohd Fitri R, Mohd HairulHisam H & Muhammad Amir K. Abdullah MZ1; Yusof A1; Abd Rahman N1; Sulong S2; Mohd Nur A3 Institute for Medical Research, Ministry of Health Malaysia. 1 School of Dental Sciences, Universiti Sains Malaysia Universiti Kebangsaan Malaysia Medical Centre 3 United Nations University International Institute for Global Health 2 Human may be exposed to lead through occupations or by breathing air, consuming food or water, or swallowing dirt that contains lead. The main target organ for lead toxicity is the nervous system, with children being the most vulnerable group. Blood lead analysis is the most accurate method for assessing lead exposure and is commonly used. This study was conducted to examine the compatibility of blood lead levels using graphite furnace atomic absorption spectrophotometry (GFAAS) and inductively coupled mass spectrometry (ICP-MS). Blood lead levels by GFAAS was analyzed using standard method NCCLS C40-A whilst analysis by ICP-MS was based on method 6020A. A total of 60 Dental caries is the most significant component of oral disease burden and restoration is the only intervention to treat it. Most people perceived that to have dental restoration in Malaysian government clinic is cheap as fee per restoration in the Fee Act 1951 is only RM2.00 regardless of materials used or extensiveness of the cavity. With the need for prudent expenditure, oral healthcare planners are obliged to seek evidences based on economic evaluation. This study aimed to determine the cost 25 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 samples were analyzed by both methods. Statistical analyses of all the samples showed very good correlation between both methods (r2 = 0.94) with an intraclass correlation of 0.96 (95%CI: 0.94; 0.98). Further analysis by subdividing the blood lead level results of ICP-MS using the cutoff point of <10 g/dl and 10 g/dl showed good agreement in both groups. The agreement however was better for higher blood lead levels. In conclusion, both GFAAS and ICP-MS can be used inter-convertibly to determine blood lead levels especially when the blood lead levels are high. Precautions should be employed for between method differences when the blood lead levels are low. overcome the coding error in every level of coding process. In order to ensure the quality of coding, those who are responsible for the coding process should be able to deliver at their level best. Keyword: Coding Error, Procedure Coding, Diagnosis Coding, Casemix, Fraud in Casemix, Upcoding, Miscoding Oral 23 WORKPLACE VIOLENCE AMONG HEALTHCARE WORKERS IN EMERGENCY DEPARTMENT, HOSPITAL UNIVERSITI SAINS MALAYSIA Keywords: Plumbum, method development, biomonitoring Oral 22 CODING ERRORS OF DIAGNOSIS AND PROCEDURES CLASSIFICATION: IMPACT ON IMPLEMENTATION OF CASEMIX SYSTEM Zulraini J1, Zaliha I2, Aziah D1, YN Azwany1 1 Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia 2 Population Health and Preventive Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, 68100 Batu Caves, Selangor Darul Ehsan, Malaysia SA Zafirah1, Syed Aljunid2, Sharifa Ezat WP1, Amrizal MN2. Workplace violence is one of the neglected occupational health issues in the past and now, become new major threat that has dramatically gained high attention globally. It affects all kinds of job categories at various setting of workplace. This study was carried out to determine the proportion of workplace violence (physical abuse, verbal abuse, bully, sexual and racial harassment) and its associated factors among healthcare workers in Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM). A cross sectional study was conducted in March 2011 among healthcare workers who fulfilled the study criteria. Validated Malay Version of Workplace Violence Questionnaire was administered to 126 consented healthcare workers in ED, HUSM. The information on socio-demography, occupational profile, their experience, witness or report the incident of workplace violence which were based on experience of the respondents 12 month prior to the study were gathered from the validated questionnaire. Among 126 respondents, the mean (SD) age and work experience were 37.0(9.34) years old and 11.6 (8.90) years respectively. Job categories of respondents as follows: doctors (n=21, 16.7%), paramedic (n=49, 38.9%) and support group (n=56, 44.4%). Majority of the respondents (n=64, 50.8%) were verbally abused, 20 (15.9%) were physically violence, 17 (13.5%) were bullied, seven (5.6%) were sexually harassed and five (4%) were racially harassed in the workplace. The mean (SD) age of those who claimed to be verbally abused was 35.2 (8.66) years old with work experience of 9.8 (8.00) years and almost half of them (n=30, 46.9%) were paramedics, 25(39.1%) 1 University Kebangsaan Malaysia Medical Centre United Nations University – Institute of Global Health 2 As Procedure and Diagnosis Coding are two of the most essential components in Casemix System, coding error may lead to far-reaching consequences. These are impact on hospital reimbursement and the behaviors of providers in health service provision. This study is aimed to identify the source of coding error in the use of diagnosis and procedure classification and its implications. A review of various published papers, articles and literature was conducted through Google, Science Direct, PubMed, Elsevier websites. Several keywords were entered in combination of: miscoding, upcoding, undercoding, fraud in casemix system, hospital reimbursement and medical reimbursement. The search strategies identified that source of coding error can be divided into 3 main categories; Physician, Medical Coder and Keypunching. In Australia Victoria Hospital the coding error rate is 73% (1994-1995), in Arab Saudi it is 30% (2005), average of 84% in UK (2001), 84.5% in Florida and 8% in University Kebangsaan Malaysia Medical Centre Malaysia (2004). In addition, this study also identified that coding error is one of the sources of fraudulent behavior towards hospital reimbursement. Complexity in coding process is not deniable. Thus it is crucial to identify the source of coding error in every step of coding process. This will be the preference in developing tools to 26 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 from support group and nine (14.1%) were doctors. We found that, healthcare staff who works in shift have 2.78 times the odds to be a victim of workplace violence (95% CI: 1.06, 7.30, p value = 0.038) and a staff who is one year younger will be protected by having 0.96 times the odds (95% CI: 0.92, 0.99, p value = 0.046). The percentages of workplace violence in ED of all forms are significant to render the need of workplace intervention in order to ensure conducive workplace environment in such a busy setting. factors, medical history, work history, type of work and quality of life post-acute coronary syndrome. In conclusion, the duration of sick leave and percentage of return to work varies between countries. The factors predict sick leave duration and factors associated with return to work were almost similar with a few differences. The factors were also broad. Keywords: sick leave, return to work, acute coronary syndrome, myocardial infarction, ischaemic heart disease and employees Keyword: Workplace violence, healthcare worker, emergency department. Oral 25 Oral 24 PUBLIC ACCEPTANCE TOWARDS SMOKE FREE INITIATIVES IN PERLIS DETERMINANTS OF SICK LEAVE DURATION AND RETURN TO WORK POST-ACUTE CORONARY SYNDROME: A REVIEW OF THE LITERATURE Zulhizzam A, Ghazali O, Kamariah H and Azmi A Public Health Division, Perlis State Department 01000 Kangar, Perlis, Malaysia Sahrol Nizam Abu Bakar1 Mohd Nazri Shafei2 Norsa’adah Bachok3 Zurkurnai Yusof4 Mansor Yahya5 Health Smoking is among known risk factor for the development of non-communicable diseases (NCDs) morbidity and mortality. During the National Health Morbidity Survey 2006, the prevalence of current smoker in Perlis was 33.1% with estimated 36,674 of those aged 18 years and above, who smoked. Perlis State Health Department plans to initiate Smoke Free Initiatives (SFI) with the introduction of new areas of smoke free zones. The objective of this study is to evaluate the public acceptance towards SFI in Perlis. A community survey was conducted in July 2012. A convenience sampling was done among the shop owners and the public consumers, and the survey was done in four areas at Arau, Kangar, Kuala Perlis and Padang Besar. Each respondent was interviewed using a pre-tested questionnaire. The variables of interest covered various domains namely knowledge and attitude, about smoking complications, smoke free areas, enforcement activities, dedicated area to smoke, introduction of new smoke free zones and public opinion whether SFI will be successful or not, in Perlis. A total of 831 respondents participated in the survey. There were 456 males (54.9%) and 375 females (45.1%). A total of 416 (50.1%) were shop owners and 415 (49.9%) were the public consumers. Among the shop owners, 90 (21.6%) were food premises outlet and 326 (78.4%) were of various categories of premises. Interestingly, 88.9% of respondents were in favours of initiation of the smoke free zones in Perlis. About 88.6% consumers and 90.9% shop owners supported SFI in Perlis with the adjusted odds ratio 0.66, 95%CI (0.40–1.06). In terms of support towards SFI, there were no significant difference between food premises outlet owners and other various categories of premise owners. As a conclusion, during this community survey, the majority were in favours of 1 Postgraduate students Department of Community Medicine, USM; 2 Lecturer Department of Community Medicine, USM; 3 Lecturer Departments of Biostatistics and Research Methodology, USM; 4 Consultant Cardiologist and Lecturer Department of Medicine, USM; 5 Consultant Cardiologist, Hospital Raja Perempuan Zainab 2, Kelantan. Acute Coronary syndrome (ACS) is the main cause of morbidity and mortality in cardiovascular disease in the world. Sick leave duration was important to benefit the employees for being able to return to work post-acute coronary syndrome. The aim of this review was to identify the sick leave duration, percentage of return to work post ACS. The second aim was to determine factors predict sick leave duration and associated factors with return to work post ACS among employees. Multiple search engines were used to retrieve article from online journal such as Google scholar, Pubmed and online database subscribed by Universiti Sains Malaysia such as EBSCOhost, Springer and Science Direct. The Keywords used were “sick leave, return to work, acute coronary syndrome, myocardial infarction, ischaemic heart disease and employees post-acute coronary syndrome”. From this review, two articles described duration of sick leave ranges from 51 days to 134 days and eleven articles described percentage of return to work from 48% to 93%. Factors that predict duration of sick leave duration and factors associated with return to work were social and demographic factors, psychosocial 27 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 the implementation of Smoke Free Initiatives in Perlis. significant was computer skill course (OR 2.94, 95% CI 0.98,8.78). There was no significant factor associated with anxiety among respondents using electronic medical record. The prevalence of depression, anxiety and stress respondents using electronic medical record were within range of prevalence depression, anxiety and stress in Malaysia and worldwide. There were no different in mental health outcome among those doctors and nurses using electronic medical record compared to manual medical record. This reflects the successful of Telehealth projects in Malaysia by Ministry of Health and also may reflect the good coping mechanism. In this study, we were found that age was predicted factor for depression among respondents using electronic medical record. We also able to show that computer skill course and marital status were factors that associated with stress level among respondents usingelectronic medical record. Keyword: smoke free initiatives Oral 26 EFFECT OF ELECTRONIC MEDICAL RECORD UTILIZATION ON DEPRESSION, ANXIETY AND STRESS AMONG DOCTORS AND NURSES IN JOHOR Ahmad Fairuz M1, Mohd Ismail I2, Mohd Nazri S3 1 Management & Science University, Shah Alam, Malaysia; 2,3 Universiti Sains Malaysia, Kampus Kesihatan Kubang Kerian, Kelantan, Malaysia. Keywords: Electronic Medical Record (EMR), depression, anxiety, stress, Depression, Anxiety, Stress Scale (DASS21) Questionnaire Healthcare systems throughout the world and in Malaysia are transforming from industrial age healthcare system to information and communication age healthcare system. This transformation will support and strengthened by telemedicine. However, many doctors and nurses are facing with the challenges and obstacles of this implementation of electronic medical record. This study was designed to evaluate the effect of electronic medical record utilization on depression, anxiety and stress among doctors and nurses in Johor. A comparative cross-sectional study was conducted between January till April 2012 among doctors and nurses in Hospital Sultan Ismail, Johor Bharu (HSIJB) which using electronic medical record and Hospital Pakar Sultanah Fatimah, Muar (HPSF) using manual medical record. Data was collected using self-administered questionnaire which consists of socio-demographic and occupational characteristics and validated Malay version of Depression, Anxiety, and Stress Scales-21 items (DASS-21). There were 130 respondents with response rate 91% for electronic medical record and 123 respondents with response rate 86% for manual medical record. The mean (SD) age of respondents electronic medical record and manual medical record group were 34.7 (9.42) and 29.7 (6.15). The mean (SD) duration of respondents using electronic medical record was 46.1 (35.83) months. The prevalence of depression, anxiety and stress among respondents using electronic medical record were 6.9%, 25.4% and 12.3%. There were no significance difference proportion of depression, anxiety and stress between respondents using electronic medical record and manual medical record. In multivariable analysis, the significant factors associated with depression among respondents using electronic medical record was age (OR 1.10, 95% CI 1.02,1.19). The significant factors associated with stress among respondents using EMR was marital status (OR 3.33, 95% CI 1.10,10.09) and borderline Oral 27 FACTORS INFLUENCING HEALTH SEEKING BEHAVIOR AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN PRIMARY CARE SETTING LL Low1, SF Tong2, WY Low1 1 Faculty of Medicine University of Malaya Kuala Lumpur MALAYSIA 2 Department of Family Medicine Universiti Kebangsaan Malaysia Kuala Lumpur MALAYSIA Type 2 Diabetes Mellitus (T2DM) is public health problem posing considerable burden to the health systems of many countries. The society and health care providers have an important role to shape the health seeking behaviour of patients with T2DM. This study aimed to explore factors influencing health seeking behaviours among patients with T2DM in primary care setting. We adopted qualitative exploratory study using thematic analysis. Twelve patients with T2DM, nine family members of the above patients and five health care providers, were interviewed using a semi-structured interview guide. In addition, three focus group discussions were carried out among thirteen health care providers from public primary care centres. Study centres were two public primary care centres and five clinics of private general practitioners in the state of Selangor, Malaysia. The in-depth interviews were audio-taped and transcribed verbatim, followed by line by line coding. Constant comparison was used to identify the themes. Data 28 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 management was facilitated using Nvivo 10. The study revealed the influence of society (family members or relatives, friends, colleagues and peers) and the health care providers in shaping the patients approach to managing their illnesses. How the society and health care providers contribute to the way patients manage their illness also emerged from the study. Majority shared the support and advice received from society and health care providers played a crucial role in lifestyle change and management of diabetes. Family members and friends showing concerns and encouragement to seek care had affected patients‟ decision to experiment with different treatment modalities (modern, traditional or self-care). Exploring factors affecting patients‟ ways of seeking diabetes care could give an opportunity to understand patients‟ health seeking behaviours. The finding from this study might help the program managers and clinicians to have better understanding of human behaviour, from the patients‟ experience. cigarette packaging and 59.8% of them think that they will get disease as shown on cigarette packaging if they continue on smoking. Whereas, 89.0% of children believed that smoking will affect their health. However, only 50.5% of the children rated “highly believe” on the descriptors and pictorial health warnings on the packaging. In both groups, different designs and pictorial warnings gave different perception. Additionally, the children whose parents were smokers were significantly less likely to believe the descriptors and pictorial images shown on the packaging (p<0.05). The existence of the current pictorial health warnings add little message to adult smokers and their child. We should be looking into introducing plain packaging, as in Australia, to reduce the erroneous misconceptions of risk communicated through pack design features. Keywords: Diabetes Mellitus, Health Seeking Behaviour, Social Influence, Primary Care Setting, Qualitative Study Oral 29 Keywords: cigarette packaging; children; risk perception KNOWLEDGE, ATTITUDE AND PRACTICE ON FAMILY PLANNING AMONG ORANG ASLI WOMEN IN ROMPIN DISTRICT, PAHANG Oral 28 THE IMPACT OF CIGARETTE PACKAGING AND HEALTH WARNINGS ON RISK PERCEPTION IN YOUNG CHILDREN IN RELATION TO THEIR PARENTS SMOKING STATUS Aznita Iryany MN1, Mohd Hashim MH2 1 Rompin District Health Office Department of Community Medicine, Universiti Sains Malaysia 2 Family planning is one of the measures to adress the issue of poor maternal health among Orang Asli women. Understanding their knowledge level and cultural sensitivities may facilitate in the promotional activities on family planning. This study aimed to determine the knowledge, attitude and practice of family planning among Orang Asli women in Rompin district, as well as the associated factors that influence their knowledge on family planning. A cross-sectional study was conducted from 23rd February to 20th March 2011 involving 109 Orang Asli women in Rompin district selected via multistage sampling. Data was collected using a validated interview-guided questionnaire and analysed using SPSS Software version 18.0. Results showed the mean (SD) knowledge score was 69.9% (11.95) with a proportion of good knowledge of 11.9%. The mean (SD) attitude score was 81.56% (14.15) with a proportion of satisfactory attitude of 47.7%. The prevalence of contraceptive practice was 76.1% (95% CI 68.5, 84.7), with oral contraceptive pills being the major contraceptive method used. Multivariable analysis showed that increasing age, higher educational level, higher household income and previous contraceptive use were associated with higher knowledge score. In conclusion, this study showed that knowledge and Siti Munira Y1, Noridayu A2, NurQaasimah M2, Wan Nor Atiqah WM2, Wan Muhammad Hafiz WJ2, Mohd Hafiz MH2 1 Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA 2 Faculty of Medicine, Universiti Teknologi MARA Cigarette packaging is one of the most prominent forms of tobacco marketing in Malaysia. The current study examined the impact of pack design and health warnings on risk perception and brand appeal among children ages between 10-12 years. We also investigated this relationship with their parent‟s smoking status. A cross sectional study was conducted among students from standard four to standard six, in a primary school in Klang Valley. The total respondents were 281 child-parent pairs. We administered two different sets of questionnaire for parents and their child on socio demographic, pictorial health warnings and their perception on the packaging, attractiveness, brand, health impact and purchase interest. Results were analysed by SPSS 20.0 and the mainstay of analysis include multivariate regression analysis. Among parents, 33.5% of them believed in warning labels on 29 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 attitude on family planning among Orang Asli women are still low. Individual approach via counselling was recommended to provide the Orang Asli women with better knowledge on family planning and to better understand their sociodemographic and reproductive health background. and the findings could guide policy makers in making more effective and appropriate Internet policies regarding pornography. Keywords: adolescent, premarital pregnancy, sexual and reproductive health knowledge Oral 31 Keywords: family planning, Orang Asli, knowledge, attitude, practice, contraception CORRELATES OF CURRENT SMOKING AMONG ADOLESCENT SCHOOL CHILDREN Oral 30 SEXUAL AND REPRODUCTIVE HEALTH KNOWLEDGE OF PREMARITAL PREGNANT ADOLESENTS IN RAUDHATUS SAKINAH GH Tee, Gurpreet K, KH Lim, Muhammad Fadhli MY, Hamizatul Akmal AH, Hazrin H Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia Many studies have shown that cigarette smoking play a prominent role as a gateway to substance use. Similarly, adolescents who reported having been bullied were also more likely to be current smokers. This study aimed to determine the prevalence andcorrelates of current smoking among adolescent school children. This study is part of the nationwide school-based Global School Health Survey (GSHS). GSHS was conducted among 25,507 Forms 1 to 5 students using a two-stage cluster sampling design technique. The students who consented to participate in the survey completed pre-tested self-administered tobacco use module questionnaires. Multivariable logistic regression was used to measure the associations between selected socio-demographic characteristics and health-related behaviours. The overall prevalence of current smoking was 11.5% (95% CI: 10.4 - 12.7). Current smoking was significantly associated with males [20.9% (95% CI: 18.9 - 23.0)], Bumiputra Sarawak [95% CI: 20.2 (16.7 – 24.2)], being attacked at least once in the last 12 months [16.9% (95% CI: 15.4 – 18.6)], current drinkers [28.4% (95% CI: 24.6 – 32.4)] and using drug at least once in the past 12 months [55.9% (95% CI: 48.7 – 62.9)]. Multivariable logistic regression revealed that current smoking remained significantly associated with males (aOR=12.48; 95% CI: 10.16 – 15.34), drug use (aOR=3.10; 95% CI: 1.50 - 6.39), current drinkers (aOR=4.35; 95% CI: 3.36 – 5.64) and being attacked at least once in the last 12 months (aOR=1.35; 95% CI: 1.12 – 1.63).Smoking is associated with several health-related behaviors that pose risk to the adolescent school children's social and smoking related-health problems. Thus, there is an urgent need for early and integrated prevention program which address multiple risk behaviors simultaneously. A Safiya,1,2, Mohd Yusof Sidek1, KI Musa1 1 Department of Community Medicine, School of Medical Sciences, USM 2 Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu Knowledge is one of the most important factors affecting adolescents‟ sexual and reproductive health. This study aimed to assess the sexual and reproductive health knowledge of premarital pregnant adolescents in Raudhatus Sakinah (RS), an NGO organized shelter home for problematic female adolescents and to identify the factors related to their knowledge. Thirty-three residents of RS institutions in Kelantan, Johor and Penang consented to participate in a cross-sectional study which used a self-administered validated questionnaire as the study tool. The study found that the mean (SD) age of first coitus was 16.3(2.0) years and the mean (SD) age of first pregnancy was 17.1(1.4) years. Almost all (97%) respondents had watched pornography. Most of them had good knowledge on reproductive organs but poor knowledge on the details of pregnancy and its complications. Multiple linear regressions were used for multivariable analysis. Knowledge score of premarital pregnant adolescent increase by 14 (95% CI 6.59,21.42) units among those who had watched pornography compared to those who did not watch. Knowledge score increased by 3.80 (95% CI 1.24,6.34) units for premarital pregnant adolescent with history of rape. For every year increase in age at first coitus, knowledge increased by 0.80 (95% CI 0.12,1.46) units. For each year of increase in age of the partner at the first coitus of the girl, the knowledge score decreased by 0.47 (95% CI 0.15,0.79) units. In conclusion, their sexual and reproductive health knowledge was significantly related to their age at first coitus, history of rape, age of partner at first coitus of the girl and history of watching pornography. This study highlights the danger of easily available pornography materials, Keywords: smoking, current drinkers, drug used, bullied, attacked 30 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 4 Oral 32 Titiwangsa District Health Office, Kuala Lumpur Legionnaires‟ disease was first described by Fraser et al following an outbreak of pneumonia among participants of the American Legion Convention, Philadelphia in 1976. It was caused by Legionella pneumophila which commonly found in aquatic environment. Notification was received on 26th July 2013 from a hospital on five cases with lab positive Legionella among patient admitted in General Intensive Care Unit. On further questioning, there were another 23 cases were tested positive with three related deaths giving fatality rate of 12%. An immediate investigation was done which aimed to determine the occurrence of the outbreak in the hospital, the epidemiological description, the source of infection and immediate prevention and control activities. It is a retrospective cohort study of previous 28 confirmed cases and a cross-sectional study on patients and health care workers from six affected wards. Laboratory investigations were done which includes blood and urine samples from symptomatic respondents and water and swab samples from the cooling tower, misting devices and water dispensers. A total of 264patients and 216 health care workers were examined and 49 of them (attack rate 10.2%) were defined as cases. Blood and urine samples revealed 5 out of 49 (10.2%) samples were found positive for Legionella giving the total number of cases were 33 with six related deaths. Water samples from the cooling tower 2,3 and 5 which is located opposite the affected wards and a water dispenser showed positive for Legionella pneumophila Serogroup 1 and 2. In conclusion, there was an outbreak of Legionella involving 30 patients and 3 health care workers in a hospital from Mac until July 2013. The sources of infection were from the cooling towers and water dispenser in the ward. The hospital was instructed to manually clean both of the source and regular maintenance of the cooling towers. PREVALENCE AND PREDICTORS OF ILLICIT DRUG USE AMONG SCHOOL-GOING ADOLESCENTS IN MALAYSIA: GLOBAL SCHOOL HEALTH SURVEY Mohamad Naim MR1, Norhafizah S1, Fadhli MY1, Yusoff S1, Lim KH1, Norzawati Y1, Noor Ani A1 1 Institute for Public Health, Ministry of Health Malaysia Illicit drug use among adolescents is a public health problem and has been increasing in Malaysia. This study aims to determine the prevalence and predictors of illicit drug use among school-going adolescents in Malaysia. Data from Global School Health Survey (GSHS 2012) conducted by Ministry of Health Malaysia was analysed. It was a population based survey of 25,507 students. Two stage stratified sampling based on school and class were used. Overall, the prevalence of lifetime illicit drug use was 1.7% (2.5% male, 0.9% female). Among those who had lifetime illicit drug use, 8.1% were currently smoking, 9.0% were current drinkers, 6.2% ever had sexual intercourse, 3.0% were engaged in truancy problems, 3.3% had lack of peer support, 2.6% and 1.6% showed low and medium prevalence of parental attachment. Illicit drug use was significantly associated with current smoking (aOR=7.18; 95% CI: 5.36-9.63), current alcohol use (aOR=4.80; 95% CI: 3.57-6.45), sexual intercourse (aOR=4.88; 95% CI: 3.64-6.54), truancy (aOR=1.41; 95% CI: 1.06-1.88) and lack of peer support (aOR=1.56; 95% CI: 1.16-2.09), low parental attachment (aOR=3.18; 95% CI: 1.65-6.15), and medium parental attachment (aOR=2.33; 95% CI: 1.24-4.38). Public health interventions aimed to prevent illicit drug use among adolescents should be designed with the understanding that illicit drug use is associated with risky behaviours. Keywords: Legionellosis, hospital, cooling tower Oral 34 A MEASLES OUTBREAK AT A PRIVATE WELFARE CENTRE IN KUALA LUMPUR, FEBRUARY 2012 Keyword: Illicit drug use, adolescent, GSHS Oral 33 A LEGIONELLA OUTBREAK AT A HOSPITAL IN KUALA LUMPUR 1 1 1 Rohani I, 1Nurul Hafizah MY,2Norhaida U, 3Sarah Hassan, 1Tarmizie N Kuala Lumpur and Putrajaya Federal Territory Health Department 2 Johor State Health Department 3 Cheras District Health Office, Kuala Lumpur Rohani I, 2Thilaka C, 3Rosmawati A, 4Zakiah MY, Deenesh K, 1Ummi Kalthum S, 1Balachandran S 4 1 Kuala Lumpur and Putrajaya Federal Territory Health Department 2 Johor State Health Department 3 Deputy Director General Office (PH), Ministry of Health Measles incidence rate in Kuala Lumpur (KL) had increased drastically from 2006 to 2011 (0 -10.1 per 100,000 population). The immunization coverage 31 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 was 86.7% compared to standard > 95%. The State Health Department (JKWPKL) received measles notifications among residents of a private welfare centre on February 2012. Investigation was done to verify the outbreak, describe epidemiologically, identify the source and carry out measures to contain the outbreak. A cohort study was done on all residents of the centre. Cases defined as individuals staying at the welfare centre with history of fever and rash with conjunctivitis, coryza or cough, from February 2012 with confirmed Measles serologically and with epidemiological link. The investigation consists of the epidemiological study by interviewing all residents using questionnaire, the environmental studies of the centre and laboratory studies for serology confirmation and viral isolation. Seventeen children were infected out of 33 residents (51.5% Attack rate). Age range of cases was from 6 months to 14 years old (median 6 years). The index case contracted measles two weeks before the outbreak. Five out of 8 samples (62.5%) were IgM Measles positive. The contributing factors observed were non-immunised status (100%, p<0.05) and at the earlier stage of infection, cases were not isolated. In conclusion, there was an outbreak of measles among 17 children at a welfare centre on February 2013. The risk factor identified was the nonimmunized status among residentsandresulted in measles outbreak in the centre among the susceptible children. Fifteen residents age 6 months to 15 years were given measles vaccination. Isolation room was set up to isolate the infected children. Defaulter tracing and mopping of eligible children for immunization were done to improve the immunization coverage. from all districts in Selangor. Investigations were conducted to identify the causative agent, risk factors and to describe the outbreak epidemiologically as well as recommend measures to prevent future similar cases. Active case detection for contact tracing and food handlers were also conducted. Cases were defined as any patients who fulfill the clinical criteria and positive laboratory test. As of 7 th September 2013, a total of 36 confirmed cases of typhoid fever. There was an increase of 50% of cases reported as compared to the same period in 2012. Out of 36 confirmed cases, 21 were sporadic (58%) and 15 were outbreak (42%). Most were male (69%), Malaysians (61%) and 94% cases were admitted for treatment. High incidence rate was seen among adult group (50%) and teenagers (28%). Laboratory analysis shown 78% confirmed cases were positive for blood culture, 19% were positive for stool culture and only 3% were Widal test positive. The increased number of typhoid cases with a male predominance among Malaysian in the age 25-60 years call for more vigorous efforts to improve hygiene, continuous public health education, together with better serology test (typhidot) to identify carriers among cases and food handlers, are some measures to control this disease. Keywords: Epidemiological analysis, Salmonella typhi, Selangor, typhoid, E-notis Oral 36 DENGUE VIRUS INFECTION AMONG FOREIGNERS IN KUALA LUMPUR AND PUTRAJAYA, 2010 TO 2012 Keywords: Measles outbreak, institution, nonvaccinated Oral 35 Wong YM, Zainal Abidin AB EPIDEMIOLOGICAL ANALYSIS OF TYPHOID FEVER IN SELANGOR FROM A RETRIEVED REGISTRY 2013 Vector-borne Disease Control Unit, Wilayah Persekutuan Kuala Lumpur & Putrajaya Health Department Dengue virus infection is increasingly being recognized as a major emerging tropical in the world including Malaysia. This study aimed to determine the characteristics of dengue fever among foreigners in Kuala Lumpur and Putrajaya. We analyzed the data from the eDengue and Vekpro online national surveillance data from 2010 to 2012 with a number of 472 reported cases of dengue fever during that period. Careful evaluation was done to evaluate the demography, efficacy of diagnosis with prompt management and the healthseeking behavior among those reported cases. Of the 472 cases, majority of the cases were from Myanmar (16%), Indonesia (10%), Iran (10%), Pakistan (8%), India (7%) and Bangladesh (7%) with 99.4% of cases fulfilling the clinical criteria for dengue virus infection and they had reported similar clinical presentations compared to fellow Mas Norehan A 1,Harishah T 1,Wan Nor Fareeda W.Y 1 , Mohmad Farhan K 1 1-Selangor State Health Department Typhoid fever, also known as enteric fever, is a potentially fatal multi-systemic illness caused primarily by Salmonella typhi.S. typhi is a highly adapted human-specific pathogen, and the illness caused by these bacteria is a serious public health concern, particularly in developing countries. The aim of the study was to study the trend and to describe the epidemiology of cases from 1st January 2013 to 7th September 2013. Data was obtained from E-Notis, case reports and also outbreak reports 32 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Malaysians. IgM serology was positive in 67.6% of the foreigners reported as dengue fever. The peak age group of patients with dengue fever was at 2140 years old with a median and mean age of 29.3 and 30.9 respectively. Of these cases, only 41.7 %(197) of the foreigners were diagnosed within three days from the onset of dengue fever and 215 (45.6%) cases were reported from primary healthcare facilities. In conclusion, steps need to be taken to increase awareness of dengue virus infection among foreigners as more than half of them had delayed seeking medical attention for dengue fever by more than 3 days of onset. This retrospective study would be beneficial in the health promotion and primary prevention of dengue transmission by strategically increases their awareness and improves their health-seeking behavior. based on self-reporting by the patients without biochemical verification which might lead to an underestimation of failure rates. In conclusion, the variable of received counseling alone (without pharmacological treatment) is the only factor associated with failure of quit attempts among smokers who sought treatment at outpatient QSS in Klang Health District. Identification of these factors is importance to strengthen the existing QSS and optimize the quit rate among the smokers who attempt to quit. Keywords: attempts factors associated, failure, quit Oral 38 CERVICAL CANCER SCREENING COVERAGE AT HEALTH CLINICS, KUALA LUMPUR IN 2012 Keywords: dengue, foreigners, surveillance, Kuala Lumpur Oral 37 Shanthi V1, Chia SY1, Ummi Kalthom S1 QUIT SMOKING SERVICES IN KLANG HEALTH DISTRICT: FACTORS ASSOCIATED WITH FAILURE OF QUIT ATTEMPTS 1 State Health Department of Wilayah Persekutuan Kuala Lumpur & Putrajaya Cervical cancer, the second most common cancer in women worldwide is an important public health issue. It is potentially preventable and treatable, since it takes many years to develop detectable precursor lesions. The aim of screening is to detect and allow early treatment of preinvasive lesions and thus reduce the incidence and mortality from the disease. Data was collected from Record PKW 102 Pind. 2/2007 and PKW 202 Pind. 2/2207 of Sentul, Batu, Cheras, Jinjang and Tanglin health Clinics. All cases registered in the above records were included in the study. Data was analyzed using the SPSS 16 version. Total of 3657 cases was registered at the above clinics in 2012. Malays were 45% while Chinese, Indian, others and foreigners were 36.8%, 15.9%, 1.3% and 0.9% respectively. Among them 67% were in the age group of 40 to 64 years and 4.2% above 65 years of age. Newly registered patients were 46.9%. HPV positive was detected in 6 cases (0.2%). Abnormal results were seen in 7.7% with six cases identified as squamous cell carcinoma and one as adenocarcinoma which were detected in patients above 40 years of age. Promotion must be increased among the ethnic groups other than the Malays. Rigorous coverage must be carried for patients above 40 years of age who usually attend the outpatient clinics. Coverage in Kuala Lumpur is fairly well which can be improved further by conducting outreach programmes at community and inter-agency level. Ho BK, Nelli Y, Menaga M, Parimala D, Daisy V, Nor Izah D, Che Azlan S Klang Health Department, Ministry of Health, Selangor, Malaysia Smoking is a serious public health problem. Considering the difficulties in quitting smoking, this study aimed to identify factors associated with failure of quit attempts among smokers who sought care at the outpatient Quit Smoking Services (QSS) in Klang Health District. This was a retrospective study reviewing records of all smokers (n=130) who attended the three established quit smoking clinic in Klang Health District from January 2012 – June 2013. We used descriptive statistics to describe baseline socio-demographic factors and logistic regression to identify factors associated with failure to quit. The results showed that the patients were mostly male (93.8%), more than 31 years of age (70.8%), employed (79.2%), married (76.9%), completed secondary education (83.1%), low to moderate level of addiction (82.3%), smoked less than 20 cigarettes per day (80.8%), counseled by doctors (73.1%), received counseling alone (43.8%) and received pharmacological treatment plus counseling (56.2%). The overall quit rate was 31.5%. Multivariate analysis revealed that smokers who received counseling alone i.e. without pharmacological treatment (adj. OR=25.36; CI: 6.38-100.78; p<0.001) was associated with failure to quit at 6 months. One limitation of this study was that the smoking status at 6 months was mainly Keywords: cervical cancer, coverage, Pap smear, abnormal results 33 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 39 1Centre for Occupational & Environmental Health, Faculty of Medical & Human Sciences, The University of Manchester, UK; 2North West Lung Centre, University Hospital of South Manchester, Manchester, UK; 3Institute for Public Health, Ministry of Health Malaysia A CROSS SECTIONAL STUDY ON PREVALENCE, KNOWLEDGE AND PRACTICE ON DIABETES IN A VILLAGE IN KINTA DISTRICT, PERAK Morbidity and mortality from obstructive respiratory diseases have increased. Occupational risk factors can be important determinants of disease development. In this study we investigated the association between exposure to occupational lung carcinogens and recorded airflow obstruction in high risk populations. This was a population-based study, with subjects aged 40-75 and registered with General Practices (GP) in the Wythenshawe District of Manchester, United Kingdom. A total of 257 participants have completed a questionnaire on occupational exposures, smoking status, family history, respiratory symptoms and also undertook spirometry. 165 participants (64.2%) had a history of occupational exposure to lung carcinogens and 141 (54.9%) of them had been exposed to dust. Occupational exposure to asbestos and other mineral dusts were strongly associated with airflow obstruction compared with no exposure (p<0.05) with an OR 4.42 (95% CI 2.14 – 9.10) and OR 3.44 (95% CI 1.58 – 7.46), respectively. The results of this study reaffirmed that those workers exposed to occupational carcinogens were at a higher risk of having airflow obstruction, a marker of lung cancer risk. Davinder S1, Sandheep S1, MM Soe1 1 Universiti Kuala Lumpur Royal College of Medicine Perak, Perak, Malaysia Diabetes has become a modern day medical challenge due to its myriad of complications. In view of the rising number of cases in developed and undeveloped areas, a study was conducted on knowledge and practice regarding diabetes among residents of a village in Kinta district, Perak. A total of 242 residents from Kampung Sri Kinta who were aged 40 years and above consented to participate in this study. Data were collected using a structured questionnaire by interviewing the participants. The prevalence of reported diabetes was 27.7% (95%CI: 22.1 -33.3). Among diabetics, the proportion of females to males was almost two to one. Most of the diabetics (53.8%) were below 50 years of age. Only 53.3% (95%CI: 47.1-59.6) of respondents had good knowledge scores on diabetes. Diabetics had significantly higher knowledge scores [64.2% (95%CI:52.7-75.7)] compared to non-diabetics [49.1%(95%CI: 41.7-56.5)] (X2=4.4, p-value <0.05). However only 50.8% (95%CI: 38.8-62.8) of diabetics practised good diabetic care. In conclusion, this study shows that there still exists a differential gap in knowledge and practice despite the implementation of many health programmes. The mismatch between knowledge and practice has to be addressed. Continuous public education will increase knowledge however an important end point should be that it reminds and empowers diabetics to practice good diabetic care. Innovative and captivating health promotion programmes may help in this aspect. Keywords: Diabetes, practice, community prevalence, Keywords: airflow obstruction, carcinogens, lung cancer risk occupational Oral 41 PREVALENCE AND FACTORS ASSOCIATED WITH OVERWEIGHT AMONG ADOLESCENTS Rampal L1, Garba JA1, Hejar AR1, Salmiah MS1 1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Malaysia knowledge, Obesity is a well-established risk factor for cardiovascular disease and psychological disorders. Obesity in adolescents can continue up to adulthood and increases the chance of developing noncommunicable diseases both in childhood and adulthood. The aim of the study was to determine the prevalence and factors associated with obesity among secondary school students in Petaling district, Selangor.An analytic cross sectional study using sampling with probability proportionate to size was conducted and five schools were selected from forms 1, 2 and 4 that were not taking major exams. Self-administered pretested questionnaire Oral 40 EARLY DETECTION OF AIRFLOW OBSTRUCTION IN A POPULATION EXPOSED TO OCCUPATIONAL LUNG CARCINOGENS Fauziah N1,3, Booton R2, Barber PV2, T Frank2, F.de Vocht1,, Povey AC1 34 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 was used to collect the data. Weight and height were also measured. Out of 2,480 respondents selected, 2,248 responded; giving an overall response rate of 90.7%. The prevalence of overweight and obesity was 13.7% and 16.7% respectively. The prevalence of obesity was significantly higher in males (15.9%) than in females (12.3%). The prevalence of obesity was significantly higher among the Malays (16.2%) as compared to the Chinese (11.5%) and Indians (10.5%). There was statistically significant association between obesity and gender, age, ethnicity, physical inactivity, selfesteem, body parts satisfaction, body size perception and smoking. Logistic regression analysis showed that the significant predictors of obesity were gender (Male‟s adjusted odd ratio, AOR = 2.4), age (AOR for 13 years = 2.0), physical inactivity (AOR = 82.8), low self-esteem (AOR = 7.8), body parts dissatisfaction (AOR = 1.5) and body size dissatisfaction (AOR = 4.7). The findings can be used by policy makers to plan preventive measures on obesity by focusing on the significant modifiable predictors. vegetables pattern; sugar and fat pattern; meat and chicken pattern which explained 12.7%, 11.6% and 10.7% variation in food intake respectively. There was significant association between ethnicity, religion, family income, educational level of parents and the dietary patterns. However, there was no significant association between overweight and the dietary patterns. It may be more effective to describe a healthy diet using results of dietary pattern analysis in public health intervention than describing single food items or nutrients. It is recommended that nutrition education programs should focus on guiding students on healthy dietary patterns so as to prevent the development of overweight and obesity. Keywords: Adolescents; Dietary Patterns; Principal Component Factor Analysis Oral 43 BULLYING AND ITS ASSOCIATED FACTORS AMONG SCHOOL ADOLESCENTS IN MALAYSIA Keywords: Obesity, Physical Activity, Self Esteem, Adolescents, Malaysian Oral 42 Diana M1,Rosnah R2, Siti Fatimah MH1 ,Riyanti S1, NurShahida AA1, MohdHazrin H1, HamizatulAkmal AH1, Cheong SM1, Noor Safiza MN1 MAJOR DIETARY INTAKE AMONG ADOLESCENTS AND THEIR ASSOCIATION WITH OVERWEIGHT 1 Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur 2 Violence and Injury Prevention Unit, Disease Control Division, Ministry of Health Malaysia, Block E3, 62590 Putrajaya Rampal L1, Garba JA1, Hejar AR1, Salmiah MS1 In Malaysia, bullying among school adolescence is a public concern as the issue has always been highlighted by the media. Unfortunately, despite the growing interest in bullying, nationwide studies on bully victimization among adolescents in Malaysia is limited. As such, secondary data analysis of existing data from the Malaysia Global SchoolBased Health Survey (GSHS) 2012 was performed to determine the prevalence and associated factors of bullying victimization among school adolescents in Malaysia. This population survey used a two-stage stratified sampling involving 234 schools from Form 1 to Form 5. Out of 25,507 students who participate in the Malaysia GSHS, 17.9% (19.8% males and 15.8% females) reported having been bullied. The common form of bullying in Malaysia for both sexes was verbal bullying rather than physical bullying. In multivariate logistic regression analysis, being a male (aOR=1.25, 95%CI [1.12-1.40]), smoking (aOR=1.36, 95%CI [1.16-1.61]), loneliness (aOR=1.97, 95%CI [1.70-2.28]), being worried (aOR=2.30, 95%CI [1.91-2.79]), no close friends (aOR=1.89, 95%CI [1.46-2.45]), and being truant (aOR=1.46, 95%CI [1.35-1.60]) were significantly associated with being bullying victimizations. Meanwhile, the protective factors found were 1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Malaysia Dietary pattern analysis has emerged as an important instrument to identify modifiable dietary risk factors for non-communicable diseases. The aim of this study was to determine the major dietary patterns among adolescents in Petaling district, Selangor and their association with sociodemographic characteristics and overweight. An analytic cross sectional study design was conducted in selected secondary schools in Petaling district. Sampling with probability proportionate to size was used and five schools were selected. Selfadministered semi quantitative food frequency questionnaire was used for data collection on 2,480 respondents. Weight was measured with a digital bathroom scale (TANITA model) and height was measured using SECA body meter. Principal component factor analysis using varimax orthogonal transformation was used to identify the dietary patterns. Chi square test was used to test association between dietary patterns with sociodemographic characteristics and overweight. Three major dietary patterns identified were fruits and 35 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 students who perceived they had good parental bonding (aOR=0.82, 95%CI [0.75-0.91]) and good parental connectedness (aOR=0.82, 95%CI [0.740.90]).The findings from this study should be used by the policy makers as a guidance to review and strengthen existing anti-bully programs. Keyword: overweight, underweight, body image obesity, thinness, Oral 45 AWARENESS ON COMMON EYE DISEASES AND BARRIERS TO EYE CARE AMONG JAKUN SUBETHNIC COMMUNITY OF ORANG ASLI (INDIGENOUS PEOPLE) IN KUANTAN, MALAYSIA Keywords: Bully, adolescents, Malaysia, National GSHS Oral 44 NUTRITIONAL STATUS AND BODY WEIGHT PERCEPTION AMONG ADOLESCENTS IN MALAYSIA Azuwan M1, Sheeladevi S2, Williams JD2 1 Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia 2 International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad Ahmad Ali Z1, Suhaila AG1, Azli B1, Norhafizah S1, Cheong SM, Noor Ani A1, Balkish MN1, Mala M1. 1 Institute for Public Health, Ministry of Health, Kuala Lumpur The current practices, services utilization, knowledge on eye diseases and barriers for service uptake can be a benchmark in deciding the provision of accessible, acceptable and affordable eye care services for indigenous community in rural settlements. This study aimed to assess the knowledge, attitude and practice (KAP) of Orang Asli on common eye diseases. A cross sectional study was conducted by means of convenient sampling in Kampung Sungai Soi, Kuala Kuantan, Pahang with the population of 241 Jakun sub-ethnic adults aged 21 years old and above which 154 of them were interviewed in to the study. They responded a structured questionnaire on awareness and knowledge on common eye diseases as well as current eye care practice. Current eye care uptake among subjects with poor eye condition was low (28.5%) and significantly higher in those who have awareness on eye diseases, have religious faith and higher income (p<0.05). Major barriers of eye care uptake were „felt no need‟ (27.4%), „no money to pay‟ (15.5%) and „not knowing the place for checkup‟ (11.9%). Subjects did not go for regular eye check mainly due to reasons of „able to see well‟ (31.2%) and „do not have serious eye problem‟ (19.4%). The overall awareness on eye diseases was moderate (47.4%) and knowledge on cataract (21.4%) and myopia (40.9%) was higher as compared to diabetic retinopathy, glaucoma, hyperopia and presbyopia. The odds of overall awareness, knowledge on cataract and knowledge on myopia were significantly less for subjects with low level of education and poor economic status. These data suggest that there is a need for health education to improve awareness and knowledge about eye diseases in the study area. The barriers of eye care uptake must be addressed for better eye care practice. The prevalence of overweight and obesity among adolescents is rising rapidly in many countries around the world, including Malaysia. Parallel to the rise in obesity, there is an increase in body dissatisfaction among adolescents. The aim of this study was to assess the nutritional status and body weight perception among adolescents in Malaysia. A cross-sectional survey that included a body weight perception questionnaire and anthropometric measurements was conducted in a representative sample of 40,011 of students from Standard 4 until Form 5 with 90.5% response rate. The findings showed BMI-for-age status, that 65.6% (95% CI: 64.566.8) of the population was in the normal range (>2SD to <+1SD). The national prevalence of severe thinness (<-3SD) and thinness (>-3SD to <-2SD) were 1.4% (95% CI: 1.2-1.6) and 6.0% (95% CI: 5.6-6.3) respectively. On the other hand, national prevalence of overweight (>+1SD to <+2SD) was 14.6% (95% CI: 14.0-15.2), and 12.3% (95% CI: 11.6-13.0) for obesity (>+2SD). Among adolescents, 46.7% (95% CI: 45.5-47.9) of them were trying to lose weight and it was significantly higher among girls. In contrast, it was noted that only 19.1% (95% CI: 18.6 -19.7) were trying to gain weight and it was significantly higher among boys. Rapid physical growth and development of children and adolescents create increased demand for energy and nutrients. However, overconsumption combined with physical inactivity would lead towards overweight and obesity. We found a probable „body image disorders‟ is noted among adolescents aged 10 to 17 years with no significant difference by sex. More girls in this age group trying to lose weight and more boys trying to gain weight. Comprehensive programs for the awareness, prevention and early detection of body image disorder for adolescents involving all parties are needed. Keyword: eye care utilization, barriers to uptake, eye diseases awareness 36 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Oral 46 The findings from this study could be used for planning of intervention program for these high risk populations. OCCUPATIONAL AND ENVIRONMENTAL CHARACTERISTICS AMONG SEROPOSITIVE TOWN SERVICE WORKERS FOR LEPTOSPIROSIS IN KELANTAN, MALAYSIA Keywords: town service workers, leptospirosis, seroprevalence, occupational characteristics, environmental characteristics Oral 47 IMPLEMENTATION OF WEBBASED GEOGRAPHICAL INFORMATION SYSTEM (GIS) APPLICATION FOR MAPPING OF HEALTH FACILITIES, SERVICES AND PROVIDERS IN MALAYSIA Mohamad Azfar Z1, Aziah D1, Mohd Nazri S1, Mohamed Rusli A1, Maizurah O2, Zahiruddin WM1, Nor Azwany Y1, Nabilah I3, Siti Asma’ H3, Mohd Nikman A4 1 Department of Community Medicine, Universiti Sains Malaysia; 2 Informatics for Community Health, Universiti Sains Malaysia; 3 Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia; 4 Department of Anaesthesiology, Universiti Sains Malaysia. Hazrin H, Tahir A, Fadhli Y Institute for Public Health, MOH This study is to design, develop, create, deploy, test and deliver, together with documentation, help manual and training for web-based Geographic Information Systems (GIS) application of health facilities and services under Ministry of Health, Malaysia. The system is web-based mapping and navigation can be used with Internet search engines such as Internet Explorer and Mozilla Firefox. The development of web mapping system was programmed by using ArcGIS Server. Tools and GIS software functions will be simplified to allow the search and analysis process to be done easier. There are four modules in the system created. First module is 'view'; for displaying list of health facilities in the system. Second module is 'search'; for obtaining information on health facilities, services, providers and specialities. Third module is 'analysis'; for gathering geographic information of an area, get ratios facilities, services, and providers of services to the population, analysis of the buffer zone (buffer) to find coverage of a health facility for a certain distance and other geostatistical analysis. Last module is 'tools' for issuing the results of the analysis in the form of tables, graphs and maps that can be stored or printed. The system is controlled by the administrator whereby users are required to request to use this application. Web mapping can be expanded by using smartphones and tablets that supports Android, iOS and Windows. This system can also know the distribution of the disease in real time whereby appropriate users can update through online. Web mapping application enables users to use the GIS database to gather information on facilities, services and service providers without having to have an in depth knowledge in the field of GIS or using GIS software. This system can be used to assist stakeholders in the Ministry of Health in planning and developing facilities and services in Malaysia. It can reduce the use of human resources especially in monitoring and Leptospirosis is presumed to be the most widespread re-emerging zoonotic disease of global importance affecting humans in tropical, subtropical and temperate zones. This study was designed to determine the seroprevalence of leptospirosis among town service workers in Kelantan, Malaysia and to describe their occupational and environmental characteristics. A cross sectional study was conducted from January until March 2013 among 321 town service workers who fulfilled the inclusion and exclusion study criteria and were randomly selected from four districts in Kelantan. Workers were interviewed using a validated questionnaire which consists of socio-demographic, occupational and environmental history and venous blood was taken from each subject for microscopic agglutination test (MAT). Sixty nine out of 321 Malay respondents (21.5%) were seropositive for leptospirosis and the predominant pathogenic serovar identified was Sarawak (52.2%). Majority of the seropositive respondents were males (92.8%) with the mean of age of 37.1 (SD 9.78) years old. The mean duration of employment was 9.6 (SD 7.82) years and the „Town Cleaner” job category recorded the highest seropositive subjects (53.6%). Noncompliance to use of personal protective equipment and unsatisfactory personal hygiene practice during or after work were high, 68.1% and 65.2% respectively. Among important known environmental factors that were associated with increased risk of leptospirosis infection studied were presence of rodents in house (81.2%), distance from house to river ≤200m (39.1%) and house area affected by flood (31.9%). In conclusion, occupational and environmental factors contribute to high seroprevalence of leptospirosis among town service workers in Kelantan, Malaysia. 37 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 providing health services information and facilities in Malaysia. Keywords: web mapping, GIS, database. Oral 48 VALIDITY AND RELIABILITY OF THE MALAY VERSION OF THE STROKE KNOWLEDGE, ATTITUDE AND PRACTICE QUESTIONNAIRE Noriah M¹, Mohd Ismail I¹, Norsa’adah B² ¹Department of Community Medicine, Universiti Sains Malaysia, Kelantan, Malaysia; ²Biostatistic & Research Methodology Unit, Universiti Sains Malaysia, Kelantan, Malaysia Stroke is the second most common cause of death and major cause of disability worldwide. 80% of strokes are preventable. Poor knowledge of stroke risk factors and stroke warning signs, limits the effectiveness of its preventive measure. Development of appropriate tool to encounter this problem is necessary. This study is aim to determine the validity and reliability of the Malay Version of The Stroke‟s Knowledge, Attitude and Practice Questionnaire towards prevention of stroke among hypertensive patients in Terengganu. It was a cross sectional study involvinghypertensive patients aged 35 and above who never been diagnosed to have stroke or transient ischaemic attack.Face validity, content validity and construct validity were performed accordingly. The exploratory factor analysis was applied, Cronbach‟s alpha was determined to check the internal consistency and test-retest was done to test for reliability. There were a total of 172 hypertensive patientsinvolved. Most of the factors loading in all domains were more than 0.5. The internal consistency reliability was good as the Cronbach‟s alpha of all domains were above 0.6 (ranging from 0.60 to 0.84). The test retest reliability was found to be substantial with Kappa agreement value of more than 0.60 and Inter Class Correlation was good where all items score above 0.82.In conclusions, the questionnaire is valid and reliable to be used to assess the level of knowledge, attitude and practice on stroke. Keywords: stroke stroke, validity questionnaire. questionnaire, KAP stroke, questionnaire, reliability 38 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 POSTER Poster 02 Poster 01 LEPTOSPIROSIS IN TERENGGANU, MALAYSIA 2010 – 2012. THE PRIVATE HAEMODIALYSIS CENTRE FINANCIAL ARRANGEMENTS IN MALAYSIA: AN EXPLORATORY STUDY Liza AL, Ummi Nadiah Y, Ismail I, Ahmad Nazri S, Yusmaliza MY, Wan Nur Farhana WA, Kamil SM, Mazlizaini G, Mohd J, Anwa S Leptospirosis can be a serious public health issue in a humid tropical and subtropical country such as Malaysia. The actual disease burden is unknown until recently it being a notifiable disease under the Prevention and Control of Communicable Diseases Act 1988 in 2011. The 3 year leptospirosis data surveillance was reviewed to determine its epidemiological situation. The Terengganu leptospirosis surveillance data from 2010 - 2012 was reviewed. The data was obtained from the enotification surveillance system and Terengganu state hospital. Analysis includes epidemiological characterization of cases and serology status of each case. The data was analysed using Microsoft Excel 2007. Of the 456 leptospirosis cases reported during the 3 years period, 44.3% (202) were probable and 25.8 % (118) confirmed with 14 (3.1%) deaths. Leptospirosis case rate (CR) range: 3.3 15.7 cases per 100,000 populations. There were two major outbreaks with CR > 3.3 cases per 100,000 population in 2011. Leptospirosis case fatality rate (CFR) range: 2.4% - 5.6 %, mean 3.1%. The ethnicspecific CR was highest among the Non-Malay Bumiputras who are mainly the aboriginal. Age CR was highest among the 10 - 69 years age group. Gender CR was male 4 times higher than female. Leptospirosis is a major public health problem in Terengganu especially among the aboriginal and across the school-going age groups to elderly. Concerted efforts of all involved are needed to reduce the incidence of leptospirosis infection. Public awareness campaigns need to be enhanced. Rapid diagnostic test is recommended for use at the periphery clinics and hospitals. Adilius M, Siti Haniza M Institute for Health System Research, Ministry of Health Malaysia The Ministry of Health had been very influential in the growth of the private haemodialysis centre. However, many patients still pay from their own pocket for haemodialysis service. Many NGOs and charity bodies engaged to the effort of providing financial aid as dialysis known to be resourceintensive. There had been few studies looking at financial arrangements in private healthcare providers like haemodialysis centre. Understanding of the financial arrangements and contractual arrangement will enable measures to improve payment reimbursement and ameliorate the quality of service provided. This was a cross-sectional study which covered 426 haemodialysis centres and selection of sample (103) was conducted via simple random sampling. A semi-structured questionnaire was constructed and a face-to-face interview approached was used for data collection and data were analysed using STATA 12.The centres were mostly established in 2005 to 2009 (201, 47%). There were 183 (43%) centres registered as an NGO. 178 (42%) operated as a solo centre or as part of chain (197, 46%) and half (215, 52%) run for profit. About 80% were contracted to employer as a panel haemodialysis centre or to other organisations. On average the centres were having more contracts with employer (4). In terms of reimbursement thirdparty administrators took about 3 months to disburse. In 2011, the reported mean expenditure and revenue were RM 987,523 and RM 1,290,201 respectively. Most of the revenue collected from NGO/charity body (23.46%) and SOCSO (20.12%). The mean charge for a haemodialysis session was RM 140. Financial arrangement is unique among haemodialysis centres as centres were largely NGOowned and their contractual arrangements were predominantly with employers and other organisations. They received more revenue from NGOs/charity bodies reflecting the government support in the service. Keywords: Leptospirosis, Diagnostic test, Aboriginal Keywords: financial arrangement, contractual arrangement, haemodialysis centre, private, Malaysia 39 Notification, Burden, 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 2 Poster 03 Faculty of Medicine, Universiti Teknologi MARA In contrast to young adults of the general population, young adults attending Medical Schools represent a large but relatively unstudied population with respect to mental health issues. This study investigated the relationship between depression and resilience in association with future doctor‟s academic performance during a major exam. The target population included all Year 1 and 2 Preclinical Medical students of a public university in Malaysia. We administered a validated questionnaire on socio demographic, Beck‟s Depression Scale and Resilience Scale. The latest year-end results of the students were obtained from the exam office and recorded. Two hundred and thirty one students responded (60%). Among the respondents, 7.1% had moderate to severe depression. Students with “moderate” to “severe depression”, had less likelihood of eating vegetables and fruits (OR=0.381; 95% CI: 0.168; 0.865), and less likelihood of attending religious talks (OR=0.293; 95% CI: 0.111; 0.776). As for resilience, 48% of the medical students showed moderate to high resilience. No factors were significantly associated with resilience. When we examined CGPA of the students in relation to the Depression and Resilience scores, students with high resilience had significantly higher CGPA results. In contrast, depression score is inversely correlated with academic achievements. In conclusion, students with poor academic performance in medical school have higher tendency of depression. In addition, having greater resilience may enhance academic performance. Implications for developing coping skills, student counselling and stress/depression management strategies are discussed. STUDIES ON MALAYSIAN HEALTHCARE SYSTEM: LISTENING TO THE PEOPLE'S VOICE Najwa M1 , Hasmuny O1, Nordin S1 , SitiSa’adiah HN2 1 Health Policy and Planning Unit, Planning Division, Ministry of Health 2 Institute for Health Behavioural Research, Ministry of Health The establishment of health policies should take into account proposals submitted by various stakeholders, including civil society. Aware of this, the Ministry of Health has taken a more open approach. A series of Public Engagement Tour was undertaken to obtain feedback, ideas and recommendations on how to improve Malaysian health system from the community. From March to Dicember 2012, a total of 10 series of public forums have been implemented involving 10 States and accepting the presence of 3,853 people. This Forum uses the same format in every State. This Forum is run by a moderator and a panel of 3 members respectively representing the Ministry of health, private medical Practitioners and representatives of non-governmental organizations or community. Panel members present about issues, challenges and expectations of the health system from the point of view of their respective fields. Question and answer session was then opened to the audience either in the form of oral and writing.Results from analysis showed that in general, people have a positive view of the health system. However, there are still many problems faced by the people when using the current health services. People also expect the existing health system to be strengthened. Suggestions and views expressed will be accounted for in an effort to improve the existing health system. Keywords: Depression; resilience; medical students; academic performance Poster 05 REFERRAL PATTERN OF PRIMARY CARE PROVIDERS IN THE MALAYSIAN PUBLIC HEALTHCARE SYSTEM Poster 04 DEPRESSION AND RESILIENCE IN RELATION TO ACADEMIC PERFORMANCE AMONG MEDICAL STUDENTS IN A PUBLIC UNIVERSITY Ang KT1, Ho BK2, Mimi O3, Salmah N4, Salmiah MS5, Magesiwaran M1, Noridah MS6 1 Institute for Health Management Selangor Health Department 3 Family Development Division, Ministry of Health Malaysia 2 Siti Munira Y1, Nurhuda I1, Nor Aini MN1, Imran Z2, Muhammad Ammar AR2, Elisa Shafura S2, Fatheen Atheerah AR2, „Aisyatul Najiha H2 Primary care providers play an important role in ensuring appropriate referrals to secondary care facilities. Identifying the referral patterns can help to assess their function as primary care gatekeepers. There is no known published data on 1 Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA 40 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 this subject in Malaysia. This cross-sectional study described the referral pattern of primary care providers in the Malaysian public sector. It involved 28 health clinics, 14 of which had the services of resident Family Medicine Specialists (FMS) while the rest had visiting FMS. The clinics were randomly selected by multi-stage sampling and stratified by regions in Peninsular Malaysia. The information was gathered using self-administered pre-tested questionnaire of patients referred to hospitals from March to April 2012. A panel of 3 senior FMS independently assessed the appropriateness and avoidable/unavoidable referrals using set criteria. Disagreement in the assessment was corrected by consensus in a subsequent face to face meeting. Analyses were made using SPSS Version 20. The overall mean referral rate was 1.76%. Referral rate for clinics without resident FMS was higher (1.94%) compared to clinics with resident FMS (1.56%) but the difference was not statistically significant. Complexity and severity of illness were the main reasons for referrals. Majority of referred cases were considered appropriate (96.1%). Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rates and very high level of appropriate referrals from public primary care providers to hospitals indicate that they have performed their role as gatekeepers effectively. arrangements with purchasers, sources of revenue and expenditures to all the private facilities but postal survey were used for dental clinics. The study showed that medical (84%) and dental (87%) clinics were established as sole proprietor and hospitals (71%) and ambulatory care centres (65%) established themselves as a company. All the private facilities had contractual arrangements with purchasers such as panels to employer‟s company, insurance company, third party administrator (TPA) and others such as „Baitulmal‟ and NonGovernmental Organisations (NGOs). Seventy two per cent of Medical clinics and 80.2% of Haemodialysis Centre had at least one contractual arrangement with employer panel. About 69% of private hospitals had at least one contractual arrangements with TPA and 68.9% of private hospitals at least one contractual arrangements with insurance company. The private facilities on average received more than 70% of the revenue in cash. Hospitals annual revenue on average was RM38 million and a hospital annual expenditure on average was RM30 million. In conclusion, the study provides baseline information of the financial sources which were from the employers/employee, individuals/households, donor agencies and TPA as well as insurance company. Keywords: Referral pattern, gate-keeping, primary care, public healthcare system Poster 07 Poster 06 FACTORS ASSOCIATED WITH NO ANTENATAL BOOKING AMONG PREGNANT WOMEN WITH HIV IN SELANGOR Keywords: private, facilities HOW WELL DO WE KNOW OUR PARTNERS? Siti Haniza M1, Adilius M1, Sarah J1, Sai Gaayathri S1, Wan Shihabuddin WM, Look CH, Halim AH, Rozita Halina TH 2, Nordin S 2 Dr Fazlina Mohamed Yusoff, Dr Ho Bee Kiau, Dr Salmiah Sharif, Dr Vickneswari Ayadurai , Dr. Noranizah Muzaid, , Dr Masitah Mohamad, Dr. Rosnah Mat Isa 1 Institute for Health Systems Research, Ministry of Health Malaysia 2 Planning Division, Ministry of Health Malaysia Antenatal booking is an important initial step for prevention of vertical transmission of HIV infection. This study was done to determine the factors associated with no antenatal booking among HIV pregnant women in Selangor. This was a retrospective, cross-sectional study involving 131 patients who were notified as HIV positive in pregnancy in 2011-2012 in Selangor. The results showed that 78.6 %(N=103) of these HIV positive pregnant women had antenatal booking while 21.4% (N=28) had no antenatal booking. The mean age was 28.9 ± 5.3 years (range: 18-39). 64.9% (N=85) were Malaysian, 64.9% (N=85) were not working, 84.0% (N=110) were married, 61.8% (N=81) were known HIV, 73.3% (N=96) were multipara, 34.4% (N=45) of their partners have HIV and 65.6% (N=86) were Malaysian citizen. Multivariable logistic regression analysis revealed that factors associated with no antenatal booking among the pregnant women with HIV were those > 31 years of age (OR= 3.93; CI: Private sector has a very important and prominent role in complementing the healthcare services. Their range of services varies and we are yet to understand its setting. This study aimed at giving an overview understanding of the private sector in terms of flow of financial resources. Private sector providers were varied. This descriptive study focused mainly on hospitals, maternity homes, ambulatory care centres, dialysis centres, dental clinics and medical clinics. Data were collected from randomly sampled medical clinics and haemodialysis centres and universal sampled for hospitals, ambulatory care centres, maternity homes and dental clinics. Structured questionnaires were used and a face to face interview were carried out to obtain information on their establishment characteristics, contractual 41 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 1.45-10.63), not working (OR= 4.21; CI: 1.29-13.74), partner with unknown HIV status (OR= 6.38; CI: 1.78-22.87). In conclusion, pregnant women with HIV who were > 31 years old, were not working and whose partners HIV status was unknown were more likely to have no antenatal booking. Indentifying and close monitoring of these women is important to improve the PMTCT program. Keywords: Costing, operating cost, Klinik 1Malaysia with medical officer Poster 09 PERINATAL MORTALITY REVIEW: OPPORTUNITY FOR INTERVENTION IN KUALA LANGAT DISTRICT Keywords: booking status, PMTCT Poster 08 Noraziani K, Lasa I, Shuaita MN, Siti Harirotul A, Nor Azila MI COST OF OPERATING KLINIK 1MALAYSIA (K1M) WITH A MEDICAL OFFICER Kuala Langat District Health Office, Ministry of Health Malaysia. Maternal and child health information measures progress toward achieving the Millennium Development Goals (MDG4) for child survival, and serves as essential baseline information before planning for an appropriate public health interventions at a district. Activities in mortality review including notifying, reporting, registering, and investigation of the cases generate useful data for planning, monitoring, and evaluation of its health system. Statistics on stillbirths and perinatal mortality rates have not improved nationally between the years of 2000 to 2010. Similarly, the perinatal mortality rates trend is increasing at Kuala Langat District Health Office in particular since 2011. Whereas, in 2012 the pattern of reported death of children below five years of age showed that it occurred most in early neonatal age group whereby early neonatal death constitutes most of neonatal death and stillbirths constitute most of perinatal death cases. Notification forms, antenatal records and perinatal mortality review meeting documentations at the district have become a source of data for analysis. Whereby, the data recorded a few years before the year 2013 helps reveal factors that may contribute to the increasing trend of the mortality pattern that is specific for district. The distribution of socio-demographics characteristics; information on the death; and antenatal and postnatal care related factors, were analysed. However, unavailability of information on different type of maternal occupation, exposure during antenatal, detail information on paternal smoking habit limits the analysis. Possibly, this limited information could help disclose more factors contributing to the mortality. Nevertheless, analysed information aids in generating baseline information towards a better understanding of the level of maternal and child health services provided, thus strengthening the interventions taken by the health care providers in the district. Mazura M& Ramli Z Institute for Health Systems Research In order to provide immediate and affordable healthcare to the rakyat and to reduce the workload of nearby government health clinics, Klinik 1Malaysia (K1M) was established and launched in selected urban areas in December 2009. The K1M is manned by paramedic and offers treatment or procedures for minor ailments. In year 2012, medical officers were placed in 22 selected K1Ms with the intension to increase the scope of treatment and provide more benefits to the population. This study aimed at estimating the cost difference of operating K1M with a medical officer as compared to those manned by paramedic. K1M Taman Sentosa Klang was purposively chosen and data from an earlier studywas re-analysed as a comparison. Data on activity reports, inventory and medication lists were gathered from the K1M, District Health Office and State Health Department. Straight-line depreciation was used and the cost data were inflated to year 2013. Total cost of running for K1M with a medical officer was estimated at RM821,844. Whereas the cost of K1Ms without a medical officer range from RM271,042 to RM573,665. Average operating cost per patient visit in K1M with a medical officer was RM19.10 as compared to those without a medical officer which range between RM11.67 to RM17.29. However, when capital expenditure such as renovation cost, medical and non-medical assets cost were included in the calculation, the average operating cost per patient visit for K1M with a medical officer was RM20.14 as compared to those without a medical officer which range between RM12.01 to RM17.87. The contributing factors to these differences were due to an increase number of manpower, consumables and medications which lead to an increase in the cost of operating the K1M. This finding could provide basic information on the estimated operating cost of K1M with a medical officer for future planning. Keywords: Perinatal, mortality review, antenatal care, child health, district intervention 42 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 10 Poster 11 MANAGING ACUTE DIARRHOEAL DISEASES AMONG UNIVERSITY STUDENTS USING SYNDROMIC NOTIFICATION APPROACH 1MALAYSIA MOBILE CLINICS – AN INNOVATION TOWARDS UNIVERSAL PRIMARY HEALTH CARE COVERAGE IN MALAYSIA Noraliza NM, Fazar AJ, Maryam AG, Rohani I Kawselyah Juval1, Kamaliah Mohamad Noh1, Noridah Mohd Salleh1, Rachel Koshy1, Muhamad Nazimim1 Communicable Disease Control Unit, Kuala Lumpur and Putrajaya Federal Territory Health Department, Ministry of Health Malaysia 1 Family Health Development Division, Ministry Of Health Malaysia Syndromic notification is a notification of health event in which the case definition is based on a syndrome, not a specific disease such as acute gastrointestinal syndrome and acute respiratory syndrome. On the 6th of September 2012, a notification was received on 40 students from a public university with symptoms of fever and diarrhoea, who had come back from an expedition at Gunung Tahan. Investigation was done immediately which aimed to determine the occurrence of outbreak, finding the microorganism involved and possible source of infection. Investigation using questionnaire and medical examination was done to all who went for the expedition. Blood and stool samples taken from those symptomatic students were sent to various laboratories. The provisional diagnosis made using syndromic approach were Leptospirosis, Meiloidosis, Food poisoning, Scrub Tyhus and Ameobiasis. A total of 290 students involved in the expedition which started on the 28th August till 5th. September 2012 with 140 of them were having similar symptoms (Case attack rate: 46.7%). The expedition participants had stopped at six checkpoints on the mountain site. Two third of the tract was in middle of jungle with scarce water supply. They obtained water from rain water and waterholes along the tract and did not take any bath. They were given dry food for their entire journey. Laboratory results showed one student positive for Leptospirae (4.8%: 21 samples) and two positive for Shigella Sonnei (10%: 20 samples). All other results were negative. As a conclusion, it was an outbreak of Shigella poisoning, co-infection with Leptospirosis among a public university students starting from 28th August 2013, probably due to contaminated drinking raw water and river. We managed the outbreak using syndromic notification approach from the start which resulted in getting clearer picture of the situation, as well as the correct diagnosis. Mobile clinic services have been utilised in Malaysia to increase access to primary health care services in Malaysia since the 1950s. They are generally manned by paramedics to deliver preventive and curative care and have helped the country achieve its enviable coverage of childhood immunisation, for example. In 2010, vehicles customised to be on site clinics, was for the first time introduced in the Ministry of Health in collaboration with the 1Malaysia Development Berhad Foundation. The 1Malaysia Mobile Clinic, better known as KB1M targeted the vulnerable populations in the rural areas residing mainly in estates, traditional villages and Orang Asli settlements. It provides primary health care services but has a doctor in its team as well, thus expanding the scope of services of the traditional mobile clinic services. This includes outpatient, MCH, expanded scope as well as supporting services through point of care tests. There are currently five buses and three boats operating in Perak, Selangor, Pahang, Johore, Sabah and Sarawak. Locations have been identified as stations for the KB1M and generally they are visited fortnightly. The services provided are free of charge. Currently there are 132 stations covering 269 villages. As of June 2013, a total of 13,514 clients have been registered with the KB1M with 17.6% of the population covered. With the KB1M services, the objective of equitable delivery of healthcare is attained for the rural poor population resulting in the reduction of disease burden for these populations thus attaining universal health coverage in the country. Keywords: Mobile health clinics, mobile health teams and rural health clinics Keywords:diarrhoeal diseases, syndromic notification approach 43 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 12 Poster 13 ACCESS OF ANTENATAL HEALTHCARE AMONG NONCITIZENS AT GOVERNMENT MATERNAL & CHILD HEALTH (MCH) CLINICS, FEDERAL TERRITORY OF KUALA LUMPUR IN 2012 DENGUE CASES IN SEPANG, SELANGOR OVER 5 YEARS – A REVIEW Ruhaini I, Fariza F, Meftahuddin T, Latifah M, Mohd Zahrulnizam S Sepang District Health Office, Selangor Dengue, one of the main anthropod-borne viral diseases in human morbidity and mortality is becoming an important public health problem. This review aimed to demonstrate the dengue incidence and its associated factors in Sepang, Selangor between 2008 and 2012. We analysed all dengue cases registered through the Dengue Cases Registration Book as well as the more recent eDengue System (2011-2012) in Sepang District Health Office, Selangor between 2008 and 2012. During the 5 years period, the district health office received a total of 1490 registered dengue cases. Of these, 1345 (90.3%) were cases with dengue fever (DF) and 145 (9.7%) with dengue hemorrhagic fever (DHF). The mean age was 27.4±14.6 years old with the majority Malays (947; 63.6%). Of the 3 mukim in Sepang district, the highest number of dengue cases was reported in Dengkil (710; 47.7%) followed by Labu (534; 35.8%) and Sepang (246; 16.5%). The number of dengue cases in Sepang had decreased from 2009 to 2011 but surged back in 2012, as was the trend for the whole of Selangor. Sepang contributed 2.0% (1490) of dengue cases in Selangor (73,176) from 2008 to 2012. Our bivariate analysis showed significant association of DHF with ethnicity (Malay and others) and sub-division/mukim (Dengkil and Labu). We found significant differences in time interval between onset of symptoms to diagnosis, platelet count and packed cell volume between DHF and DF cases. Multivariate logistic regression analysis revealed that living in Dengkil (aOR=4.82; CI: 2.04-11.36) was the most important factor associated with DHF followed by being Malay (aOR=2.05; CI: 1.06-3.96). In conclusion, the incidence of dengue in Sepang was relatively low compared to the rest of Selangor. Intervention needs to be appropriate for young Malays. Multidisciplinary approach especially public health education plays an important role for behavioral modification to combat dengue, together as a team. Chia SY1, Shanthi V1, Balachandran S1 State Health Department of Federal Territory of Kuala Lumpur & Putrajaya Antenatal care is generally acknowledged as an effective method of preventing adverse outcomes in pregnant women and their babies. The present pattern of routine antenatal care in Malaysia is to encourage a first antenatal or „booking‟ visit at or below 12 weeks gestation, followed by monthly visits up to 28 weeks, fortnightly visits up to 36 weeks and weekly visits thereafter. This service is provided for all mothers including non-citizens seeking antenatal care at government clinic. In Klang valley there are about five clinics having more than 15% of non-citizens seeking antenatal care. This study was carried out to assess usage of antenatal services by non-citizens and to identify the common risk factors. Retrospective data was collected from antenatal card KIK/1(b)/96 of noncitizens registered in 2012 from government MCH clinics in Kuala Lumpur. Relevant data to this study on gestational week, maternal age and number of visits was analyzed using SPSS version 16. All noncitizens comprising of individuals seeking employment opportunities, further education, accompanying their spouse and UNHCR refugees were included in this study. 2616 non-citizens were seen at 21 MCH clinics in Kuala Lumpur in 2012. Among the non-citizens visiting the clinics, 59.2% were Myanmar nationals. 56.4% mothers were coded with green tag, 17.1% with yellow tag and 1.7% with red tag. Late booking was seen among 10% of mothers. 6.8% came with unsure of dates. Average visit was 2.9 visits with 99.4% seen by registered nurses and 94.3% seen by the medical officer. Common risk factors seen were anemia, gestational diabetes mellitus, pregnancy induced hypertension and unsure of dates. Improving the maternal care of non-citizens is challenging as their nomadic movements with „pay out of pocket‟ for healthcare services are the main reasons for not seeking early antenatal care. Keywords: Sepang Keywords: Antenatal care, Maternal and child health, refugee, foreigner, immigrant. 44 dengue, district, review, Selangor, 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 14 The district health office received a death notification of a foreigner from a temporary detention centre (DTS) by the nearby hospital in June 2012, due to septic shock secondary to leptospirosis with multiorgan failure.The objective is to verify the cause of death, identify whether leptospirosis outbreak occur, identify cause(s) of death/outbreak and identify control and preventive measures. Investigation and control team was formed immediately. Investigation done by reviewing medical records, active case detection among other inmates, passive case detection from 2 clinics and 2 hospitals near-by, laboratory tests for other inmates at risk as well as environment risk assessment the detention centre. 3 days food samples were taken for dietary assessment. Definitions of leptospirosis and thiamin-deficiency disorder were used. The case was detained for 4 months, brought into the near-by clinic and hospital twice before admitted for vomiting, hemoptysis, melena, jaundice, hypotension, bilateral ankle edema and low-grade fever, without respiratory symptoms or hepatomegaly. No laboratory investigation for leptospirosis or nutritiondeficiency was done. No similar case found among inmates. Blood test for leptospiral infection for other inmates was negative. The detention cell was overcrowded, although clean. Daily food sample contained 50% energy, 13% protein and 30% thiamine as compared to Malaysian RNI. The case was not likely leptospiral infection, but clinically thiamin-deficiency. There was no outbreak occured. Supplied food for the detainees was nutritionally inadequate. All detainees were given Vitamin B complex tablet daily, food supply was monitored closely by the DTS and health department and biweekly health assessment was done. Nutrition and environment assessment done every 6 months while number of detainees was strictly monitored by the authority. TRADITIONAL POSTPARTUM PRACTICES AMONG MALAYSIAN MOTHERS: A REVIEW Fariza F, Shamsuddin K, Sharifa Ezat WP Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre Care during postpartum period has not gained as much attention as during pregnancy and birth. The objective of this review is to explore the traditional postpartum practices among Malaysian mothers with respect to different ethnic beliefs. Comprehensive postpartum care is essential for identifying physical and psychosocial problems to reduce postpartum complications. In Malaysia, there are more programmes focusing on the care during antenatal and ensuring safe delivery but fewer on postpartum care. This might be due to the fact that in a multiethnic society, the various postpartum practices took hold. The multitude of socio-cultural beliefs, traditional postpartum practices and longstanding „taboo‟, makes it difficult to implement a standard programme catering for women during this period. Many cultures around the world have certain postpartum practices which they considered important for preventing future ill health. Across cultures, the common rationale for such practices is for maternal health restoration. As in other countries, most Malaysian mothers though from different ethnicity also have some commonalities in postpartum regime and practices in terms of beliefs and adherence to food taboos, traditional postpartum massage, use of traditional herbs and acknowledgment on the role of older female family members in postpartum care. However, current trend shows more lenient observation of traditional postpartum practices. The challenge is to develop an ideal complementary approach in integrating both traditional and modern postpartum practices in a multi-ethnic society. Keywords: Leptospirosis, detention centre Thiamin-deficiency, Poster 16 INVESTIGATING LEGIONELLOSIS: NEED FOR A PROPER COMPREHENSIVE GUIDELINES Keywords: Malaysian mothers, maternal, multiethnic, socio-cultural beliefs, traditional postpartum practices Poster 15 Othman Bw, Lily Rmz, Imran A, Saman Mb INVESTIGATING SUSPECTED LEPTOSPIROSIS DEATH IN A DETENTION CENTRE (DTS) Ft Putrajaya Health Office, Putrajaya The district health office received notification of a Legionella case from a hospital in April 2013. The case is a 58 year-old lady, public servant staying in a government quarters.To confirm the case, verify the outbreak, identify cause of infection/outbreak and identify control and preventive measures. Investigation and control team was formed Rahimah N, Othman BW, Norerwana M, Azlinda H, Ruzaimy AR FT Putrajaya Health Office, Putrajaya 45 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 immediately. Investigation done through medical records review, active case detection among colleagues, passive case detection from 4 clinics and 2 hospitals near-by and environment risk assessment of the cooling complex for the residential district and the hospital. The index case was a known diabetic, presented with low grade fever and unproductive cough with lethargy and disorientation. Two episodes of fever were observed in the hospital. Serial chest x-ray showed recurrent pneumonia. Urine for Legionella was positive 10 days after admission but serology were negative. Other bacteriological studies were negative. She was successfully treated for diabetic ketoacidosis and antibiotic (Azithromycin). None of her colleagues had fever during the study period and no other Legionella case reported at the nearby hospital. The city has two central Gas District Cooling complexes; both managed by the same operator, and have monthly maintenance with 6monthly legionella sampling. Water sampling from one of the tower revealed low-titre positive to L pneumophillia Serogroup 1. Sample from hospital cooling tower was negative. This was a single probable Legionella case occurred in a immunecompromised lady. Source of infection was inconclusive. Cooling tower operator was allowed to continue their operation with advice to improve quality assurance activity. Physicians were also adviced to investigate suspected legionella cases appropriately while hospital laboratories were adviced to keep legionella-positive samples for further investigation. An official and updated guideline for investigation and management of legionella outbreak is timely needed. DHF over year duration in an urban district in Malaysia. A case control study was conducted among 276 diagnosed dengue fever patients (i.e. 68 DHF cases and 208 normal Dengue Fever (DF) as controls) from January 2012- August 2013 in the District of Gombak. Reported diagnoses were obtained and demographic data were collected from patients retrospectively. We performed a logistic regression analysis to assess the relationship between socio demographic and onset of symptoms to diagnosis. Mean days of onset to diagnosis of DF and DHF were 3.82 (SD=1.68) and 4.29 (SD=1.259) days respectively. DHF was associated with time of onset of symptoms to diagnosis of 3- 4 days (OR=7.34; 95% CI: 1.65-32.71) and 5-<7 days (OR=6.48; 95% CI: 1.36-30.78), as compared to DF. The result was not significant for > 7 days. Being non-Malay and receiving inpatient treatment appears to be significantly related to DHF. Other factors such as age, sex, nationality and household locality were non-contributing. Non-Malays and later detection of DF were associated with increased risk of DHF. The two factors may be used for earlier detection, closer clinical monitoring and early hospitalization among patients suspected of DHF in our population. Keywords: Dengue fever; Gombak; susceptibility Poster 18 TREND OF MATERNAL MORTALITY IN FEDERAL TERRITORY OF KUALA LUMPUR FROM 2008 TO 2012 Keywords: Legionella, cooling tower. Poster 17 Noriah H1, Noorzila I1 SUSCEPTIBILITY TO SEVERE DENGUE INFECTIONS IN AN URBAN DISTRICT IN MALAYSIA: A CASE CONTROL STUDY 1 Family Health Development Unit, State Health Department of Federal Territory Kuala Lumpur &Putrajaya A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Malaysia is working towards improving maternal care diligently by investigating maternal death and taking quick remedial actions to prevent similar occurrence. Mortality data which is collected monthly was compiled to analyse MMR, death category, place of antenatal care, death according to citizenship and commonest cause of death among the preventable deaths in Kuala Lumpur from 2008 to 2012 by using SPSS Version 16.0. There were 53 deaths occurred in Kuala Lumpur within that period. MMR in 2008 was 25.4 per 100,000 livebirths. It declined to 14.1 per 100,000 livebirths in 2011 but increased to 23.6 per 100,000 livebirths in 2012. Siti Munira Yasin1,3, Ariza Zakaria2,3, Ruziyah Omar3, Rozlan Ishak3, Aminuddin Makpol2, Siti Zakiah Mesbah3, Azura Abul Hasan Ashari3 1 Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA 2 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia 3 Gombak Health District Office, Selangor Dengue haemorrhagic fever (DHF) is a severe form of dengue, characterized by bleeding and severe leakages. A number of DHF risk factors have been suggested. However, these factors differ by population and may not be generalized. This study explored demographic and other risk factors for 46 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Direct deaths contributed 48%, indirect 23% and fortuitous 29% respectively. Deaths among Malaysians were higher compared to the nonMalaysian.Out of 53 deaths, 39 cases or 73.6% were Malaysians and 14 cases or 26.4% were nonMalaysians. Government facilities were the choice to have the antenatal care in 2008 but in later years private facilities were their choice among the deaths. In 2012, 56% of the deaths cases had their antenatal care in either private clinic or private hospitals. Maternal mortality in Kuala Lumpur had shown a reduction trend till 2011 then it increased in 2012. The principal causes of deaths were medical disorders in pregnancy, obstetric embolism, post-partum haemorrhage and hypertensive disorders of pregnancy. Optimization of antenatal, intrapartum and postpartum care in both government and private facilities is vital in order to reduce the maternal mortality. infection, Aspergillus sp and Penicillium sp. In conclusion, there was an outbreak of Haemophilus Influenza infection among 88 students at a government school who stayed at Hostel A possibly due to crowded situation in the hostel. All cases were treated and isolated from the other healthy students until they recovered. Both 3rd and 4th floor at Hostel A were ordered to be closed and all the students were moved to a new hostel at nearby area. Keywords: URTI outbreak, Haemophilus Influenza school hostel, Poster 20 ACUTE DIARRHEA AND HYGIENE PRACTICE AMONG WOMEN WHO MANAGE HOMES AT KUALA TERENGGANU DISTRICT Keywords: maternal mortality, direct, indirect, fortuitous Poster 19 Azmawati MN1, Dalila M1 A URTI OUTBREAK AT A GOVERNMENT SCHOOL IN KUALA LUMPUR 1 Department of Community Health, UKM Medical Centre, Kuala Lumpur, Malaysia Hygiene behavior and diarrhea research in Malaysia is quite new and is rapidly increasing in number. The World Health organization (WHO), has tried to encourage communities and families to promote desirable hygienic behavior. Therefore the study focus on determine the prevalence of diarrhea and practice of hygiene among women who manage home. A cross sectional study was carried out in Mei-December 2012 in Kuala Terengganu district, Malaysia. A total of 216 women have been selected by using simple random sampling selection method. Data was collected using validated hygiene behavior questionnaire. Data was analyzed by using SPSS version 19.0.Age of respondents was around 20 to 55 years old with the mean age of 39.8 ± 8.2 years. Majority of respondent are educated till secondary education (54.2%) and most of them are working (56%). Among the respondents and household, less than half having diarrhea (23.1%) and (15.3%) respectively. Overall, respondents were practice good hygiene behavior (84.7%); hand washing (85.6%); food preparation (87%); environmental cleanliness (51.4%); and water usage (86.1%). In bivariate chi-square analysis, result of this study indicated that there were seven factors significantly associated with diarrhea i.e. age (p=0.033), education level(p=0.026), household‟s income(p=0.008), hand washing(<0.001), food preparation(p<0.001), environmental cleanliness(p=0.005), and water usage<0.001. Further analysis, by using multiple logistic regressions showed that thewater usage is significant predictors to the occurring of diarrhea (p<0.001).Poor hygiene practices such as hand washing, food preparation, environmental 1 Asyraf Z, 1Haliza AM, 1Mokhtar O, 2Rohani I 1 Cheras District Health Office, Kuala Lumpur Kuala Lumpur and Putrajaya Federal Territory Health Department In crowded conditions, sporadic respiratory tract infections can lead to an outbreak either by bacteria, virus, fungus or others. They can be transmitted via contaminated aerosol, droplet, or direct hand-to-hand contact with infected secretions. A notification was received from a clinic on 18th February 2013 regarding 18 students from a school came down with respiratory symptoms. Investigation was done immediately to determine occurrence of outbreak, identify the cause and to prevent the outbreak from spreading. It is a cohort study involving all students from the school in which medical examination, environmental investigation and laboratory samples were taken. A total of 482 students were investigated and 88 students (18.3% attack rate) had similar symptoms. 41 cases (46.6%) of cases stayed at Hostel A which showed significant findings (p<0.05) with relative risk of 2.2 (1.041.52, 95% confidence interval). Hostel A is a rented and modified private building which housed 122 students. Environmental investigation showed colonies of fungus were spotted at building walls especiallyon the 3rd and 4th floor.There was leaking of the air conditioning system. The CO2 level was 741 ppm, more than the permitted level of 175 ppm.Throat swab samples from the cases showed positive for Haemophilus Influenza and environmental samples showed positive for fungus 2 47 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 cleanliness, and water usage may cause diarrhea. Intervention should be more focus on thats issues. Poster 22 Keywords: Diarrhea, hygiene practice, women, water usage LEVEL OF CATASTROPHIC HEALTH EXPENDITURE AND ITS INFLUENCING FACTORS AMONG INPATIENTS ADMITTED TO HOSPITAL KUALA LUMPUR Poster 21 THE WILLINGNESS TO PAY FOR DRUGS AMONG SELANGOR STATE POPULATION Yang Rashidi A, Azimatun Noor A, Shamsul Azhar S Department of Community Health, Faculty of Medicine, UKM Medical Centre. Siti Nurul Akma A1; Sharifa Ezat WP2; Azimatun Noor A2; Ramli Z3, Ruhaini I4. Catastrophic health expenditure (CHE) is a term used for any health expenditure that can pose threats towards a household's financial capacity and capability in order to maintain its subsistence needs. Globally, more than 150 million individuals from 44 million households face CHE every year. This study is specific to a hospital inpatients‟ perspective in Malaysia. The objective of this study is to measure the CHE level among the inpatients in Hospital Kuala Lumpur and to determine what the factors which influence CHE among the patients are, for example the socio-demographic factors, types of disease, types of treatments and severity / chronicity of the disease. This hopefully can give extra information in the formulation of the Malaysian National Healthcare Financing (NHF) in terms of which type of patients/ disease that needs to be targeted and how much support is needed for these patients. This cross sectional study was done in Hospital Kuala Lumpur during the period of May 2013 until June 2013. There were 77 cases sampled using the stratified sampling method and the study was done using validated questionnaires and interview with patients in the ward. The CHE level was found to be 7.8%. There were significant differences in CHE among the groups in the marital status (p = 0.028), the household income (p = 0.013), the household size (p = 0.004) and the average number of acute illness per year (p = 0.018) categories. Maintaining prepayment mechanisms are the key to reducing catastrophic health expenditure. The policy decision-makers can use the information presented in this paper to better target financial risk-protection strategies for example in patients with smaller household income, larger household size and more frequent acute illnesses. 1 Center for Applied Management Studies, Faculty of Business Management, Universiti Teknologi MARA 2 Dept of Community Health, Faculty of Medicine, National University of Malaysia Medical Centre 3 Institute for Health Systems Research, National Institutes of Health 4 Health District Office, Sepang The escalation of healthcare costs is a global healthcare challenge in most countries. This is in line with the increase in theprevalence of diseases which induces an escalation in drug expenditures. In Malaysia, national drug expenditure has seen an increase whereby the Malaysian Ministry of Health allocated up to RM 1.402 billion in 2009 for drug expenditures. Since Malaysia has no social health insurance schemes, most of the expenditures are still highly subsidized by the government. Thus, Malaysia is approaching towards increasing demands to control the rise of health care costs in order to guarantee the capabilities of health care financial support in the future. As a result, this study was conducted to measure the patient‟s willingness to pay for drugs within the Selangor state population. A cross-sectional study was conducted at selected health clinics in Selangor and the collection of data was conducted in August 2012. The face-to-face questionnaires were distributed to 324 sampled respondents. Most of the respondents with a total of 234 (72.2%) were in disagreement or were not willing to pay for drug charges. Among those who were willing to pay, the overall willingness to pay for drugs for both chronic and acute diseases has an equal median of RM10. In a nutshell, the results indicate that patients have a low willingness to pay for drugs for chronic and acute diseases. In addition, most of our citizens are in a comfort zone whereby health services are highly subsidized. Hence, they are not ready to make a change from the norm of having free services to paid drugs charges. Keywords: Catastrophic health expenditure, Hospital inpatients, Health expenditure Keywords: Willingness-to-pay, Drugs expenditure 48 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 23 Majority of them (n=137, 74.9%) had very poor maximal oxygen uptake (VO2 max in ml/kg/min) for cardiovascular fitness. As conclusion, prevalence of CVD risk factors among male community leaders in Kelantan was surprisingly high. Thus, it is hope that the intervention phase among community leaders will be able to initiate behavioral changes and convey message of health benefits to the community in order to promote a sustainable healthy lifestyle promotion. HIGH PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS AMONG COMMUNITY LEADERS IN KELANTAN Zulraini J1, AA Ismail1, YN Azwany1, Tengku MA1, Ismail MS2. Keywords: Cardiovascular disease risk factors, community leaders 1 Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia 2 Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia Poster 24 DO PATIENTS ADMITTED WITH DENGUE FEVER HAVE A COMPLETE DIAGNOSIS AND ENOUGH FLUID? Cardiovascular diseases (CVD) become a major threat that lead to disability and premature death globally. Effectiveness of the programs on behavior change in the community is still lacking. Community leaders are expected to lead their people to a better life and thus expected to be able to help in behavior change program. A community-based study randomized 6 months control trial was designed to determine the impact of an intervention to reduce CVD risk factors among male community leaders in Kelantan. This report is on the preliminary cross sectional baseline study which was done in June 2013 among qualified and registeredcommunity leaders from various categories. Three districts in Kelantan were selected using simple random sampling followed by health screening among 140 community leaders/district (first stage cluster) to select 61 sedentary community leaders/district (simple random sampling in second stage cluster) who are in either contemplation or preparation stage of readiness to become more physically active for the next intervention study. Baseline sociodemographic, anthropometric measurements, CVD risk factors and physical fitness were collected at baseline using a validated questionnaire. Among 183 (61/district) community leaders, almost three quarter are leaders from non-governmental organizations (n=135, 73.8%), followed by 33 religious leaders (18.0%), nine politicians (4.9%) and six leaders (3.3%) from community organization in government sector. The mean (SD) age was 47.97(9.49) years old and majority (n=177, 96.7%) were Malay. Most of them had high education level (n=122, 66.7%) and from middle annual household income (n=116, 63.4%). The mean (SD) BMI was 26.53 (3.80). Baseline mean (SD) steps/day and VO2 max (ml/kg/min) were 3227.51 (1126.18) and 23.22 (6.22) respectively. For clinical parameters: mean (SD) total cholesterol, LDL, and FBS were 6.04 (1.08), 3.97 (0.94) and 5.61(1.89) respectively. Prevalence of CVD risk factors were high: overweight/obese, abdominal obesity, central obesity, hypercholesterolemia, hypertension, Diabetes Mellitus and smoking are 86.8%, 54.1%, 55.2%, 79.2%, 24.0%, 10.9% and 31.1% respectively. Norfarahdina R, Nurulraziquin MJ, Nurain MN Department of Medicine Hospital Putrajaya There are 3 phases of illness in dengue fever, which are febrile, critical and recovery phase. The recovery phase is accompanied by a reduction in haematocrit level. Patients with warning signs such as high haematocrit, persistent vomiting, abdominal pain, mucosal bleeding, restless / lethargy and tender hepatomegaly have the possibility of having disease progression. A complete diagnosis is important to risk stratify the patients. The fluid management in patients with warning sign is recommended to be 5-7 ml/kg/hour. This cross sectional study is aimed to assess the completeness of the diagnosis of dengue, the fluid management on admission and the outcome of the admission in term of days of hospitalization and the haematocrit level on discharge. We analysed data from 55 patients who were admitted with dengue fever in Hospital Putrajaya medical ward from January to March 2013. The completeness of the diagnosis made was based on the documentation of phase of illness and warning sign in the clinical notes. The results were analyzed using SPSS version 15. There were 30 male patients and 25 female patients admitted from January to March 2013. All patients were admitted with warning signs, mostly were high haematocrit (63.6%) and persistent vomiting (49.1%). A complete diagnosis was made in all patients. Most of the patients were on 3-5 ml/kg/hour (41.8%) and the mean duration of hospital stay was 2.6 days. Mean hematocrit on admission was 43.7 ± 3.8 and 41.69 ± 3.9 on discharge. To conclude, a complete diagnosis was made in all patients. In general, rate of fluid administration was lower than recommended. However, patients recovered uneventfully with a reduction of haematocrit. 49 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Keywords: dengue fever Poster 26 Poster 25 DIETARY FACTORS INFLUENCING O6-ALKYLGUANINE-DNA ALKYLTRANSFERASE (MGMT) ACTIVITY IN PATIENTS ATTENDING A BRONCHOSCOPY CLINIC REDUCING THE OCCURRENCE OF DENGUE FEVER IN PPA DESA REJANG SETAPAK THROUGH INTEGRATED VECTOR MANAGEMENT (IVM) APPROACH, 2013-2014 Fauziah N1,5, O’Donnell PNS2, Barber PV2, Booton R2Billson H1, Derbyshire E3, Margison GP4, Povey AC1 Zainal Abidin AB1, Dahlia B2, Zakiah Y2, Khadijah K1 1 Centre for Occupational & Environmental Health, Faculty of Medical & Human Sciences, the University of Manchester, UK; 2 North West Lung Centre, Wythenshawe Hospital, Manchester, UK; 3 Research Institute for Health and Social Change, Manchester Metropolitan University, Manchester, UK; 4 CR-UK Carcinogenesis Group, Paterson Institute for Cancer Research, Manchester, UK; 5 Institute for Public Health, Ministry of Health Malaysia 1 Vector-borne Disease Control Unit, Wilayah Persekutuan Kuala Lumpur & Putrajaya Health Department 2 Pejabat Kesihatan Titiwangsa, Wilayah Persekutuan Kuala Lumpur & Putrajaya Health Department Dengue remains a public health issue in PPA Desa Rejang Setapak, Kuala Lumpur. The locality reported an average of 10 dengue cases annually from the year 2009 to 2012 with a yearly recurrent of outbreak without fail. An entomological assessment revealed that the main factors which favour the breeding of Aedes sp mosquitoes were illegal dumpsites particularly on idle lands, sanitation issues from the stalls around the neighborhood, stagnant water on uneven cement surfaces of common walkways and corridors as well as sawed metal poles with a hollow center. To address these issues, a pilot project was planned to be carried out from September 2013 until August 2014 via the Integrated Vector Management (IVM) approach involving the community and interagencies cooperation in the prevention and control activities. The process evaluation will include the following: the formation of COMBI team, vectordensity reduction via monitoring of Aedes index(A.I) <1%, Breteau index(B.I) < 5, Container index(C.I) < 10%, Mosquitoes Larvae Trapping Device(MLTD) < 10%, a decrease in offences under the Destruction of Disease-bearing Insect Act 1975, an increase in community awareness of the destruction of Aedes breeding sites via the knowledge, attitude and practices(KAP) survey as well as no dengue cases reported during the study period. This pilot project will be monitored on a weekly basis and its progress documented on a 3-monthly report. It is hoped that a positive attitude would be instilled in the community to ensure the elimination of mosquitoes breeding sites and a reduction in the occurrence of dengue cases and outbreaks in the locality. The multi-agencies and community involved should remain committed in dengue prevention and control to make this pilot project a success. The DNA repair protein, O6-alkylguanine DNA alkyltransferase (MGMT), provides protection against the mutagenic and carcinogenic consequences of exposure to alkylating agents such as those found in cigarette smoke. Little is known about the factors that influence MGMT activity in human tissues. The association between dietary factors, lung cancer and activity of MGMT was examined. Dietary data was obtained from a food frequency questionnaire (FFQ).Functional MGMT activity in peripheral blood mononuclear cells (PBMCs) and lung bronchial epithelial cells (BECs) was measured in patients attending a bronchoscopy clinic. Mean MGMT activity (±SD) in PBMCs (n= 45) and BECs (n= 35) was 9.49 + 4.44 and 1.93 + 1.61 Fmol/µg DNA respectively. MGMT activity was not associated with age, gender, smoking status and diseases status. MGMT activity in PBMCs, but not BECs was significantly associated with consumption of eggs (p=0.01), milk (p=0.03), calcium (p<0.01), vitamin C (p=0.03), and iron intake (p=0.01) in the diet. Dietary Vitamin C and iron show a doseresponse with MGMT activity in PMBCs.Dietary factors appear to modify MGMT activity in PBMCs but not BECs. The findings suggest that the dietary factors may influence DNA repair protein activity and potentially may alter the incidence of lung cancer. Keywords: dietary factors, MGMT, lung cancer Keywords: Dengue, Integrated vector Management (IVM), PPA Desa Rejang 50 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 27 Poster 28 MALNUTRITION AND ITS RISK FACTORS AMONG HOSPITALISED PATIENTS AT KUALA LUMPUR GENERAL HOSPITAL SEXUAL RISK BEHAVIOR: TEENS’ EXPERIENCES Hatta M.1, Fadzilah K.2, Balkish MN.1, Faizah P.1, Norzawati Y.1, Yussof S., Hazrin H.1 1 1 2 3 Nor AzianMZ , Suzana S , Romzi A ,Azahadi O Institute for Public Health Office for Deputy Director-General of Health (Public Health), Ministry of Health Malaysia 2 1 1 Institute for Public Health, Kuala Lumpur, Malaysia 2 Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia 3 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia High risk sexual behavior among young adults is distressing. These activities pose to unintended health outcomes including sexually transmitted infections (STIs) and unintended pregnancy. The aim of this study was to describe the high risk sexual characteristics among the selected form four students who ever had sex in Malaysia. This crosssectional school survey was conducted in the year 2012 involving 2,769 form four students in fifteen government schools. One district was randomly selected from each state, a systematic sampling was used to choose a school from the selected district. All form four students from the selected schools were invited to participate in the survey. A self-administered validated questionnaire was used to assess risky sexual behavior of respondents. Analysis of descriptive data were done using SPSS version 19.0. Among the respondents, 10.3% (n=285) reported ever had sex in their lifetime. Half of them had their first sex at age of 15 years old. There were 64.8% consented, forced sex (24.1%) and 11.1% had sex under the influenced of drug and alcohol. Homosexual activity was reported 13.8%. Among them, 28.0% ever used condom and 30.1% did not know about condom and 19.8% did not believe condom could minimize the risk of STIs. Among the girls who had sex, 5.3% experienced pregnancy and 78.6% out of them aborted. Those reported watching pornography (61.0%) and read pornographic (58.1%) materials mainly obtained them from Internet (47.0%), friends (29.3%), printed materials (4.3%) and mobile phone (3.0%). They agreed to have sex before they get married (14.9%), kissing (46.5%), and holding hand (53.4%) when they were in love. They will allow their partner to touch their sexual part (27.1%). Among them, 35.5% believed sexual education will increase social problem and 57.3% agreed sex education is informative. Upon permission from their parent, 71.1% agreed to do HIV testing. Malnutrition in hospitalised individuals is the result of many factors. It is associated with certain disease and might be influenced by social status of the patients. The aim of this study was to determine the nutritional status of adult hospitalised patients. Secondly, to determine the effect of social factors and medical history associated with the risk of malnutrition.The cross sectional study involved 151 patients aged 18 to 65 years old in medical and surgical wards, Kuala Lumpur General Hospital. Nutritional status was assessed by using Subjective Global Assessment (SGA) within the first 48 hours of hospital admission. Gender, age, life habits, social status, medical condition were investigated as possible associated risk factors. The t-test and chisquare were used to compare the data. Univariate and multivariate analysis were used to identify the factors associated with malnutrition. Malnutrition was present in 19.9% of the patient, with 2.1% of the patients were severely malnourished. Univariate logistic regression indicated that malnutrition was associated with polymorbidity (OR= 3.34; P<0.01), taking five or more medications (OR= 2.57; P< 0.05), age (OR=1.06; P<0.001), unemployment (OR= 2.28; P<0.05) and physically inactive (OR=2.72; P<0.05). Multivariate analysis demonstrated that polymorbidity (OR=2.64; P<0.05), age (OR=1.10; P<0.01) and physically inactive (OR=4.61; P<0.05) were strongly associated with the occurrence of malnutrition. Malnutrition is prevalent among the surgical and medical patients in this study, especially among those with advanced age, physically inactive and had co-morbidities. A routine nutritional screening and/or assessment to these risk groups is highly recommended to allow for early identification and intervention of malnutrition. Keyword(s): Risky Sexual Behavior, Sex Education, HIV Testing Keywords: Malnutrition, Subjective Global Assessment, nutritional status, hospitalised patients 51 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 29 Poster 30 THE ASSOCIATION OF PORNOGRAPHY EXPOSURE WITH ADOLESCENTS’ SEXUAL BEHAVIOR SUSCEPTIBILITY TO INITIATE SMOKING AMONG SECONDARY SCHOOL NON-SMOKERS IN MALAYSIA Hazrin H¹, Hatta M¹, Norzawati Y¹, Faizah P¹, Yussof M¹, Riyanti S1. Fadzilah K² Lim KH1, Hasimah I1, Helen Tee GH1, Gurpreet K1, Jasvindar K1, Lim KK1 1 1 Institute for Public Health Office of Deputy Director-General of Health (Public Health), Ministry of Health Malaysia Institute of Public Health, JalanBangsar, 50590, Kuala Lumpur 2 Susceptibility to smoking has been established as a reliable predictor of smoking initiation. This paper aims to describe the prevalence and inter- and intrapersonal factors associated with susceptibility to initiate smoking among secondary school students in Malaysia. Data was obtained from the Global School Health Survey (GSHS) which employed a cross sectional study design and two-stage stratified sampling to obtain a representative sample of secondary school students in Malaysia. A validated questionnaire was used to obtain the data. Data were weighted in the analysis to account for the complex study design and response rate. The overall prevalence of susceptible to smoking was 6.0%, and the prevalence was significantly higher among male compared to female students (9.5% vs. 3.6%). However there was no difference in prevalence between lower and upper secondary school students. Multivariable analyses revealed higher odds of susceptible to smoking among male students (aOR 3.54, 95%CI 2.80-4.44) and students of indigenous Sabahan or Sarawakian descent(aOR 1.62, 95%CI 1.21-2.18). Multivariate analyses further revealed that susceptible students were more likely to have symptoms of depression (aOR 1.54; 1.21-1.96) or from families with one or both parents/guardians who smoked (aOR 1.48, 95%CI 1.21-1.82; aOR 2.33, 95%CI 1.22-4.44). These results indicate that inter and intrapersonal factors are associated with susceptibility to smoking. Follow-up programmes(both family- and school-based primary prevention programs) need to concentrate on male secondary school students and capitalise on the modifiable factors associated with susceptibility to smoking to reduce smoking initiation among adolescents in Malaysia. Concern has been raised that the accessibility of pornographic materials may lead to potentially serious ramification to adolescent sexual development. The aim of this study was to investigate the relationship of pornography exposure towards adolescents‟ attitudes and behaviour with regard to sexual risk behavior.This cross sectional school survey was conducted in the year 2012 involving 2,769 form four students from fifteen government schools. One district was randomly selected from each state, a systematic sampling was used to choose a school from the selected district. All form four students from the selected schools were invited to participate in the survey. A self-administered validated questionnaire was used to assess the exposure of pornographic materials and their impact on sexual behavior. Analysis of descriptive data were done using SPSS version 19. The response rate was 97.9% (n=2712). Among all respondents, 44.8% of students exposed to pornographic materials. The prevalence was significantly higher among rural students (47.5%) and boys (57.4%). Those who exposed to pornography, 16.0% had engaged in sex, experienced kissing (26.9%), touching and caressing (24.1%) and also had friends who ever had sex (42.2%). The internet (47.3%) and friends (29.8%) were the two most common sources of pornographic material. There was no significant difference between heterosexuality (71.3%) and homosexuality (72.2%) with pornography exposure.The findings showed that pornography exposure has significant influence on risky sexual behaviour among adolescents. Controlling accessibility of pornographic materials is necessity for the assurance of early prevention to underage sexual behaviour that linked to risky health outcomes in future. Keywords: Susceptibility to smoking, adolescents, Global School Health Survey, smoking initiation Keyword(s): Pornographic material, sexual risk, adolescents 52 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 31 Poster 32 VIOLENCE RELATED BEHAVIOURS AMONG ADOLESCENTS IN MALAYSIA; A CROSS SECTIONAL SURVEY AMONG SECONDARY SCHOOL STUDENTS SUICIDAL BEHAVIOURS AMONG MALAYSIAN ADOLESCENTS: WHAT’S THE CURRENT SITUATION? Noor Ani A1, Cheong SM1,Azriman R2, Nurashikin2, Mala M1, Fadhli MY1, Siti Fatimah1, Gurpreet K1, Noor Safiza MN1. Nur Shahida AA1, Diana M1, Siti Fatimah MH1, Rosnah R2,Mohd Hazrin H1 1 Institute for Public Health, Ministry of Health Malaysia; 2 Disease Control Division, Ministry of Health Malaysia 1 Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur 2 Violence and Injury Prevention Unit, Disease Control Division, Ministry of Health Malaysia, Block E3, 62590 Putrajaya Adolescence and early adulthood are times of greatest risk for first onset of suicidal behaviours. The aim of this study is to identify risk and protective factors that are associated with suicidal behaviours among Malaysian adolescents. Data from Malaysia Global School-based Study 2012, a nation-wide study using two-stage cluster sampling design involving 234 schools with 25,410 students Form 1 to Form 5, was analysed. A total of 25,174 students (response rate of 99.1%) responded to this topic using a self-administered validated bi-lingual questionnaire developed by World Health Organisation and DASS21. Multivariable analysis was used to assess the association between demographic, health-related behaviours and protective factors with suicidal behaviour. The overall prevalence of reported suicidal behaviour was 13.0% (95% Confidence Interval: 12.10-14.04), with suicidal ideation, plan and attempt reported in 7.9% (95% CI: 7.30-8.59), 6.3% (95% CI: 5.82-6.93) and 6.6% (95% CI: 5.97-7.40) respectively. Binary logistic regression revealed that suicidal behaviour were positively associated with depression [aOR: 2.03 (95% CI: 1.81-2.27)], anxiety [aOR: 1.28 (95% CI: 1.16-1.42)], stress [aOR: 1.66 (95% CI: 1.451.89)], physical and verbal abused at home [aOR: 2.13 (95% CI: 1.87-2.42); aOR: 1.77 (95% CI: 1.601.96)], bullied [aOR: 1.68 (95% CI: 1.51-1.88)], current smoker [aOR: 1.53 (95% CI: 1.31-1.79], current drinker [aOR: 1.43 (95% CI: 1.22-1.68)], and drug abused aOR: 4.02 (95% CI: 2.81-5.14)]. In addition, suicidal behaviour was significantly higher among female students [aOR: 1.31 (95% CI: 1.191.45)], Indians [aOR: 2.41 (95% CI: 2.03-2.85)] and Chinese [aOR: 1.95 (95% CI: 1.72-2.20)] compared to Malay students. Having close friends [aOR: 0.28 (95% CI: 0.23-0.33)] was strongly protective against suicidal behaviour, while family factors such as parental caring attitudes and marital status were not statistically associated with suicidal behavior. Understanding of risk and protective factors is important in providing holistic and comprehensive approach in the management of suicidal behaviour among adolescents. Experiencing violence at home has been associated with the likelihood of being involved in violence behaviour among school adolescents. The aim of this study was to describe the pattern of violence and unintentional injuries among Malaysian‟s secondary schools students. A total of 234 schools were selected and students from selected classes completed a standard self-administered questionnaire based on WHO Global School-Based Student Health Survey. Questions on violence at school and home were included. Data was analysed using SPSS 17.0. In the aspect of violent behaviour among Malaysian students, 27.8% (95% CI: 26.529.1) admitted to have been physically attacked, 27.4% (95% CI: 26.0-28.7) involved in physical fight and 17.9% (95% CI: 16.8-19.0) were bullied, whereby the prevalence were significantly higher among males compared to females in all three situations. Overall, 34.9% (95% CI: 33.6-36.3)of students were seriously injured one or more times during the past 12 months. The most common causes of serious injury was fall [36.7%(95% CI: 34.838.6)], followed by cut or stab wound [26.5% ( 95% CI: 24.9-28.3)] and motor vehicle accident or being hit by a motor vehicle 20.0% (95% CI: 18.3-21.8). Meanwhile, 11.1% (95% CI:10.2-12.2) and 42.7%(95% CI: 41.5-44.0) of students were physically and verbally abuse at home respectively.This study showed that there was a positive association between violent home environment and the likelihood of violence behaviour among the adolescents at school.Intervention strategies should be put in place to deal with this social issue. Efforts should then be emphasized on good parenting skills to curb the problem of violence behaviour among adolescents. Keywords: violence behaviour, adolescent, injury. 53 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Keywords: suicidal behavior; risk and protective factors; Malaysia Global School-basedStudy 2012; DASS21 Keywords: Physical activity, predictors, physically active adolescents, Poster 34 Poster 33 PHYSICALLY ACTIVE ADOLESCENTS: WHAT ARE THE PREDICTORS? WHAT PARENTS AND SCHOOLS CAN DO TO BUILD PROTECTIVE FACTORS AMONG ADOLESCENTS? Chan YY, Lim KK, Teh CH, Azahadi O, Azli B, Hamizatul Akmal AH, Norhafizah S, Leni T, Tee GH, Noor Ani A Noor Safiza MN1, Nik Rubiah NR2 , Norzawati Y1 , Diana M1 , Leni T1 , Afiq A1 , Noor Ani A1 1 Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia 2 Family Health Development Division, Ministry of Health Malaysia Institute for Public Health, Ministry of Health Malaysia Regular physical activity provides adolescents with important physical, mental, and social health benefits. Participation of adolescents in physical activity is determined by demographics, healthrelated factors, interpersonal and psychosocial factors. The objective of this study was to determine the factors that predict adolescents‟ physical activity. We analysed data from the Malaysia Global School-based Student Health Survey (GSHS) 2012, a national school-based survey with two-stage cluster sampling design involving a total of 25,507 (response rate of 89%) students in Form 1 to Form 5 from 234 government schools throughout Malaysia. Students completed the GSHS selfadministered questionnaires by recording their responses on a computer-scannable answer sheet. Multivariable logistic regression was used to assess the associations between demographics, healthrelated behaviours, protective factors, psychosocial factors and being physically active. Adolescents who obtained a total of at least 60 minutes of physical activity per day on at least 5 days during the past 7 days were considered as being physically active. The overall prevalence of being physically active was 22.7% (95% CI: 21.5-23.9), 30.0% (95% CI: 28.5-31.6) among males and 15.3% (95% CI: 14.116.7) among females. Multivariable logistic regression analysis revealed that males (aOR=2.77; 95% CI: 2.51-3.06), fruits and vegetables consumption of five or more times per day (aOR=1.33; 95% CI: 1.23-1.44), peer support at school (aOR=1.52; 95% CI: 1.40-1.65), parental or guardian connectedness (aOR=1.26; 95% CI: 1.171.36), and parental or guardian bonding (aOR=1.28; 95% CI: 1.17-1.41) were significantly associated with being physically active among school-aged adolescents. Adolescents who were overweight or obese (aOR=0.79; 95% CI: 0.72-0.87) were less likely to be physically active. School-based physical activity interventions should incorporate a multicomponent approach considering gender, healthy lifestyle, peer support and parental involvement in interventions designed to promote regular physical activity and active lifestyle among adolescents. Protective factors are determinants which reduce the likelihood of negative consequences among the adolescents from exposure to sexual risk behaviours, violence, alcohol use and depression. This study aimed to describe protective factors among adolescents at secondary schools (Form 1 to 5) who participated in the Global Health School Survey (GSHS) 2012. The GSHS employed a twostage cluster sampling design which involved 234 schools in Malaysia. Eligible students (N=25, 414) aged 13-17 years old completed a standard selfadministered questionnaire. Questions on protective factors included truancy problems, school environment (peer factor) and parent/caregiver factors. Descriptive and univariate analyses between protective factors and bullying were performed. Overall, 30.9 % (CI: 29.34-32.44) of the students had truancy problem. 52.3% (CI: 50.4-54.2) of female students reported their peers are more kind and helpful, which is higher than male students (36.3%, CI: 34.3-38.2). However, the students reported that only 14% (CI: 13.5-15.0) of their parents checked their homework and 43% of the parents (CI:41.8-44.3) knew what their children were doing during their free time. Truancy problems among the adolescents are also associated with bullying victimisation (aOR=1.28, 95% CI: 1.191.14, p<0.001). In conclusion, protective factors among adolescents in Malaysia are still low. Parents and schools can build protective factors among adolescents through various activities at schools. For example, the anti-truancy or bullying programme can be strengthened under the school counselling unit. Innovative and creative ways are required to create awareness among the parents and to continuously inculcate parental involvement and caring attitude among the school community. Keywords: Protective factors adolescents, Malaysia GSHS 54 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Poster 35 Malaysian Global School-based Health Survey (GSHS) 2012, was a cross sectional study which employed a two-stage clustering sample design to obtain a representative sample of students from Form 1 to 5 studying in government secondary schools. A total of 234 schools were selected systematically with probability proportional to enrolment using a random start. Classes were selected with systematic equal probability sampling and all students from the selected classes were included in this survey. Data collection was conducted from 23 February to 26 April 2012. A total of 25,507 students responded to the survey, summing up to a response rate of 88.8%. Overall, in the past 30 days, 2.7% (95% CI: 2.4-3.1) of the students reported not brushing their teeth daily while 86.5% (95% CI: 85.6-87.4) claimed they brushed their teeth at least 2 times daily. More than half of the students, 57.2% (95% CI: 55.6-58.8) reported using fluoridated toothpaste while 13.1% (95% CI: 12.1-14.1) claimed that they used nonfluoridated toothpaste. About 29.7% (95% CI: 28.531.0) reported they did not know whether their toothpaste contain fluoride. Males were found to have poorer oral hygiene behaviour compared to females. Hence, there is a need to strengthen oral health policies in schools to further enhance positive oral hygiene practises among adolescents. ADOLESCENTS BREAKFAST HABITS IN MALAYSIA: MALAYSIA SCHOOL BASED NUTRITION SURVEY 2012 Suhaila AG1, Hafizah Mohd Shahril1, Ahmad Ali Z1, Azli B1, Hatta M1, Yeo Pei Sien1 Institute for Public Health, Ministry of Health, Kuala Lumpur 1 Breakfast consumption is an important component of nutrition which positively impact on adolescent‟s health and well - being. The objective of this study was to assess breakfast habits with sociodemography factors and nutritional status among adolescents in Malaysia. The data from Malaysia School based Nutrition Survey was analysed. This survey was a two-stage cluster sample design involving 40,011 of students from standard 4 until form 5 with the response rate of 90.5%. The findings indicate that 28.1% (95%CI: ) took breakfast daily, 55.5% (95%CI: ) consumed breakfast intermittently and 16.4% (95%CI: ) skipped breakfast daily. Multivariate logistic regression analysis revealed that older adolescents aged 13-18 years old (aOR 2.59: 95% CI: 2.20 – 3.04) and Chinese (aOR 1.76: 95% CI: 1.43 –2.16) were significantly associated with skipping breakfast. Adolescents with different nutritional status showed that overweight (aOR 1.27: 95% CI: 1.15 – 1.40) and obese (aOR 1.39: 95% CI: 1.25 – 1.55) adolescents were significantly more likely to skip breakfast. Socio demographic differences, in particular age group, ethnicity and nutritional status need to be considered in the development of nutritional intervention programs intended for adolescents. Keywords: Oral hygiene practises, adolescents, Malaysia GSHS Poster 37 ALCOHOL CONSUMPTION AMONG ADOLESCENTS IN MALAYSIA Hamizatul Akmal AH¹, Hatta M¹, Mala M¹, Rozanim K², Yusoff S¹, Chong ZL¹ ¹Institute for Public Health, Ministry of Health Malaysia; ²Division of Disease Control, Ministry of Health Malaysia Keywords: breakfast, early meal, nutritional status Poster 36 Early-onset of alcohol drinking among adolescents poses high probability of becoming alcohol dependent which propels into adulthood. Alcohol use has detrimental effects on physical and mental while impairing cognitive development. The aim of this study was to assess the prevalence of alcohol consumption among adolescents in Malaysia. Data from the Malaysian Global School-based Student Health Survey 2012, a cross-sectional study using two-stage cluster sampling technique was used. A total of 25,507 students (response rate of 88.8%) aged 12 to 17 years old have participated in this study by completing a self-administered questionnaire. The prevalence of current drinker among adolescents was 8.9% (95% CI: 7.8-10.1). Prevalence of alcohol use among males was significantly higher than females. Among those who ORAL HEALTH PRACTICES AMONG ADOLESCENTS IN MALAYSIA Riyanti S1, Yaw SL2, Nurrul A2, Khairiyah AM2, Balkish MN1, Yeo PS1 1 Institute for Public Health, Ministry of Health, Malaysia 2 Oral Health Division, Ministry of Health Malaysia Proper oral hygiene practices are essential for maintaining oral health. The purpose of this study was to assess the prevalence of oral hygiene practices amongst adolescents in Malaysia. The 55 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 ever drink alcohol, 63.5% had their first drink before age 14 years old. 26.5% (95% CI: 24.2-29.0) of current drinker consumed two or more drinks on a typical day that they drank. Among current drinkers, 34.6% (95% CI: 30.6-38.9) usually got the alcohol from their family. Among respondents, 6.3% (95% CI: 5.6-7.2) had reported drunkenness while 2.5% (95% CI: 2.2-2.9) got into trouble with their family or friends, missed school or got into fighting during their life as a result of drinking alcohol. In both cases, males significantly had higher prevalence than females. Early prevention program such as awareness and advocacy activities, screening and brief intervention of alcohol use are vital to reduce alcohol-related harm among adolescent. Logistic regression revealed that females [OR=1.38 (95% CI:1.21-1.57)], living in urban [OR=1.07 (95% CI: 0.94-1.23)], government/semi government employees [OR=1.63 (95% CI:1.36-1.95)], having secondary education [OR=1.64 (95% CI: 1.27-2.12 ), and widow/widower/divorcee [OR=1.24 (95% CI: 0.95-1.63)] were more likely to be obese as compared to respondents with BMI < 30kg/m2. Intervention strategies need to focus to this identified risk groups in order to halt obesity problem in Malaysia. Keywords: Alcohol, Adolescents, Alcohol-related harm, Malaysia Poster 38 ADOLESCENTS IN MALAYSIA: IS ANXIETY ASSOCIATED WITH SOCIO-DEMOGRAPHIC, MENTAL HEALTH, ENVIRONMENTAL, AND NUTRITIONAL FACTORS? Cheong SM1, Jasvindar K1, Balkish MN1, Dr. Noor Ani A1, Gurpreet K1, Helen Tee Guat Hiong1, Azriman R2, Nurashikin I2, Diana Mahat1, Siti Fatimah MH1, Leni T1, Suhaila AG1 1 Institute for Public Health, Ministry of Health Malaysia; 2 Diseases Control Division, Ministry of Health Malaysia Adolescents are vulnerable to various mental health problems. Anxiety is one of the most common mental health problems among adolescents. This study aimed to determine the prevalence and factors associated with anxiety amongst adolescents aged below 18 years old. We analysed data from the National Health and Morbidity Survey (NHMS) 2012, a cross-sectional school-based survey with twostage cluster sampling design involving a total of 25,502 students Form one to five from 234 schools. The status of mental health was determined using the validated DASS 21 questionnaire. Anxiety was defined as respondents having moderate to extremely severe anxiety symptoms by the DASS scoring system. The overall prevalence of anxiety amongst adolescents was 39.6%. Obesity was higher among females [17.6% (95% CI: 16.5-18.9)], peak at the age of 55-59 age group [20.2% (95% CI: 17.623.1)], and higher among widow/widower/divorcee [17.2% (95% CI: 14.7-19.9)], and unpaid worker/home maker [20.9% (95% CI: 19.0-22.9)]. 56 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 MJPHM NOTICE TO CONTRIBUTORS detail to allow other researchers to repeat the study. Identify all drugs and chemicals used including generic name(s), dosage(s) and route(s) of administration. Statistical tests used should be given in sufficient detail and the use of any computer software should also be mentioned. For studies with ethical consideration such as clinical trials, studies done among minorities etc. the statement of approval from relevant ethical committee has to be mentioned as set out by the Helsinki Declaration. 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Better health, nutrition and aducation for the school- aged childern Trans R Soc Trop Med Hyg 1997; 91:1-2 57 7th NATIONAL PUBLIC HEALTH CONFERENCE 2013 Public-Private Partnership towards Achieving Universal Health Coverage 11 – 13th November 2013 Books and Other Monographs Personal Author (s) 1. Colton, T. Statistics in medicine. Little, Brown and Company: Boston, 1974. Chapter in Book 1. DeFronzo RA. Diabetic Nephropathy. In Junior DP, Sherwin RS. (eds). Diabetes Mellitus. Connecticut: Appleton and Lange, 1997. Agency Publication 1. Ministry of Health. Annual Report 1999. Electronic Material 1. Norai MS, Jumiatin O, Farizah H. Effective triaging in Putrajaya Health Clinic. Malaysian J Public Health Med 2002; 2:45-9. Available from: http: www.pppkam.org.my/mjphm/detailarticl e.asp?id=31&issue=Vol2(2):2002 (accessed 1 April 2004) Tables and illustrations: Arabic numerals should be used when numbering tables, illustrations and diagrams. 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