The Southeast Asian Journal of Tropical Medicine and Public Health
DISASTER-RELATED NUTRITION AWARENESS AMONG ADULTS IN TÜRKİYE
Nutritional problems frequently occur during disasters due to limited access to safe food, clean water and appropriate food storage conditions. Proper knowledge regarding nutrition before, during and after disasters may help reduce nutrition-related health risks and improve disaster preparedness. In this study we aimed to evaluate disaster-related nutrition knowledge and practices among adults living on the European side of İstanbul, Türkiye and to identify any associations between these knowledge scores and demographic, anthropometric and dietary factors in order to inform efforts to improve preparedness in the study population. This cross-sectional study was conducted during August-December 2025. Subjects aged 19-65 years were recruited through face-to-face interviews conducted in universities, public areas and accessible community settings. The minimum number of subjects calculated to be needed for the study was 200. Data were collected using a structured questionnaire asking about demographic characteristics, dietary habits, a 24-hour diet recall and anthropometric measurements. We assessed disaster-related nutritional knowledge with 18 researcher-developed questions asking about emergency food selection, food safety, food storage, hydration, infant feeding and nutrition for vulnerable groups during disasters. Knowledge scores were calculated based on the percentage of correct responses. Current diet was assessed using a 24-hour diet recall obtained by a trained dietitian and analyzed using Beslenme Bilgi Sistemi (BEBIS) software. A total of 254 subjects were included in the study, 228 (89.8%) females. The mean (±standard deviation) age of subjects was 27 (±11) (range: 19-65) years. Male subjects had a significantly higher body mass index and waist-to-hip ratio than female subjects (p-value <0.05). Diet was similar between males and females, although vitamin B2 intake was significantly lower among males and vitamin C intake was significantly higher among females (p-value <0.05). The overall nutrition in disaster-related nutrition knowledge correct response percentage was 59.1%. When asked about the foods that should be included in an emergency kit, 15.4% of subjects in the 19-39 year age group and 33.3% of those in the 40-65 year age group answered correctly (p-value = 0.012). 62.7% of female subjects and 57.7% of male subjects provided the correct answer to the question regarding foods that should not be consumed at the onset of a disaster (p-value = 0.044). Female subjects who were parents had a significantly higher percentage of correct answers (64.21%) than those who were not parents (58.49%) (p-value = 0.035) but there was no significant difference in male subjects (p-value >0.05). Female subjects who regularly took medication had a significantly higher percentage of correct answers (62.43%) than those who did not (58.85%) (p-value = 0.020) but there was no significant difference in male subjects (p-value >0.05). We found a significant negative association between waist circumference and percentage of correct answers to disaster-related nutrition knowledge questions among male subjects (p-value = 0.032) but not female subjects (p-value = 0.896). We found a significant positive association among female between correct answers disaster-related nutrition knowledge and daily intake of potassium (p-value <0.001), magnesium (p-value = 0.006), iron (p-value = 0.038), vitamin B2 (p-value = 0.012) and vitamin B6 (p-value = 0.008) based on the 24-hour diet but in males we only found a sigificant assocition between correct answer and calcium (p-value = 0.039) and phosphorus (p-value = 0.025) intake. In summary, the overall disaster-related nutrition knowledge among study subjects was only fair and was significantly associated with parental status, regular medication use, waist circumference and current dietary intake. We conclude, there is a need to educate the study population regarding disaster-related nutrition. Further studies are need to determine how best to educate the study population regarding this imporatnt issue in order to reduce risk for nutrition-related problems during disasters.
Copyright (c) 2026 The Southeast Asian Journal of Tropical Medicine and Public Health
FACTORS ASSOCIATED WITH UNDERWEIGHT, OVERWEIGHT AND OBESITY AMONG SCHOOL-AGE CHILDREN IN A HIGH-ALTITUDE REGION OF CHINA
Childhood undernutrition and overnutrition are major public health problems among school-age children in high-altitude multi-ethnic regions of the People’s Republic of China. In this study, we aimed to determine factors independently associated with underweight, overweight and obesity among school-age children in Qinghai Province, a high-altitude multi-ethnic region of western China, in order to inform efforts to prevent these conditions. The students were chosen by multi-stage stratified cluster random sampling. One primary school from each city or prefecture was selected and then one class per grade (grades 1-6) was selected from each study school and the parents of all the students in that class were invited to participate in the study. Inclusion criteria for the students were enrollment in a selected class, being aged 7-12 years, being a resident of Qinghai Province for at least 3 years prior to the study, having parents able to communicate in the survey language and being willing to participate in the study. Exclusion criteria for the students were not meeting inclusion criteria, being hospitalized during the previous month, having a chronic disease that could affect their weight, currently taking glucocorticoids and having a major weight change prior to the study. The minimum number of students calculated to be needed for the study was 807. Study subjects were a parent from each student invited to participate. A parent of each student was asked to complete a self-administered questionnaire asking about demographic factors, socioeconomic status of the family, student early-life factors, student diet, student lifestyle (outdoor physical activity, electronic device use and sleep duration), parental knowledge and attitudes about nutrition and parental behaviors (parental perception of the student subject’s body-size category, parental use of food as a reward, parental restriction of snacks, parental physical exercise habits and joint parent-child exercise). Parental knowledge about nutrition was assessed with 10 questions on the questionnaire. A correct answer was given one pointand an incorrect answer was given 0 point. The total possible score had a range of 0-10. A higher score indicated better parental nutritional knowledge. Parental attitudes about balanced nutrition were assessed using 11 questions answered using a 5-point Likert scale (each question had a score from 0 (disagreement with the statement) to 4 points (completely agreed with the statement) giving a total possible score of 0-0- 44 points, with a higher score indicating more favorable parental attitudes. We measured each student’s height, weight and waist and hip circumferences. Body mass index (BMI) was calculated as weight (in kg) / height (in m²). Subjects were classified into four weight-status categories using age- and sex-specific cut-off points obtained from International Obesity Task Force criteria for underweight and Working Group on Obesity in China criteria for overweight and obesity. The underweight, normal weight, overweight and obese criteria for boys aged 7, 8, 9, 10, 11 and 12 years were ≤13.9, 14.0-17.3, 17.4-19.1, ≥19.2; ≤14.0, 14.1-18.0, 18.1-20.2, ≥20.3; ≤14.1, 14.2-18.8, 18.9-21.3, ≥21.4; ≤14.4, 14.5-19.5, 19.6-22.4, ≥22.5; ≤14.9, 15.0-20.2, 20.3-23.5, ≥23.6; and ≤15.4, 15.5-20.9, 21.0-24.6, ≥24.7 kg/m², respectively; and for girls of the same ages were ≤13.4, 13.5-17.1, 17.2-18.8, ≥18.9; ≤13.6, 13.7-18.0, 18.1-19.8, ≥19.9; ≤13.8, 13.9-18.9, 19.0-20.9, ≥21.0; ≤14.0, 14.1-19.9, 20.0-22.0, ≥22.1; ≤14.3, 14.4-21.0, 21.1-23.2, ≥23.3; and ≤14.7, 14.8-21.8, 21.9-24.4, ≥24.5 kg/m², respectively. The study was conducted during September 2021-October 2022. We used univariate and multivariate logistic regression analysis to identify factors significantly associated with underweight, overweight and obesity and the results are expressed as odds ratios (ORs) with 95% confidence intervals (CI). A total of 1,561 student subjects were included in our study: 52.0% (n = 811) females. The mean (±standard deviation (SD)) age of student subjects was 9.2 (±1.7) years. 279 student subjects (17.9%) were underweight, 1,065 (68.2%) had a normal weight, 122 (7.8%) were overweight and 95 (6.1%) were obese. On multivariate analysis variables significantly associated with higher odds of the student subject being underweight were student subject male sex (aOR: 1.61; 95%CI: 1.22-2.12, p-value <0.001) and having a higher parental subject nutrition-related attitude score (for each 1- point increase in the score there was an increase in the aOR of 1.04; 95%CI: 1.02-1.07, p-value = 0.002). The factors significantly associated with lower odds of the student subject being underweight were: having been born by cesarean section (versus vaginal delivery; aOR: 0.58; 95%CI: 0.40-0.85, p-value = 0.005), having a parental subject perception of the student subject being in a higher BMI class than the student subject’s actual BMI class (for each higher BMI class than the actual student subject class the aOR decreased by 0.62; 95%CI: 0.49-0.78, p-value <0.001), more frequent parental physical exercise (for each one-level increase on the 4-level exercise scale the aOR decreased by 0.68; 95%CI: 0.54-0.87, p-value = 0.002) and more frequent parent-child joint exercise (for each one-level increase on the 4-level exercise scale the aOR decreased by 0.72; 95%CI: 0.52-0.98, p-value = 0.039). The variables significantly associated with higher odds of the student subject being overweight (versus normal weight) were the student subject having been born by cesarean section (aOR: 1.80; 95%CI: 1.12-2.89, p-value = 0.015) and having a parental subject perception of the student subject being in a higher BMI category than the actual category (for each category higher than the actual category the aOR increased by 2.24; 95%CI: 1.72-2.92, p-value <0.001). The variables significantly associated with lower odds of the student subject being overweight were older student subject age (for every 1-year increase in the student subject age the aOR decreased by: 0.87; 95%CI: 0.76-0.98, p-value = 0.028), having a higher parental subject nutrition-related attitude score (for every 1-point increase in the score the aOR decreased by: 0.95; 95%CI: 0.92-0.98, p-value = 0.002) and more frequent parental physical exercise (for each one-level increase on the 4-level exercise scale the aOR decreased by 0.64; 95%CI: 0.46-0.89, p-value = 0.009). The factor significantly associated with higher odds of student subject obesity (versus normal weight), was having a parental subject perception of the student subject being in a higher BMI category than the actual BMI category (for each higher BMI category than the actual category the aOR increased by 1.83; 95%CI: 1.36-2.47, p-value <0.001). The factors significantly associated with lower odds of student subject obesity were older student subject age (for every 1-year increase in age the aOR decreased by: 0.71; 95%CI: 0.62-0.83, p-value <0.001) and more frequent parental physical exercise (for each one-level increase on the 4-level exercise scale the aOR decreased by 0.45; 95%CI: 0.29-0.70, p-value <0.001). In summary, factors significantly associated with greater odds of the student subject being underweight were student subject male sex and having a higher parental subject nutrition-related attitude score and with lower odds of being underweight were being born by cesarean section and having a parental subject perception of the student subject being in a higher BMI class than the actual BMI class, more frequent parental physical exercise, and more frequent parent-child joint exercise. Factors significantly associated with higher odds of student subject being overweight were having been born by cesarean section and a parental subject perception of the student subject being in a higher BMI class than the actual BMI class and with lower odds of being overweight were older student subject age, higher parental subject nutrition-related attitude score and more frequent parental physical exercise. The factor significantly associated with higher odds of student subject obesity was having a parental subject perception of the student subject being in a higher BMI class than the actual BMI class and lower odds of obesity were older student subject age and more frequent parental physical exercise. We conclude, there is a need for education of study students and their parents regarding exercise and whether the student’s weight was normal or not. Further studies are needed to determine how to improve both student and parental attitudes about exercise and nutrition.
HYBRID-CAPTURE NEXT-GENERATION SEQUENCING FOR VIRAL DETECTION IN ACUTE FEBRILE ILLNESS OF UNKNOWN ETIOLOGY PATIENTS IN NAKHON PHANOM AND TAK PROVINCES, THAILAND
An acute febrile illness (AFI) with an unknown etiology is a major diagnostic challenge in tropical settings. In this study we aimed to evaluate hybrid-capture next-generation sequencing (NGS) for detecting viral pathogens in hospitalized AFI patients with negative routine diagnostic results in order to determine the kinds of viruses causing an AFI in the study locations that were missed by routine testing and the proportion of those cases that could be detected by hybrid-capture NGS testing. We retrospectively examined previously collected serum samples obtained from patients hospitalized with AFI during 2017-2020 in Nakhon Phanom and Tak Provinces, Thailand in whom no etiology was determined and in which an adequate sample was available to conduct the specified testing. In each sample, total nucleic acids were extracted and analyzed using a hybrid-capture NGS test with the Twist Comprehensive Viral Research Panel and interpreted using a metagenomics pipeline with predefined background-subtraction and positivity criteria. The median age of the study subjects in whom the samples were obtained was 36 (range: 2-79) years, 60.0% females. Viral pathogens were detected by hybrid-capture NGS in 65 (56.5%) of the 115 samples. Cytomegalovirus (n = 29, 25.2%) and Epstein-Barr virus (n = 27, 23.5%) were the most frequently identified pathogens, followed by enterovirus A (n = 2, 1.7%), enterovirus B (n = 1, 0.9%), hepatitis B virus (n = 2, 1.7%), human herpesvirus 7 (n = 2, 1.7%), influenza A virus (n = 1, 0.9%), and Kaposi’s sarcoma-associated herpesvirus (n = 1, 0.9%). It is important to remember easily tested for viruses, such as influenza viruses, were already tested for and found to be negative in order to be included in this study. In summary, hybrid-capture NGS was able to determine more than half of samples previously testing negative with routine testing and the most common viruses detected were CMV and EBV. We conclude the hybrid-capture NGS may be beneficial for evaluating viral AFI in which the etiology is unclear with routine testing. Further studies in other populations are needed to determine when and in what situations the hybrid-capture NGS would be of most benefit in guiding management of patients with AFI of unknown etiology.
SURVEY OF PUBLIC AWARENESS IN SAUDI ARABIA ABOUT THE LINK BETWEEN BLOOD TYPE AND RISK FOR ACQUIRING CERTAIN DISEASES
Some blood types have been reported to be associated with certain diseases but public awareness of these associations in Saudi Arabia is unclear. In this study we aimed to assess awareness of the association between blood types and certain diseases among adults in Saudi Arabia in order to inform efforts to improve this awareness. Study subjects were recruited from the general population of Saudi Arabia using a convenience sampling method via an online questionnaire distributed through social media platforms. Inclusion criteria for study subjects were being aged ≥18 years, living in Saudi Arabia and completing a study questionnaire. Exclusion criteria for study subjects were not meeting inclusion criteria and incompletely filling out the questionnaire. The questionnaire was reviewed by experts and pilot-tested to ensure clarity and validity. The minimum number of study subjects determined to be needed for the study was 440 subjects. Each subject was asked to complete a questionnaire asking about demographic characteristics, current health status, beliefs about the relationship between blood type and certain diseases, awareness of these associations and whether they could name the associated diseases. We evaluated potential associations between gender, age, marital status, family history of chronic disease and subject awareness about these associations using the chi-square test. A knowledge score was given based on answers to the questions on the questionnaire, giving 1 point for each correct answer with a potential score of 0-7 points. Knowledge scores were categorized as poor (0-2 points), average (3-4 points) or good (≥5 points). 1,191 subjects were included in the study, 871 (73.1%) females. 495 subjects (41.6%) believed there could be an association between blood type and certain diseases; 332 subjects (27.9%) were aware of such associations. The mean (±standard deviation) knowledge score among study subjects regarding the association was 1.94 (±1.55) points; 765 subjects (64.2%) had a poor knowledge level, 337 (28.3%) had an average knowledge level and 89 (7.5%) had a good knowledge level. When subjects were asked to indicate which specific diseases were associated with blood type (multiple selections allowed), 410 (34.4%) mentioned stroke, 322 (27.0%) mentioned diabetes mellitus type 2, 273 (22.9%) mentioned hyperlipidemia and 238 (20.0%) mentioned hypertension. Awareness was significantly higher (p-value = 0.001) among females (n = 387, 44.4%) than males (n = 108, 33.8%). There were significant differences in subject awareness by blood type. The greatest (p-value = 0.01) awareness among subjects about the association between blood type and certain diseases was among subjects aged 18-24 years (n = 296, 45.1%) followed by those aged 25-50 years (n = 182, 37.7%) and those aged >50 years (n = 17, 32.7%) (p-value = 0.01). Significantly more (p-value = 0.02) single subjects (n = 348, 44.0%) were aware of the association between blood type and certain disease than married subjects (n = 147, 36.8%). Significantly more (p-value <0.001) subjects with a family history of chronic disease (n = 318, 45.8%) had awareness of the association between blood type and certain diseases than subjects without a family history of chronic disease (n = 177, 35.6%). 180 subjects (15.1%) stated they had adopted a preventive lifestyle based on their blood type in order to reduce their risk for developing the disease associated with their blood type. In summary, the proportion of subjects who were aware of the associations between blood type and certain diseases was low and few reported making lifestyle changes based on such associations. We conclude, given the modest strength of most associations and the absence of evidence for blood type-based preventive interventions, the public health relevance of these findings is unclear but there is a need to educate the study population regarding the association between blood type and certain disease. Further studies are needed to determine if adopting a healthy lifestyle can reduce the risk for developing these blood type disease associations and whether knowledge of these associations will result in a change in preventive lifestyle activities.
A BELIEF-BASED JUMP ROPE INTERVENTION TO PROMOTE LEISURE-TIME PHYSICAL ACTIVITY AMONG INACTIVE UNIVERSITY STUDENTS IN SOUTH KOREA: A PERCEPTION AND PROCESS EVALUATIONef-Based Jump Rope Intervention to Promote Leisure-Time Physical Activity among Inactive University Students: A Process and Outcome Evaluation
Despite persistently low levels of physical activity among university students following the COVID-19 pandemic, theory-driven interventions targeting inactive students remain limited. The study developed, implemented and evaluated a belief-based leisure-time physical activity promotion program for inactive university students. Inactive undergraduate students engaging in less than 150 minutes of physical activity per week were recruited from a South Korean university. A four-week jump rope intervention was implemented. Process evaluations, including reach, dose delivered, dose received, and fidelity, were assessed at the midpoint and the post-intervention stages. Group-by-time effects on leisure-time physical activity-related beliefs, intentions and behaviors were assessed using a generalized linear model with repeated measurements at four time points (pre-intervention, midpoint, post-intervention, and one-month follow-up). Significant changes in the intervention effects were observed for key leisure-time physical activity-related beliefs. Compared with the control group, physically inactive students with high intervention adherence demonstrated greater increases in perceived mental and physical health benefits from the post-intervention period through to the one-month follow-up. Improvements were also observed in the perceived “friends’ approval” and control beliefs related to exercise facilities and exercise partners, particularly at the midpoint assessment. These findings indicate that belief-based leisure-time physical activity interventions informed by empirically identified beliefs can effectively modify targeted beliefs among physically inactive university students. Future studies should determine whether sustained belief changes can translate into longer-term improvements in physical activity behavior.
GLYCEMIC CONTROL AND BMI AMONG ETHNIC MINORITY OLDER ADULTS IN NORTHERN THAILAND: IMPACT OF HEALTH LITERACY AND SELF-MANAGEMENT
Type 2 diabetes mellitus imposes a disproportionate health burden on older adults of ethnic minorities in northern Thailand. These groups face a “double burden” of geographic isolation and language barrier, the latter stemming from the use of Thai in health information dissemination. The study aimed to examine the predictive relationships of health literacy (HL), diabetes distress and self-management behaviors with clinical outcomes (fasting blood sugar [FBS] and body mass index [BMI]). A cross-sectional predictive correlational study was conducted among 150 ethnic minority older adults recruited from five sub-district health-promoting hospitals in Chiang Rai Province, northern Thailand. Data were collected through face-to-face interviews using the Diabetes Self-Management Questionnaire (DSMQ) and Diabetes Distress Scale (DDS-17). Participants (66 ± 6 years of age) exhibited high vulnerability, namely 70% with no formal education and 58% obesity. Multiple linear regression models revealed that age (β = -0.296, p-value <0.001) and HL (β = -0.263, p-value = 0.001) are significant negative predictors of FBS; whereas self-management is a significant positive predictor of FBS (β = 0.169, p-value = 0.029), suggesting a “reactive management”. Age is the sole significant negative predictor of BMI (β = -0.166, p-value = 0.047). HL acted as a critical determinant of glycemic control, distinct from diabetes distress. The findings indicated that public health interventions should shift from text-based directives to visual, bilingual models to overcome any language barrier.
ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND SARCOPENIA AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA: A CROSS-SECTIONAL STUDY
Physical activity has been reported to be an effective method to reduce the risk of sarcopenia. In this cross-sectional study, we aimed to determine if there is a significant association between physical activity levels and the prevalence of sarcopenia among middle-aged and older adults in China in order to inform efforts to prevent and manage sarcopenia in the study population. The data used in our study were obtained retrospectively from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. The CHARLS assessed physical activity levels among study subjects using the International Physical Activity Questionnaire (IPAQ) asking about activity during the previous week, expressed as metabolic equivalents of task in minutes (MET-minutes) per week. Sarcopenia in our study was defined using the 2019 Asian Working Group for Sarcopenia (AWGS) criteria and classified as possible sarcopenia, sarcopenia and severe sarcopenia. Study subjects were divided into 3 groups based on their physical activity levels following IPAQ criteria as: low (<600 MET-min/week, reference group), moderate (600-3,000 MET-min/week) and high (>3,000 MET-min/week). We used multivariable logistic regression analysis and restricted cubic splines to identify significant associations between physical activity levels and sarcopenia. A total of 8,449 subjects were included in the study: 52.4% (n = 4,426) females. The mean (±standard deviation (SD)) age of study subjects was 66.1 (±8.6) years (range: 45–90 years). The mean (±SD) body mass index (BMI) of subjects was 23.56 (±3.70) kg/m². 1,855 subjects (22.0%) met the 2019 AWGS criteria for having possible sarcopenia and 1,346 (15.9%) met the criteria for sarcopenia and 605 (7.2%) met the criteria for severe sarcopenia. The median (interquartile range (IQR)) physical activity levels among subjects without sarcopenia, those having possible sarcopenia, sarcopenia and severe sarcopenia were: 2,562.00 (933.00-7,337.00), 1,782.00 (462.00-6,716.25), 2,032.50 (309.50-6,318.00) and 1,732.50 (462.00-5,544.00) MET-min/week, respectively. The median IQR among subjects without sarcopenia was statistically higher than among subjects in the other 3 groups (p-value <0.001). After adjusting for age, gender, marital status, location of residence, education level, body mass index, smoking status, alcohol consumption status and retirement status, subjects in the moderate and high physical activity level groups had significantly lower odds of having possible sarcopenia than subjects in the low physical activity group (moderate activity level versus (vs) low activity level: adjusted odds ratio (aOR): 0.791; 95% confidence interval (CI): 0.683-0.915, p-value = 0.002 and high activity level vs low activity level: aOR: 0.679; 95% CI: 0.594-0.776, p-value <0.001). Subjects in the high physical activity level had significantly lower odds of having sarcopenia than subjects in the low activity level group (aOR: 0.745; 95% CI: 0.584-0.950, p-value = 0.017). Subjects in the high physical activity level group had significantly lower odds of having severe sarcopenia than subjects in the low activity level group (aOR: 0.679; 95% CI: 0.499-0.923, p-value = 0.013). Restricted cubic spline analysis showed subjects in the high activity group had significantly lower odds of having possible sarcopenia by overall association than subjects in the low activity group (p-value <0.001) and subjects in the high activity group had significantly lower odds of having possible sarcopenia by nonlinear association than subjects in the low physical activity group (p-value = 0.001). However, subjects in the high activity group did not have significantly lower odds of sarcopenia than subjects in the low physical activity group by overall association or nonlinear association (p-value = 0.560). For severe sarcopenia, the overall association approached significance but was not significant (p-value = 0.054). When all sarcopenia categories were combined, on restricted cubic spline analysis, subjects with high activity levels had significantly lower odds of having any kind of sarcopenia than subjects in the low physical activity group for overall association (p-value <0.001) and nonlinear association (p-value = 0.002). Subgroup analysis revealed subjects who did not smoke and had a high activity level had lower odds of having possible sarcopenia than subjects with a high activity level who did smoke (aOR: 0.644; 95% CI: 0.553-0.750, p-value <0.001). Subgroup analysis also showed subjects who were not retired and who had a high physical activity level had lower odds of having possible sarcopenia than retired subjects who had a high physical activity level (aOR: 0.654; 95% CI: 0.566-0.756, p-value <0.001). No significant differences were found by sarcopenia category (p-value for interaction >0.05). In summary, subjects with higher physical activity levels had significantly lower odds of having possible sarcopenia, sarcopenia and severe sarcopenia than subjects with low physical activity levels. We conclude, moderate to high physical activity levels are recommended for subjects in the study group in order to prevent or manage sarcopenia. Further studies are needed to determine if interventions to increase physical activity are able to prevent or reduce sarcopenia in this population.
LEGIONELLA WATER SURVEILLANCE IN SOUTHEASTERN TURKIYE:A FIVE-YEAR EPIDEMIOLOGICAL EVALUATION
Legionella is a waterborne Gram-negative bacterium transmitted mainly through inhalation of contaminated aerosol from artificial water systems, such as those found in healthcare facilities and hotels. In this study we aimed to determine the prevalence and temporal trends of Legionella in hospitals and hotels in southeastern Türkiye in order to inform prevention strategies at these study sites. Water samples were collected from hot- and cold-water systems from study sites and sent for culture and filtration with acid treatment in order to detect Legionella spp from January 2019 to December 2023. Water samples were collected from faucets, shower heads, storage reservoirs, hot and cold-water tanks and were processed within 24 hours of collection. A total of 67 hospitals and 7 hotels were purposively selected for the study. A total of 7,112 water samples were collected and included in the study; 6,934 (97.4%) from hospitals and 178 (2.6%) from hotels. Of these, 624 samples (8.8%) were positive for Legionella spp; 596 (95.5%), from hospitals and 28 samples (4.5%) from hotels (p-value<0.001). The most common sites with positive specimens were from faucets (n = 327, 52.4%) and shower heads (n = 182, 29.2%). 430 samples (68.9%) were positive for serogroups 2-14 and 182 samples (29.2%) were positive for serogroup 1 (p-value<0.001). The mean bacterial concentration among positive study samples was relatively low (52 CFU/ml). The numbers of positive samples during the Spring, Summer, Winter and Autumn were 130 (20.8%), 205 (32.9%), 111 (17.8%) and 178 (28.5%) samples, respectively (p-value<0.001). In summary, Legionella contamination was widespread in healthcare water systems in Southeast Türkiye with the most common serogroups being L. pneumophila serogroups 2–14. Conclusion, there is a need for improved water management and continuous surveillance at the study sites to reduce the risk of contracting Legionella infection at the study institutions. After implementing these prevention measures further studies are needed to determine their efficacy.
A 5-YEAR REVIEW OF TRAUMA CASES AMONG PATIENTS AGE 15-64 YEARS PRESENTING TO A SINGLE TRAUMA CENTER IN NORTHWESTERN CHINA
Trauma is a major cause of morbidity, mortality and time lost from work in the People’s Republic of China. In this study we aimed to review the characteristics of trauma cases among patients aged 15-64 years who presented to a single trauma center in northwestern China in order to inform efforts to prevent and manage this trauma. We retrospectively reviewed the trauma database at the First Hospital of Lanzhou University during 1 June 2020-31 May 2025. The inclusion criteria for study subjects were: 1) being aged 15-to 64 years, 2) being seen at the trauma center at the study institution for an injury, 3) having medical records documenting the mechanism of injury, 4) having complete medical records that included relevant demographic and clinical data necessary for comprehensive analysis, and 5) presenting to the study institution during the study period. The exclusion criterion for study subjects was: having missing or incomplete medical records. A total of 27,974 subjects were included in the study: 16,223 (58.0%) males (p-value <0.001). The mean (±standard deviation) age of subjects was 36.6 (±13.3) (range: 15-64) years. The most common causes of trauma were falls (n = 12,951, 46.30%), followed by road traffic accidents (n = 4,858, 17.37%), other trauma (n = 3,517, 12.57%) and cuts/stabs (n = 3,199, 11.44%). The most common injured areas were extremities (n = 18,602, 66.53%) and head/neck (n = 5,911, 21.11%). The most common time of injuries was 14:00-16:00 (n = 3,945, 14.10%), followed by 20:00-22:00 (n = 3,531, 12.62%) and 12:00-14:00 (n = 3,424, 12.24%). The mostcases occurred during the Spring (n = 8,631, 30.85%), followed by Summer (n = 7,257, 25.95%), Fall (n = 6,590, 23.57%) and Winter (n = 5,496, 19.65%) (p-value <0.001). In summary, trauma was most common among young-to-middle-aged males with the most common types being falls and road traffic accidents, occurring more in the Spring the and mid-afternoon. In conclusion, public health prevention efforts need to prioritize younger men, especially in the Spring and focus on prevention of falls and promote road safety. Future studies are needed to determine what cost-effective interventions can reduce these trauma cases.
REVIEW OF STREPTOMYCIN-ASSOCIATED OTOTOXICITY IN BRUCELLOSIS CASES
Brucellosis is a zoonotic infectious disease with a worldwide distribution and one of the challenges with its treatment is the risk of ototoxicity associated with aminoglycoside-containing regimens. In this study we aimed to review streptomycin-containing brucellosis treatment cases in order to determine the incidence of streptomycin-induced ototoxicity in the study population in order to inform treatment efforts. We conducted a single-center retrospective cohort study. Study subject inclusion criteria were being aged ≥18 years, having been diagnosed with brucellosis at the study institution during 10 January 2023-31 March 2024, having normal tympanic membranes on otoscopy, receiving a treatment regimen containing streptomycin and having undergone pure tone audiometry assessing air conduction at 500, 1000, 2000 and 4000 Hz. Hearing loss was classified as mild (26-40 dB), moderate (41-55 dB), moderately severe (56-70 dB), severe (71-90 dB) and profound (≥91 dB). Study subject exclusion criteria were pregnancy or lactation, chronic renal failure, receiving ongoing chemotherapy for a malignancy, use of known ototoxic medications (excluding nonsteroidal anti-inflammatory drugs) within the previous 3 months, having the presence of severe hearing loss at baseline prior to treatment and having missing data. A total of 70 subjects were included in our study, 60% (n = 42) females. The mean (±standard deviation (SD)) age of study subjects was 43 (±14) (range: 19-70) years. At baseline the number of subjects with hearing loss was 9 (13%); during treatment 7 (10%); 5 (71%), 1 (14%), 0 (0%), 1 (14%) and 0 (0%) had mild, moderate, moderately severe, severe and profound hearing loss, respectively; at completion 0 subjects (0%) had hearing loss. The mean (±SD) age of subjects who developed temporary high-frequency hearing loss during treatment was 57 (±4) years, significantly higher (p-value = 0.030) than the age of subjects without hearing loss, which was 43 (±2) years. In summary, among our study subjects, streptomycin-associated ototoxicity during standard brucellosis treatment was uncommon and reversible. However, older subjects were at greater risk of developing temporary but reversible ototoxicity. We conclude streptomycin is safe to use in brucellosis-treatment regimens in the study population. However, caution should be used in older adults and may warrant audiological testing during and at the end of treatment among older patients. Further testing is needed to determine at what age such testing may be considered.
ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVELS AND CARDIOMETABOLIC MULTIMORBIDITY IN CHINESE MIDDLE-AGED AND OLDER ADULTS
Physical activity has been reported to be an effective method to reduce the risk of cardiometabolic multimorbidity (CMM). In this prospective cohort study, we aimed to determine if there is a significant association between physical activity levels and the incidence of CMM among middle-aged and older adults in China in order to inform efforts to reduce CMM in the study population. CMM was defined as the concurrent presence of at least two of the following three diseases: heart disease, stroke, and diabetes, based on self-reported physician diagnoses. This study was based on data from the China Health and Retirement Longitudinal Study (CHARLS) conducted during 2015-2020. Study subjects were randomly selected using multistage stratified probability proportional sampling from 28 provinces across China. Inclusion criteria for study subjects were being aged ≥45 years at baseline (2015), having no history of stroke, diabetes or heart disease at baseline, completing all three waves of follow-up, and having complete data regarding physical activity and other study variables. Exclusion criteria for subjects were having CMM at baseline, incomplete follow-up data and missing key variables. Physical activity level was assessed using a standardized questionnaire asking about vigorous, moderate, and light activities during the previous week, expressed as metabolic equivalents of task in minutes (MET-minutes) per week. Study subjects were then equally divided into 4 groups based on their baseline total weekly MET-minutes as follows: Quartile (Q)1 (reference group) (<1,732.5 MET-min/week), Q2 (1,732.5-5,287.5 MET-min/week), Q3 (5,287.5-11,848.5 MET-min/week) and Q4 (≥11,848.5 MET-min/week). We used time-varying Cox proportional hazards regression analysis and restricted cubic splines to identify significant associations between physical activity levels and CMM incidence. A total of 4,516 subjects were included in the study (1,129 subjects in each quartile): 52.8% (n = 2,384) females. The mean (±standard deviation (SD)) age of study subjects was 57.3 (±8.9) years. The mean (±SD) body mass index of subjects was 23.8 (±3.7) kg/m². During the follow-up period, 151 subjects (3.3%) developed CMM. The mean (±SD) physical activity levels were 6,190.8 (±7,106.5) MET-min/week for the CMM group and 7,430.9 (±6,779.4) MET-min/week for the non-CMM group (p-value = 0.036). After adjusting for age, gender, marital status, residence, education, BMI, smoking, drinking, and retirement status, subjects in Q2, Q3, and Q4 had significantly lower hazard ratios (HR) (Q2: HR = 0.537; 95% confidence interval (CI): 0.351-0.821, p-value = 0.004; Q3: HR = 0.490; 95% CI: 0.313-0.767, p-value = 0.002; Q4: HR = 0.479; 95% CI: 0.282-0.814, p-value = 0.007) of developing CMM than subjects in Q1. Subgroup analyses revealed that the protective effects of physical activity were particularly pronounced among non-smokers (Q2: HR = 0.382; 95% CI: 0.230-0.634, p-value <0.001; Q3: HR = 0.475; 95% CI: 0.293-0.772, p-value = 0.003; Q4: HR = 0.522; 95% CI: 0.297-0.918, p-value = 0.024) with a significant interaction (p-value for interaction = 0.006). The protective effects of activity were also significantly greater among overweight and obese participants (Q2: HR = 0.568; 95% CI: 0.337-0.958, p-value = 0.034; Q3: HR = 0.319; 95% CI: 0.168-0.605, p-value <0.001; Q4: HR = 0.433; 95% CI: 0.215-0.869, p-value = 0.019). Restricted cubic spline analysis revealed a significant overall association between total physical activity and CMM risk (p-value for overall = 0.007), although the nonlinear association was not statistically significant (p-value for nonlinear = 0.210). In summary, subjects with higher levels of physical activity had significantly lower risk of developing CMM than subjects in the lowest activity quartile, and this protective effect was particularly evident among non-smokers and overweight and obese individuals. We conclude that higher physical activity levels are associated with reduced CMM risk among study subjects. Further studies are needed to determine if interventions to increase physical activity are able to prevent CMM in this population and to elucidate the mechanisms underlying the differential effects across subgroups.
ROLE OF DIGITAL MEDIA INFLUENCE ON CANCER AWARENESS AMONG UNIVERSITY STUDENTS IN SAUDI ARABIA: A CROSS-SECTIONAL STUDY
Cancer remains a major public health challenge in Saudi Arabia, and university students mainly rely on digital media for health information. Thus, the study evaluated cancer awareness among university students and examined the associations among the types of digital platforms used with their levels of cancer awareness. A cross-sectional study was conducted among 429 university students using a validated self-administered questionnaire to gather sociodemographic characteristics and digital media use for information on cancer. The majority of students reported social media as their primary source for cancer information, followed by online/AI-based platforms and videos. The overall cancer awareness was average, with a better awareness of treatment side-effects compared with other awareness categories. The students’ level of cancer awareness depended on their age, educational program enrolled, residence location (urban or rural), and type/frequency of digital media accessed, with students having a lower general cancer awareness level being more likely to depend on social media for information. These findings indicated that digital media, particularly social media, are significantly associated with the level of cancer awareness among university students. Strengthening trustworthy, youth-friendly cancer awareness online content will help raise cancer understanding among the young population and facilitate adherence to public policies and recommendations on cancer prevention and control.
READINESS FOR HOSPITAL DISCHARGE AND INFLUENCING FACTORS OF FAMILY CAREGIVERS OF PATIENTS WITH COGNITIVE IMPAIRMENT AFTER TRAUMATIC BRAIN INJURY: A CROSS-SECTIONAL SURVEY FROM WENZHOU, PR CHINA
Traumatic brain injury (TBI) creates substantial challenges for patients and their family caregivers, especially during hospital-to-home transition. Given the family caregivers’ primary role in post-discharge care in PR China, this cross-sectional study enrolled TBI patients and their respective family caregivers (n = 146 for each group) at a tertiary hospital in Wenzhou, Zhejiang to assess the caregivers’ readiness for patients’ discharge and identify predictors of preparedness via several validated questionnaires, namely Readiness for Hospital Discharge Scale (FAM-RHDS), General Self-Efficacy Scale (GSES), Family Needs Questionnaire - Revised (FNQ-R), and Quality of Life after Brain Injury (QOLIBRI). The results showed that 64% of caregivers had high readiness. Multiple regression analysis identified caregiver education level, self-efficacy and family needs, and patient’s age and quality of life as significant predictors, covering 74.6% of variance in discharge readiness. In conclusion, this study showed that a family caregiver readiness for the TBI patient’s hospital discharge was affected by both caregiver- and patient-related factors, highlighting the need for targeted interventions, such as personalized education programs and support services, to enhance caregivers’ readiness and optimize post-discharge outcomes for TBI patients.
EFFECT OF PLAN-DO-CHECK-ACT CYCLE ON CONTROLLING RISK OF MULTIDRUG-RESISTANT ORGANISM INFECTIONS AMONG PATIENTS IN INTENSIVE CARE UNIT, THE SECOND XIANGYA HOSPITAL, CENTRAL SOUTH UNIVERSITY, HUNAN, PR CHINA
Patients in the intensive care unit (ICU) are at a high risk of developing multidrug-resistant organism (MDRO) infections because of their critical condition, frequent invasive procedures and inappropriate use of broad-spectrum antibiotics. This study evaluated the effect of the Plan-Do-Check-Act (PDCA) cycle system on controlling the risk of MDRO infections in ICU patients. Patients who tested negative for bacterial infection upon hospital admission were randomly assigned to control and PDCA groups (n = 64 per group) for routine MDRO prevention and control measures (the former group) and routine measures together with the PDCA cycle-based management (the latter group) during their ICU stay. Patients’ MDRO infection rate, antimicrobial use density, ICU length of stay, total hospitalization stay and ICU MDRO contamination were significantly reduced in the PDCA group compared to the control (p-value <0.050). However, the 28-day mortality was not different between the two groups. In addition, nurses’ hand hygiene behavior was significantly improved in the PDCA group compared to the control (n = 30 per group). The results confirmed the utility of the PDCA cycle system for bacterial infection prevention and control in ICUs. However, its long-term benefits need to be determined through expanding the cohort size and extending the intervention duration.
FACTORS ASSOCIATED WITH COVID-19 OUTBREAK PREVENTION BEHAVIOR AMONG VILLAGE HEALTH VOLUNTEERS IN CHIANG RAI, THAILAND
Coronavirus disease 2019 (COVID-19) remains a public health concern in Thailand, posing significant risks to individuals with chronic illnesses and the elderly. To reduce the spread of COVID-19, village health volunteers (VHVs) play a vital role in preventing and controlling diseases at the community level. The cross-sectional study examined factors associated with COVID-19 prevention behavior among VHVs in Chiang Rai Province. Participants (n = 362) were selected using a two-stage cluster random sampling method, and data were collected between June and August 2022 using a structured questionnaire. The results showed that VHVs had a high level of COVID-19 prevention behavior, which was associated with knowledge of disease, perceived self-efficacy, work motivation, and social support. Female VHVs exhibited significantly better prevention behavior than males (p-value <0.05). To further maintain and reinforce VHVs’ COVID-19 prevention behavior, more training programs should be organized, and initiatives that foster self-efficacy, boost work motivation and offer ongoing social support should be implemented.
LOW-LEVEL CIRCULATION OF CHIKUNGUNYA VIRUS DURING COVID-19 MOBILITY RESTRICTIONS IN THE KLANG VALLEY, MALAYSIA
Chikungunya virus (CHIKV) and dengue virus (DENV) co-circulate in Malaysia, share Aedes mosquito vectors, and present with overlapping early clinical manifestations, making laboratory confirmation essential for accurate diagnosis. This study aimed to identify CHIKV infections among patients clinically suspected of dengue but testing negative for dengue markers during the COVID-19 pandemic and to characterize any detected viruses genomically. From May 2020 to May 2021, 917 serum specimens from patients at the Universiti Malaya Medical Centre who were negative for dengue NS1 antigen, anti-dengue IgM, and DENV RNA were screened for CHIKV using a validated in-house pan-Alphavirus RT-PCR targeting the conserved nsP4 gene. One specimen (0.11%) tested positive. Complete genome sequencing generated an approximately 11.6 kb genome, and phylogenetic analysis placed the isolate within the East/Central/South African (ECSA) genotype, clustering closely with strains from Myanmar and Thailand. The isolate carried amino acid substitutions of epidemiological relevance (E1-211E, E1-226A, and E2-264A), characteristic of a regionally adapted ECSA lineage capable of efficient transmission by Ae. aegypti. These genomic features support persistence of a regional endemic lineage rather than a new introduction. The exceptionally low detection rate during Malaysia’s Movement Control Order (MCO) period further supports evidence that CHIKV transmission is strongly shaped by human mobility and behavioral exposure patterns. Recovery of a complete genome during this period provides a valuable baseline for monitoring viral evolution or re-emergence as mobility returns to pre-pandemic levels. Integrating CHIKV testing into dengue-negative febrile illness workups and maintaining genomic surveillance will be essential for early detection of resurgence.
BUILT ENVIRONMENT BARRIERS AND FACILITATORS TO PHYSICAL ACTIVITY IN INDIAN CITIES: A SCOPING REVIEW
Extensive research in developed countries confirms the influence of the urban built environment (BE) on physical activity (PA), but similar studies in low- and middle-income countries, such as India, are limited. A scoping review was conducted through a systematic search of the Web of Science, Scopus and PubMed databases, as well as additional sources, to identify articles on BE, PA and BE influence on PA conducted in India up to June 2024. Twenty-seven articles were chosen based on PRISMA-ScR guidelines. Four themes across demographic groups and locations were classified, namely walking and cycling infrastructure, safety from traffic and crime, access to PA resources, and aesthetics and environmental quality, together with age- and gender-specific findings. Several research gaps were also identified, such as reliance on self-reported questionnaires, limited use of objective assessment tools, under-representation of specific demographic groups, and insufficient studies on diverse BE types and PA environments. The scoping review provided a comprehensive synthesis of barriers and facilitators of PA in Indian cities. The findings highlighted the need for context-specific and demographic-sensitive research to assist urban designers in understanding the impact of the built environment on residents’ physical activity.
IMPROVING THE DISASTER PREPAREDNESS AT THE COMMUNITY LEVEL: A SYSTEMATIC REVIEW
The Sendai Framework for Disaster Risk Reduction 2015 adopted “Build Back Better” which involves consideration of the community to be encouraged to use their effort and their resources to participate in disaster risk reduction. Resources devoted to community preparedness can often be minimal and the evaluation of such efforts is not systematic. This study aimed to perform a systematic review of articles that cover the interventions of community disaster preparedness. Articles involving the interventions used to improve disaster preparedness in the community which were published during 2000-2023 and appeared in the international electronic databases, namely PubMed, Science Direct, and Google Scholar, were reviewed. The study quality was assessed with the criteria adapted from the Joana Briggs Institute (JBI) Critical Appraisal Tool. Of 705 publications initially identified, 10 studies (five randomized control trials, three community-engaged research, and two quasi-experimental research design) were eligible to be included in the review. The combination of discussions and disaster drill were the most studied of the interventions, and were therefore the most effective community preparedness intervention. By systematically exploring the type of intervention for disaster preparedness, this systematic review gives essential information to develop an intervention to improve community involvement for disaster risk reduction.
Alfi Nurfita Chasanah Alfi Nurfita Chasanah
Copyright (c) 2023 The Southeast Asian Journal of Tropical Medicine and Public Health
HEAT-RELATED ILLNESS PREVENTION BEHAVIORS AMONG OLDER ADULTS IN SOUTHERN THAILAND: DETERMINANTS BASED ON HEALTH BELIEF MODEL
Global warming poses a major health threat, particularly through heat-related illnesses among vulnerable populations. A cross-sectional analytical study was used to analyze the determinants of heat-related illness (HRI) prevention behaviors among older adults in southern Thailand to assist effective interventions for reducing heat-related morbidity and mortality. A multistage cluster sampling was used to recruit functioning older adults (n = 280, Barthel ADL Index ≥12) residing in five provinces with the highest average temperatures in southern Thailand, namely Krabi, Nakhon Si Thammarat, Phuket, Songkhla, and Surat Thani. Data were collected between June and October using a structured questionnaire based on the Health Belief Model framework. Results revealed that income, perceived susceptibility, perceived severity, perceived benefits, perceived self-efficacy, and cues to action were positively correlated with HRI prevention behavior (p-value <0.01), whereas age and perceived barriers were negatively correlated (r = -0.13 and -0.25, respectively). Among 13 variables entered into a regression model, perceived self-efficacy, cues to action and perceived benefits were significantly associated with HRI prevention behaviors (p-value <0.001), explaining 47% of the variance. Cues to action emerged as the strongest predictor. These findings underscored the crucial role of psychological and motivational factors in shaping heat protection behaviors among older adults in high-temperature regions. Strengthening self-efficacy, enhancing awareness of benefits and promoting cues to action can guide the development of targeted heat illness prevention programs to protect vulnerable older adult populations from escalating heat-related health risks in southern Thailand.
NUTRITIONAL AWARENESS, BEHAVIORS AND BARRIERS RELATED TO SUSTAINABLE HEALTHY DIET AMONG COMMUNITY DWELLING OLDER ADULTS: A CROSS-SECTIONAL STUDY
As the global population ages, promoting healthy, sustainable diets for older adults is vital to prevent age-related diseases and enhance well-being. This study aimed to assess nutritional awareness, sustainable eating behaviors, and barriers among older adults in primary health care centers (PHCCs) in Abha, Saudi Arabia. Community-dwelling adults aged ≥60 years were included in the study. Data was collected using the Nutritional Awareness Scale (NAS), Sustainable Healthy Eating Behaviors Scale (SHEBS), demographics, lifestyle factors, and barriers to sustainable healthy eating. Among participants, 53.5% demonstrated high NAS and 53.8% high SHEBS, with a strong positive correlation (r = 0.641, p < 0.001). Higher NAS was significantly predicted by younger age (p < 0.001), urban residence (p = 0.034), sufficient income (p < 0.001), and physical exercise (p < 0.001), while married status (p < 0.001), chronic illness (p = 0.002), and ordinary diet (p < 0.001) were negative predictors. For SHEB, significant positive predictors included sufficient income (p = 0.029) and physical exercise (p < 0.001), while married status (p < 0.001) and inadequate sleep (p < 0.001) were negative predictors. Although many older adults report high nutritional awareness, barriers still hinder sustainable healthy eating. These findings underscore the importance of targeted public health initiatives enhancing access to affordable, sustainable, and healthy food, thereby promoting healthy aging. Keywords aging, nutrition, health promotion, older people, sustainability
ASSESSMENT OF HEALTH PROFESSIONALS’ PERCEPTIONS OF MEDICAL ERRORS IN PRIMARY CARE SETTINGS: A CROSS- SECTIONAL STUDY FROM ABHA, SAUDI ARABIA
Understanding perceptions and practices of medical errors in primary healthcare facilities is essential for enhancing patients’ safety and fostering a culture of transparency. A descriptive cross-sectional study was conducted regarding frontline healthcare professionals’ perceptions of the identification, reporting and outcome of medical errors within diverse clinical settings. The survey was carried out in Abha health sector, Asir region, Saudi Arabia. Respondents (n = 223) were mainly physicians, nurses and clinical laboratory technicians. Significant associations were observed between biological gender and profession, as well as perceptions of medical errors (p-value <0.05). Female responders were mainly nurses, while male responders were physicians and technicians. Males perceived medical errors as being underreported and reporting procedures unclear and time-consuming, while females perceived a lower frequency of medical errors and less uncertainty about the reporting procedures. Stratification of perceptions of medical errors according to years of work experience revealed, interestingly, no significant differences, but stratification according to sociodemographic parameters showed low perception rating among female respondents and respondents working in rural regions. The findings highlighted the importance of designing target-based interventions in reducing medical errors and impediments to the reporting process.
CHEMICAL COMPOSITIONS AND ANTIBACTERIAL ACTIVITIES OF ESSENTIAL OILS FROM AQUILARIA AGALLOCHA, ARTEMISIA ABSINTHIUM,HYSSOPUS OFFICINALIS, AND MENTHA PULEGIUM
The study evaluated the chemical composition and antibacterial activity of essential oils from Aquilaria agallocha, Artemisia absinthium, Hyssopus officinalis, and Mentha pulegium. Gas chromatography/gas chromatography mass spectrometry (GC/GC-MS) was used to analyze the essential oils’ volatile components; their antibacterial activity against multidrug-resistant clinical bacterial isolates was assessed using a disk diffusion susceptibility assay together with the determination of minimum inhibitory concentration (MIC). The major volatile chemical compound of Aq. agallocha, Ar. absinthium, H. officinalis, and M. pulegium oils were dimethyl ester dodecanedioic acid (19.65%), β-caryophyllene (18.51%), camphor (14.2%), and pulegone (58.5%), respectively. All essential oils had varying bactericidal activity against the test isolates of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes, but not Pseudomonas aeruginosa. The essential oil with the overall highest antibacterial activity was that of M. pulegium, followed by H. officinalis, Aq. agallocha and Ar. absinthium. The findings confirm that medicinal plant essential oils can play a role as an alternative treatment option against current clinical multidrug-resistant microorganisms.
Copyright (c) 2025 The Southeast Asian Journal of Tropical Medicine and Public Health
EPIDEMIOLOGY OF SCHISTOSOMA HAEMATOBIUM INFECTION AMONG SCHOOLCHILDREN IN NORTHERN SUDAN
Schistosomiasis is a major public health problem in endemic regions, particularly among school-aged children exposed to contaminated freshwater. In this study, we aimed to determine the prevalence of and sociodemographic factors associated with Schistosoma haematobium infection among primary school students in Alhafeer, Northern State, Sudan in order to inform efforts to control S. haematobium infection in the study population. Study subjects were randomly selected from 4 randomly selected study schools in the study area. Inclusion criteria for study subjects were being aged 7-14 years, attending a study school during the study period and being willing to participate in the study. Exclusion criteria for study subjects were not meeting inclusion criteria, failing to complete the study questionnaire or failing to provide the required study sample. The minimum number of subjects determined to be needed for the study was 365. Each subject was asked to complete the study questionnaire asking about demographics, paternal education and occupation, contact with bodies of water, toileting habits and the presence of a toilet at home. Each subject was also asked to provide a urine sample for microscopy to detect S. haematobium. All subjects positive for S. haematobium infection were treated. Chi-square and multivariate logistic regression analysis were used to determine associations between positive cases and selected independent variables, with statistical significance set at p-value ≤0.05. A total of 463 subjects were included in the study, 52.6% (n = 244) males. 202 subjects (43.6%) tested positive for S. haematobium infection. Of the subjects who tested positive, 135 (66.8%) were male. 109 subjects aged 7-10 years (54.0%) and 93 subjects aged 11-14 years (33.5%) tested positive for S. haematobium infection. 235 subjects (50.8%) swam in the canal and of these 135 (57.0%) tested positive for S. haematobium infection. 176 subjects (38.0%) urinated in the canal and among these 94 (53.4%) tested positive for S. haematobium infection. 130 subjects (28.1%) did not have a toilet in the house and among these 115 (88.5%) tested positive for S. haematobium infection. 333 subjects (71.9%) did have a toilet in the house and among these 87 (26.1%) tested positive for S. haematobium infection. The factors significantly associated with S. haematobium infection on the Chi-square test were swimming in the canal (p<0.0001), urinating in the canal (p<0.0001) and not having a toilet in the house (p<0.0001). The factors significantly positively associated with S. haematobium infection on multivariate logistic regression analysis were male gender (adjusted odds ratio (aOR) = 2.78; 95% confidence interval (CI): 1.90-4.06, p=0.0001) and a paternal education level of university level (aOR = 2.75; 95%CI: 1.40-5.40, p=0.010). In summary, the prevalence of S. haematobium infection among study subjects was high and more common among swimming in the canal, urinating in the canal, not having a toilet in the house, being a male and having a father with a university level education. We conclude, efforts to control S. haematobium infection should focus on preventing swimming and urinating in the canal, having a toilet in the house and should target males and those with a father with a university level education. Further studies are needed to determine what types of programs are needed to make these changes and reduce the proportion of subjects with S. haematobium infection in the study population.
SHORT REPORT ANTIMICROBIAL EFFICACY OF PULPOTOMY MATERIALS AGAINST CARIOGENIC BACTERIA: AN IN VITRO COMPARATIVE STUDY
The presence of cariogenic bacteria adversely affects pulp therapy outcome by directly influencing the healing process and long-term prognosis of treated teeth. This study compared the antimicrobial efficacy of five commonly used pulp therapy materials, namely formocresol (FC), NeoMTA®, NeoPUTTY™, ProRoot® MTA, and zinc oxide-eugenol (ZOE), against four cariogenic bacteria, Actinomyces viscosus, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Streptococcus mutans. All five materials exhibited antibacterial activity against the test bacteria. FC demonstrated the most potent bactericidal property, particularly against L. acidophilus and S. mutans, followed by ZOE, then the mineral trioxide aggregate (MTA)-based materials. However, other properties, such as bioactivity and biocompatibility, must also be considered before recommending the use of these materials in pulpotomy.
PSYCHOMETRIC PROPERTIES TESTING OF PARENT MEDIA ADDICTION AND PARENT MEDIA DEPENDENCY TOOLS IN BAHASA MALAYSIA
The rapid integration of screen-based media into daily life has altered parent-child interactions, raising concerns about its impact on early childhood development. To measure parent media addiction and dependency, two English-language instruments, namely the ‘Parent Problematic Digital Technology Use Scale’ and the ‘Media and Technology Usage and Attitudes Scale’ were translated to Bahasa Malaysia and cross-culturally adapted in this study. A cross-sectional study was conducted in a district of Selangor, Malaysia, among parents and caretakers with normal children 18 and 36 months of age to test the Bahasa Malaysia version of instruments’ content validity, internal consistency, and floor ceiling effect involving 100 participants and test-retest reliability involving 60 participants. The Cronbach’s Alpha value of 0.734 was reported for ‘Parent Problematic Digital Technology Use Scale’ and 0.839 for the Media and Technology Usage and Attitudes Scale. The items in the scales correlate adequately in the construct and lack of discriminant validity was reported to be unlikely. Thus, the Bahasa Malaysia scales provide an effective method for measuring parent media addiction and dependency, crucial factors in understanding the impact of smartphone and online use on parent-child interaction. This validated instrument should enable further exploration into the role of digital technology on parent behavior and its influence on early child development, and may guide programs and policies fostering healthier media habits in Malaysian families.
EFFECT OF RENAL DIALYSIS DURATION ON PATIENT PHYSICAL PERFORMANCE AND BLOOD METABOLITES
Maintenance hemodialysis (MHD) is a common method for preventing complications of end-stage renal disease (ESRD) and physical performance serves as an important indicator of patient health. In this cross-sectional study, we aimed to determine what the effects of extended hemodialysis (HD) sessions and long-term MHD had on subject physical performance and laboratory testing in order to determine what was the best length of a HD session that could optimize subject physical performance and laboratory tests and identify possible problems associated with the length of HD sessions. Study subjects were chosen randomly from 7 HD centers in Shanghai, People’s Republic of China during July 2020-March 2023. The minimum number of subjects determined to be needed for the study was 350. Inclusion criteria for study subjects were being aged ≥40 years, undergoing maintenance hemodialysis for ≥3 months and giving consent to be included in the study. Exclusion criteria for study subjects were being unwilling to participate in the study, not completing the required questionnaire, physical performance assessment or laboratory testing or having a serious health condition that could interfere with the physical performance assessment or blood tests. Subjects were categorized based on duration of each dialysis session into a conventional group (duration of each HD session of ≤4 hours or having ≤3 HD sessions per week) and extended group (duration of each HD session of >4 hours or having >3 HD sessions per week). Subjects were also classified by total length of time they had been undergoing MHD into a short-term group (total duration of ≤12 months) and a long-term group (total duration of >12 months). Each subject completed a questionnaire asking their age, gender, education level, alcohol consumption level and smoking status. The following physical performance tests were performed in each subject: grip strength categorized into low (males <28 kg and females <18 kg) and normal (males ≥28 kg and females ≥18 kg), a 4-meter walk test categorized into slow speed (<1.0 m/s) and normal speed (≥1.0 m/s), a knee-extension strength test categorized into weak (males <0.5×their body weight and females <0.4×their body weight) and normal (male ≥0.5×their body weight, female ≥0.4×their body weight). Subject heights and weights were checked and the body mass index (BMI) of each subject was calculated as weight in kilograms divided by height in meters squared (kg/m²). The following laboratory tests were performed on each subject: total cholesterol (TC) (normal: ≤5.2 g), triglycerides (TG) (normal: ≤1.7 mmol/l ), high-density lipoprotein-cholesterol (HDL-C) (normal:<1.04 mmol/l), low-density lipoprotein-cholesterol (LDL-C) (normal:<3.12 mmol/l), hemoglobin (HGB) (normal: 120-160 g/l for males and 110-150 g/l for females), serum albumin (ALB) (normal: 35-55 g/l) and β2-microglobulin (β2-MG) (normal: 1.28-1.95 mg/l). Statistical analyses were performed using non-parametric tests and subgroup comparisons were made. A total of 875 subjects were included in the study, 586 (67%) males. The mean (±standard deviation) age of subjects was 59 (±13) (range: 40-80) years. Of these, 512 (58.5%) were in the conventional group for duration of each dialysis session and 363 (41.5%) were in the extended group for duration of each dialysis session. Subjects in the extended group compared to the conventional group had significantly lower (p-value <0.010) (both males and females) mean grip strength (24.3 kg vs 19.4 kg), significantly lower (p-value = 0.010) overall knee extension strength (21.5 kg vs 17.0 kg), significantly lower (p-value <0.010) overall 4-meter walk speeds (1.0 m/s vs 0.7 m/s), significantly lower (p-value = 0.014) overall TG levels (2.4 mmol/l vs 1.7 mmol/l) and significantly lower (p-value <0.010) overall β2-MG levels (35.1 mg/l vs 20.5 mg/l), respectively. Subjects in the long-term treatment group compared to subjects in the short-term group had a significantly lower (p-value <0.010) overall mean grip strength (25.0 kg vs 23.8 kg), a significantly lower (p-value = 0.004) overall mean knee extension strength (21.4 kg vs 21.3 kg), a significantly lower (p-value <0.010) overall mean BMI (23.9 vs 20.2) and a significantly lower (p-value <0.05) overall mean β2-MG level (35.8 mg/l vs 28.1 mg/l). In summary, in our study population, subjects with extended HD sessions and long-term MHD both had significantly lower grip strength, knee extension strength, 4-meter walk speeds and TG and β2-MG levels and subjects with long-term MHD had significantly lower BMIs. We conclude having extended HD sessions and long term MHD resulted in poorer performance and malnutrition showing conventional HD sessions are preferred over extended HD sessions. Subjects having extended HD and with long term MHD need to have strength and nutritional assessments and possibly counseling to prevent or manage problems in these areas. Further studies are needed to determine what methods should be employed to improve and prevent deterioration in physical performance and nutrition.
EVALUATION OF ASSOCIATIONS BETWEEN DIET AND GASTROINTESTINAL DISORDERS IN SAUDI ARABIA
Gastrointestinal (GI) disorders are a public health problem in Saudi Arabia and diet may influence these conditions. In this study we aimed to evaluate associations between diet and GI disorders among Saudi adults in order to inform efforts to control and prevent these conditions. Study subjects were recruited from the Aseer Region, Saudi Arabi using online surveys distributed via social media platforms and institutional mailing lists of King Khalid University. Inclusion criteria for study subjects were: being aged ≥18 years, living in the Aseer Region, being willing and giving consent to participate in the study. Exclusion criteria for study subjects were: being unwilling to participate in the study, not completing the required questionnaire and having a serious health condition that could confound the dietary assessment. The minimum number of study subjects calculated to be needed for the study was 423. Each subject was asked to complete a self-administered questionnaire that was previously validated, adapted and pilot tested among 20 residents from the study area who met inclusion and exclusion criteria for study subjects. This cross-sectional study was conducted during January-June 2025. The questionnaire asked about consumption of fruits, vegetables, grains, dairy products, proteins/meats, sugary foods, fats and fast food. It also asked about physical activity level, smoking status, weight and height. A body mass index (BMI) was calculated from the weight and height. Dietary intake of each of the recorded items was classified as never, low (1-2 times/week), moderate (3-6 times/week) and high (≥7 times/week) following Food and Agricultural Organization (FAO), World Health Organization (WHO) guidelines. Consumption of sugary items, fats and fast food were categorized into low/healthy, moderate and high/unhealthy consumption. Physical activity was categorized as low, moderate, or high following WHO recommendations, with thresholds based on weekly minutes of moderate and vigorous activity. BMI was categorized as underweight (<18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30.0 kg/m²). Subjects were asked if they had been diagnosed with any of the following gastrointestinal (GI) disorders: constipation, functional dyspepsia, gastritis, gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD Crohn’s or ulcerative colitis), irritable bowel syndrome (IBS), and peptic ulcer disease (PUD). Associations between diet and these specific GI disorders were assessed using multivariable logistic regression analysis and reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). A total of 430 subjects were included in the study, 256 (59.5%) females. The mean (±standard deviation) age of study subjects was 36.9 (±10.8) (range: 18-65) years. Twenty-seven subjects (6.3%) never consumed fruit. 328 (76.3%), 58 (13.5%) and 17 (3.9%) had low, moderate and high fruit intake, respectively. 15 (3.5%) never consumed vegetables. 272 (63.3%), 99 (23.0%) and 44 (10.2%) had low, moderate and high vegetable intake, respectively. Three subjects (0.7%) never consumed grains. Eighty (18.6%), 191 (44.4%) and 156 (36.3%) had low, moderate and high grain intake, respectively. Nine subjects (2.1%) never consumed protein/meat. 132 (30.7%), 188 (43.7%) and 101 (23.5%) had low, moderate and high protein/meat intake, respectively. Nine subjects (2.1%) never consumed dairy products. 262 (60.9%), 121 (28.2%) and 38 (8.8%) had low, moderate and high dairy intake, respectively. Fifteen subjects (3.5%) never consumed sugary foods. 222 (51.7%), 127 (29.5%) and 66 (15.3%) had low, moderate and high sugary food intake, respectively. Eight subjects (1.9%) never consumed fat. 234 (54.4%), 138 (32.1%) and 50 (11.6%) consumed low, moderate and high fat intake; thirty-two subjects (7.4%) never consumed fast-food. 309 (71.9%), 81 (18.8%) and 8 (1.9%) had low, moderate and high fast-food intake, respectively. 117 subjects (27.2%) reported having been diagnosed with a GI disorder: 12 (2.8%) had constipation, 9 (2.1%) had functional dyspepsia, 55 (12.8%) had gastritis, 17 (4.0%) had GERD, 1 (0.2%) had IBD, 18 (4.2%) had IBS and 5 (1.2%) had PUD. Subjects with low fruit intake were significantly more likely to have a GI disorder than those on a moderate to high fruit diet (aOR = 0.685, 95%CI: 0.497-0.945, p-value = 0.021). Females were significantly less likely than males to have a GI disorder (aOR = 0.490; 95%CI: 0.273-0.878, p-value = 0.017). Insummary, subjects with a low fruit diet were significantly more likely to have a GI disorder and females were significantly less likely to have a GI disorder. We conclude, subjects with a low fruit diet and males in the study population should be encouraged to consume more fruit. Further studies are needed to determine if people with a low fruit diet and males consume more fruit if this will reduce the chance of developing a GI disorder.
PREVALENCE AND DETERMINANTS OF INTERNET GAME ADDICTION AND PSYCHOLOGICAL EFFECTS AMONG MALE STUDENTS IN HEALTH SCIENCE PROGRAMS AT JAZAN UNIVERSITY, SAUDI ARABIA
The internet has become a common means of communication, education, research, business, entertainment, and games. An excessive use of the latter has led to a disorder termed Internet Gaming Addiction (IGA). A cross-sectional study assessed the prevalence of IGA based on the Internet Gaming Disorder-20 test among male health science students (n = 486), 18-35 years of age, enrolled at Jazan University, Saudi Arabia, in 2023. Data were collected via a Google Form of a validated Arabic version of a close-ended self-answered questionnaire on the students’ sociodemographic background, academic discipline and performance, mental health, lifestyle, and recreational activity. Using univariate statistics followed by multiple logistic regression modeling, two independent risk factors were identified associated with IGA, namely, prior psychological diagnosis and internet gaming as a recreational activity. The study findings should prompt educators, health providers and administrators at colleges and universities in Saudi Arabia to implement educational programs promoting responsible gaming behavior.
ASSESSMENT OF THE STRENGTHS AND WEAKNESSES OF AN ACTIVE POPULATION-BASED PNEUMONIA SURVEILLANCE SYSTEM IN NAKHON PHANOM PROVINCE, THAILAND
Pneumonia is a major cause of morbidity and mortality in Thailand. In this study, we aimed to assess the strengths and weaknesses of an active population-based pneumonia surveillance system implemented in Nakhon Phanom Province, Thailand, in order to inform public health resource allocation in that province. The surveillance system recorded the incidence and causative organisms of pneumonia in the study province. In order to assess this surveillance system, we purposely recruited 15 key local, national, and international subjects with the experience to accurately conduct this assessment: policymakers (n = 6), epidemiologists (n = 5), laboratory technicians (n = 3) and a physician (n = 1). Each subject was interviewed using standardized questions and the answers were recorded. Interview transcripts were analyzed using conventional content analysis. The 15 subjects, consisted of 11 (73.3%) males and 4 (26.7%) females. The mean age of subjects was 51 (range: 39-61) years. The study subjects stated the surveillance system should have 5 main objectives: 1) identify the pneumonia etiological organisms, 2) detect and report pneumonia cases in a timely manner, 3) support public health policy decisions, including resource allocation and targeted prevention, such as vaccination of high-risk groups, 4) monitor changes in respiratory pathogens over time, and 5) estimate the incidence of pneumonia and associated mortality. Subjects stated the strengths of the surveillance system were 1) its strong inter-agency collaboration, 2) the surveillance system support by hospital administrators and 3) the good cooperation among physicians,nurses and surveillance officers. The subjects stated the weaknesses of the surveillance system were lack of limited sharing of the surveillance findings with the medical providers and inadequate integration between pneumonia-specific and routine hospital laboratory systems. More specifically, medical providers and routine hospital laboratories in the study area could not access the summarized laboratory results produced by the surveillance system. The subjects suggested the following improvements be made to the surveillance system: 1) improve data-sharing mechanisms among all those involved in the system, including the medical providers, 2) improve integration between the pneumonia-specific laboratory activities and routine hospital laboratory systems and 3) improve communication across local, national and international levels. In summary, the aims of the surveillance system should be to identify the causes of pneumonia, their change over time and the incidence of pneumonia in a timely manner following national public health policies. Strengths of the system were the support the system had at multiple levels but weaknesses were inadequate communication of data and lack of systems to easily share this data. We conclude more effort should be put into the system at all levels to allow adequate communication and sharing of system data. Further studies are needed to determine what reasonable technologies are needed to allow good communication and data sharing in the system at all levels and how best to integrate this into other active surveillance systems nationally.
ASSESSING THE HEALTH AND NUTRITION OF CHILDREN FROM LOW-INCOME HOUSEHOLDS IN RURAL PANDEGELANG, BANTEN, INDONESIA
Undernutrition is linked to food insecurity, which is brought on by low income, restricted access to wholesome food, low educational attainment, and poor hygiene habits, all of which contribute to the development of disease. To address undernourishment among children under five, this study aimed to evaluate the prevalence of undernutrition in children from low-income households and provide appropriate handling. Pandeglang District was selected as the study area due to its high rate of province undernourished children. Information was gathered on the children’s anthropometry, general characteristics, household socioeconomics, and 24-hour recall of food consumption. The results revealed that among the 105 children assessed, 40% were stunted, 23.8% were underweight, and 4.8% were experiencing wasting, indicating a notably high level of undernutrition. These figures place Pandeglang as the district with the highest undernutrition rates in the region, exceeding both the provincial and national averages reported in 2018. According to WHO standards, the area falls under the medium category for underweight and high category for both stunting and wasting. Dietary intake analysis using the Calculator of Inadequate Micronutrient Intake (CIMI) showed that only 55.2% of the children met energy requirements, while 50.5% and 53.3% met the needs for iron and zinc respectively. Alarmingly, nearly all (98.1%) had insufficient intake of vitamin A. This indicates that micronutrient deficiencies are a significant issue. It may have an impact on kids’ development and health. To address this problem, better diets, supplementation, and nutrition education are required.