9th APCPH Proceedings

@proceedings{APCPH2026-O-632,

title = {“Should I Accept This?” How Acceptability Unfolded in a Psychoeducation-based Person-directed Burnout Intervention Developed for Ministry of Health Hospital Nurses},

author = {Norehan Jinah1 Pangie Bakit1 Ili Abdullah Sharin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Burnout among hospital nurses is a critical workforce and well-being issue that may adversely affect staff retention and quality of care. In response, a Psychoeducation-based Person-directed Burnout Intervention Package was developed for hospital nurses in the Ministry of Health Malaysia. However, the success of such an intervention depends not only on its content, but also on whether it is perceived as acceptable in practice by its recipients. Acceptability is often reported as an endpoint judgement, but less is known about how it unfolds during participation. This study aimed to explore how, and under what conditions, hospital nurses perceived this intervention package as acceptable before wider implementation. Materials and Methods: This qualitative study was conducted as part of a broader feasibility study involving 21 eligible nurses who participated in a two-day psychoeducation-based person-directed burnout intervention package focused on self-management and relationship management. Following intervention completion, qualitative data were collected through focus group discussions. Data were analysed thematically using a framework-informed approach guided by seven domains of the Theoretical Framework of Acceptability: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. Analysis focused on how acceptability unfolded across participants’ experiences and the conditions influencing it. Coding was conducted iteratively using NVivo 12 software, with consensus reached among multiple reviewers. Results: Acceptability of the intervention emerged as a dynamic and conditional process rather than a simple endpoint judgement. Participants initially entered the programme with mixed readiness, including uncertainty, hesitation, stigma, and practical concerns related to work, travel, and family responsibilities. As participation progressed, acceptability strengthened when the programme was perceived as emotionally engaging, clearly structured, understandable, relevant to workplace stress, and psychologically safe for selective disclosure in a respectful and supportive environment. Participants described the intervention as meaningful and beneficial, citing emotional relief, enhanced self-reflection, practical coping strategies, improved communication, and greater confidence to apply selected skills in daily life and work. Although burden and opportunity costs were present, these were generally judged manageable and worthwhile when weighed against the perceived personal and professional benefits of participation. Conclusion: These findings suggest that the acceptability of burnout interventions is better understood as a process that develops through participation rather than as a static endpoint judgement. Successful implementation of burnout interventions for nurses depends not only on programme content, but also on delivery conditions that preserve relevance, psychological safety, and feasibility in practice. This highlights the importance of refining the Psychoeducation-based Person-directed Burnout Intervention Package to support meaningful engagement and manageable participation before wider implementation and larger-scale evaluation in Ministry of Health settings.},

note = {Type: Oral Presentation; Organisation: 1Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia; Corresponding author: Ili Abdullah Sharin, ppilias@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-561,

title = {A 17-Year Household Cluster of Leprosy: Surveillance Gaps.},

author = {Hazimah Hamilin1 Roshini Subramaniam1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: This case series describes a household cluster of six multibacillary leprosy cases occurring over a 17-year period (2008\textendash2025) within a single family in Kunak district, Sabah. The cluster highlights operational gaps in the long-term monitoring of high-risk household contacts and illustrates how these shortcomings contribute to the ongoing transmission despite established control measures. Materials and Methods: The first documented case involved the grandfather, who was diagnosed in 2008. Over the following years, five additional cases emerged among immediate family members. One son was diagnosed in 2017. Subsequent cases included the father (2019) and three daughters (2020, 2024, and 2025). Each case was identified through passive case detection only after noticing visible skin lesions. Diagnosis was confirmed through clinical assessment and slit-skin smear examination. National leprosy control guidelines recommend that household contacts of multibacillary cases undergo annual surveillance due to the prolonged incubation period of Mycobacterium leprae. However, upon tracing patient records, only initial contact screening had been conducted. Results: This failure to maintain regular contact monitoring likely delayed case detection and permitted continuous transmission within the family over nearly two decades, creating a critical operational gap in the surveillance system, underscoring several important public health challenges. First, passive case detections may have led to delays in diagnosis, especially in communities where awareness of early leprosy symptoms is limited. Second, failure to implement recommended annual surveillance for high-risk contacts undermines the effectiveness of control strategies. Finally, gaps in record tracking and follow-up coordination can result in missed opportunities for early case identification. Conclusion: Addressing these challenges requires strengthening contact surveillance systems through structured follow-up methods. Establishing line listing of household contacts, implementing annual screening and ensuring continuity of monitoring across health facilities can improve early detection. Community-based partnerships involving local health volunteers such as MyCHAMPION and local community leaders are essential for sustaining surveillance activities and improving awareness. In conclusion, this prolonged household cluster demonstrates how lapses in systematic follow-up of high-risk contacts can allow leprosy transmission to persist even when effective diagnostic and treatment services are readily available. Strengthening efforts will be critical to closing detection gaps and advancing toward the global goal.},

note = {Type: Poster Presentation; Organisation: 1Kunak District Health Office, Sabah, Malaysia.; Corresponding author: Roshini A/P Subramaniam, roshini16@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-616,

title = {A Case Report of Mpox Infection in Batu Pahat District},

author = {Tey Ai Chu2 Ratna Wati Rahman2 Wong Liang Tung1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Mpox is an emerging zoonotic Orthopoxvirus infection that has recently caused clusters of human cases with variable clinical severity and atypical presentations. In 2025, a total of 12 cases were reported in Malaysia, with four cases being close family members. In this case report, we present the first case of Mpox from Batu Pahat district, Johor. Case description: The patient is a 28-year-old male who sought treatment in the STI clinic due to a developing rash in the groin area. The patient reported the rashes were initially itchy, but later became painful swelling. On D5 after developing the rashes, the patient came to STI Clinic in Batu Pahat Health Clinic and was diagnosed with Herpes Genitalis and was given oral anti-viral medication and antiviral ointment. He defaulted his follow-up appointment on D9 of onset due to work schedule. On D11 of illness, the patient developed new painless rashes at both forearms, fingers and posterolateral trunk areas. The rashes at the groin area were flattened and indented. On D12 of illness, he came back to the STI clinic and was diagnosed as suspected Mpox. Skin swabs from the rashes were taken, and the result showed positive for Mpox virus. He was given antibiotics to prevent secondary bacterial infection. His clinical course was mild, and he recovered without any antiviral therapy. CDC unit of the district health office was notified, and the patient was given a Home Surveillance Order for 21 days. Upon further history, the patient had a history of travelling to Taiwan 10 days prior to onset. However, he claimed his last sexual intercourse with his male partner was before travelling to Taiwan. He denied having multiple sexual partners. A total of four close contacts were identified, including his partner, housemate, and two healthcare workers who had contact with the rashes without personal protective equipment. All the contacts were given the Mpox vaccine. Conclusion: This case highlights the challenges in diagnosing Mpox, which can be mistaken as STI, especially if the rashes only appear on the genitals. Thorough history taking is important as it can help in identifying differential diagnoses while maintaining a high index of suspicion for atypical diseases. Prompt diagnosis of Mpox infection can prevent the spread of the disease by isolating the patient as well as providing the vaccine for the contacts.},

note = {Type: Poster Presentation; Organisation: 1Batu Pahat District Health Office, Batu Pahat, Johor, Malaysia. 2Batu Pahat Health Clinic, Batu Pahat, Johor, Malaysia; Corresponding author: Wong Liang Tung, wongliangtung@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-749,

title = {A Cross-Sectional Evaluation of Key Performance Indicators in Malaysia’s Public Health Programme Using the Donabedian Framework},

author = {Zulhizzam Abdullah1 Jamiatul Aida Md Sani1 Khairul Hafidz Alkhair Khairul Amin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Key Performance Indicators (KPIs) are widely utilised across Malaysia’s Public Health Programme to monitor performance, guide strategic planning, and strengthen accountability across multiple programme areas. However, the extent to which these indicators collectively reflect overall health system performance remains unclear. The Donabedian framework, which classifies quality of care into structure, process and outcome domains, provides a useful approach to evaluate the distribution and balance of performance measurement at a system level. Materials and Methods: A cross-sectional analysis was conducted using the 2026 Public Health Programme KPI list, comprising 85 indicators drawn from multiple programme areas. Each KPI was categorised into structure, process, or outcome domains based on its functional role within the health system. Indicators were further grouped into subdomains, and descriptive analysis was performed using frequencies and percentages. Results: The majority of KPIs were outcome-based (52; 61.2%), followed by process indicators (28; 32.9%), while structure indicators remained limited (5; 5.9%). Outcome indicators captured performance across multiple domains, including disease control, clinical outcomes, behavioural change, and programme achievements. Process indicators reflected key operational functions such as service delivery, screening, surveillance, system responsiveness, and compliance with implementation across programmes. Structure indicators were minimal and largely confined to workforce competency, laboratory capacity, and system infrastructure. Conclusion: Although KPIs across the Public Health Programme are predominantly outcome-driven, application of the Donabedian framework reveals an imbalance in indicator distribution at the system level. The high proportion of outcome indicators may reflect a relatively established system capable of generating measurable outcomes across multiple programme areas. However, the limited representation of structure indicators suggests minimal programme expansion and insufficient visibility of system inputs, including resource capacity, infrastructure and organisational readiness. A more balanced KPI framework, integrating structure, process and outcome domains, is essential to support comprehensive system performance evaluation and evidence-based decision-making across the Public Health Programme.},

note = {Type: Poster Presentation; Organisation: 1Public Health Development Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Khairul Hafidz Alkhair Khairul Amin, hafidz@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-692,

title = {A Decade of Tuberculosis Burden in Johor Bahru, 2016\textendash2025: Trends, Socioeconomic Determinants, and Treatment Outcomes},

author = {Haidar Rizal Toha1 NurulNadiah Badrul Hisham1 Nabihah Ali1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Tuberculosis (TB) remains a major public health concern globally, particularly in rapidly urbanizing districts where socioeconomic disparities and transmission dynamics contribute to sustained disease burden. This study aims to describe the incidence trend, sociodemographic characteristics, clinical profiles, and treatment outcomes of TB cases in Johor Bahru District using data from the National Tuberculosis Registry (NTBR) from 2016 to 2025. Materials and Methods: A retrospective cross-sectional study was conducted using secondary data extracted from the NTBR, based on the date of diagnosis between 2016 and 2025. Descriptive analyses were performed using Microsoft Excel. Data cleaning procedures included exclusion of cases with incomplete records, duplicate entries, and changes in diagnosis to ensure data integrity. Results: A total of 10,225 TB cases were diagnosed during the study period. After excluding 251 cases due to change in diagnosis and 341 cases due to duplication or missing data, 9,633 cases were included in the final analysis. The incidence rate of TB demonstrated a declining trend from 68 per 100,000 population in 2016 to the lowest point of 49 per 100,000 population in 2021, followed by a gradual increase to 60 per 100,000 population in 2025. The mean age of TB patients was 41.9 years with males comprising 64% of cases. The majority (90%) were Malaysian, with 57% identifying as Malay. Approximately 50% had completed secondary education, while 15% attained higher education. The median household income was MYR2,500, with 98.3% earning below the Johor Bahru median household income (MYR8,977). Newly diagnosed cases accounted for 94% of cases, with 91% detected through passive case detection. Among the cases, 54% were Pulmonary TB (PTB) Smear Positive, and 29% were PTB Smear Negative. The treatment success rate was 74%, with an overall mortality rate of 54 per 100,000 population, ranging from 5 per 100,000 population in 2016 to 7 per 100,000 population in 2024. Discussion/ Conclusion: The findings demonstrates that TB in Johor Bahru remains disproportionately concentrated among individuals of working age and lower socioeconomic status, highlighting the persistent influence of structural and social determinants on disease distribution. The predominance of cases within economically productive groups has important implications for transmission dynamics, as increased mobility, occupational exposure, and delayed healthcare-seeking behaviour may facilitate sustained community spread. The declining incidence observed from 2016 to 2021, followed by a rebound thereafter, likely reflects disruption of TB detection and reporting during the COVID-19 pandemic rather than a true reduction in transmission. The high proportion of passively detected cases further supports the presence of gaps in active case-finding strategies and suggests missed opportunities for earlier diagnosis. The burden of TB in Johor Bahru is largely concentrated among individuals in the economically productive age group, particularly those from lower socioeconomic backgrounds. Strengthening targeted case finding and contact tracing, particularly among high-risk groups, is essential, while reliance on passive detection suggests delays that require addressing operational gaps at the district level.},

note = {Type: Poster Presentation; Organisation: 1Johor Bahru Health District Office, Johor Bahru, Johor Darul Ta'zim, Malaysia.; Corresponding author: Nabihah Ali, nabihah.ali@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-775,

title = {A MEASLES CLUSTER OUTBREAK AMONG MYANMAR MIGRANT WORKERS IN HIGH-DENSITY DORMITORIES: EPIDEMIOLOGICAL INVESTIGATION AND PUBLIC HEALTH RESPONSE IN KULAI, JOHOR, MALAYSIA (JANUARY\textendashAPRIL 2026)},

author = {Mohd Anwar Shahrir Bin Ahmad1 Muhammad Siddiq Bin Muhammad Nassir1 Muhammad Zaini Fikri Bin Mohd Yusop1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measles is increasingly shifting from a childhood disease to an adult public health threat, disproportionately affecting migrant worker populations with unverified vaccination histories. This paper describes a cluster outbreak of measles at worker dormitories (I-Stay 1 and I-Stay 2) in Taman Indahpura, Kulai, Johor, Malaysia, set within the broader context of the "migrant immunity gap" \textemdash a persistent pocket of susceptibility among adults aged 20\textendash40 years from countries with historically suboptimal immunisation coverage. Materials and Methods: Epidemiological investigation was initiated on 21 January 2026 following notification from a private clinic (Klinik Adham Indahpura). A confirmed case was defined as a resident or worker at the implicated premises presenting with fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis \textemdash confirmed by positive IgM serology or RT-PCR \textemdash from 28 December 2025 onwards. Active case detection (ACD) was conducted at the dormitories and two implicated factories: HID Global and Armstrong Electronic Sdn Bhd. Environmental risk assessment, viral genotyping, and contact tracing were performed systematically. Results: A total of 10 measles cases were identified, comprising 9 laboratory-confirmed cases and 1 epidemiologically linked case, among 949 exposed individuals, yielding an overall attack rate of 1.05%. All affected individuals were Myanmar nationals aged 24\textendash34 years, reflecting a susceptible migrant cohort linked to Myanmar’s historically lower measles vaccination coverage. The index case developed symptoms on 18 January 2026, with transmission continuing until 1 March 2026. All cases presented with fever and maculopapular rash, while cough occurred in 90%, coryza in 30%, and conjunctivitis in 30%. Measles virus genotype D8 was confirmed. Key outbreak drivers included overcrowded dormitory conditions (10\textendash12 occupants per room), inadequate ventilation, shared sanitation and communal spaces, and unverifiable vaccination status. Immediate case isolation was enforced following the 4-21-42 protocol \textemdash cases isolated for 4 days post-rash onset, close contacts monitored for 21 days, and active surveillance maintained for 42 days (two full incubation periods) to confirm outbreak resolution. ACD covered 949 dormitory residents across both I-Stay 1 and I-Stay 2, and 129 Armstrong Electronic factory workers. A total of 521 MR vaccinations were administered to susceptible contacts and high-risk individuals across both facilities. Emergency post-exposure prophylaxis (PEP) was offered within 72 hours to susceptible adults, with immunoglobulin reserved for high-risk individuals. Environmental disinfection was conducted in all shared spaces. A targeted mopping-up campaign on 18 April 2026 covered a 1 km radius from Mydin Hypermarket \textemdash a key congregation point for the Myanmar community \textemdash involving 10 public health officers, 280 households visited, and 11 unimmunised children vaccinated. Conclusion: This outbreak illustrates the convergence of imported measles genotype, migrant adult immunity gaps, and overcrowded living conditions as a potent epidemiological triad for measles transmission. The relatively low attack rate reflects the effectiveness of rapid outbreak detection and coordinated intervention. Sustainable prevention strategies should include mandatory pre-employment immunisation verification for migrant workers, permit-linked vaccination requirements, targeted adult measles immunisation programmes, and structural improvements to dormitory living conditions to mitigate future outbreaks.},

note = {Type: Poster Presentation; Organisation: 1Kulai District Health Office, No. 21 \& 22, Jalan Kiambang 2, Pusat Komersial Indah, Bandar Indahpura, 81000 Kulai, Johor, Malaysia.; Corresponding author: Muhamad Zaini Fikri Bin Mohd Yus:muhamadzaini@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-613,

title = {A Mixed Methods Study of The Super Skills for Life (SSL) Programme On Depression and Anxiety Among Adolescents in Welfare Homes In Klang Valley, Malaysia \textendash A Study Protocol},

author = {Wong Li Ping1 Nik Daliana Nik Farid1 Then Moli Othayamoorthy1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Adolescents residing in welfare homes represent a high-risk population with elevated vulnerability to depression and anxiety due to cumulative psychosocial adversities and limited access to timely mental health support. Despite this heightened need, emotional distress in this group remains under-recognised and under-treated. Cognitive-behavioural therapy (CBT)-based interventions have demonstrated effectiveness in addressing adolescent internalising problems; however, evidence of their effectiveness within welfare-home contexts remains limited. Super Skills for Life (SSL) is a structured CBT-based programme designed to target core mechanisms underlying depression and anxiety through skills-based delivery. This study aims to evaluate the effectiveness of SSL in reducing depression and anxiety among adolescents residing in non-governmental organisation (NGO) welfare homes, with depression and anxiety as the primary outcomes. It also examines changes in secondary outcomes (resilience, self-esteem, coping skills, mental health help-seeking attitudes). Furthermore, the study aims to qualitatively explore perceived mental well-being and programme acceptability. Materials and Methods: A mixed-methods, cluster-randomised controlled trial will be conducted in NGO-based welfare homes in the Klang Valley, Malaysia. A total of 100 adolescents aged 13-17 years will be randomly assigned, by cluster, to either an SSL intervention group or a waitlist-control group, with the waitlist-control group receiving the intervention after study completion. Quantitative outcomes, including depression, anxiety, and secondary outcomes, will be assessed at baseline, post-intervention, and three-month follow-up. Generalised estimating equations will be used to examine intervention effects over time while accounting for clustering and repeated measures. A purposive subsample of participants from the intervention group will also participate in qualitative in-depth interviews conducted within the welfare settings. Qualitative data will be analysed thematically. The transcribed interviews will be uploaded into NVivo 12.0 for further analysis. Results: The SSL intervention is hypothesised to lead to reductions in depressive and anxiety symptoms over time compared with the waitlist control group. Improvements in resilience, self-esteem, coping skills, and mental help-seeking attitudes are also anticipated among intervention participants. Qualitative findings are expected to provide contextual insights into perceived changes in mental well-being and programme acceptability within welfare-home settings. Discussion/ Conclusion: This study is anticipated to contribute robust and contextually relevant evidence on the effectiveness and acceptability of a structured CBT-based intervention for addressing depression and anxiety among adolescents in welfare-home settings. The findings may inform the development of feasible, skills-based psychosocial interventions for vulnerable adolescent populations and support the integration of structured mental health programmes into welfare-home settings, providing evidence relevant to service planning and policy discussions on mental health support.},

note = {Type: Poster Presentation; Organisation: 1Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.; Corresponding author: Then Moli Othayamoorthy, drmoli.2903@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-468,

title = {A One Health Approach to Integrated Human-Animal Mass Drug Administration for Persistent Lymphatic Filariasis in Tangkarason, Sabah, Malaysia},

author = {Khairiah Ibrahim2 Muhammad Mhd Noor2 Zulhilmi Ahmad Zulkepli1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Lymphatic filariasis (LF), caused by the zoonotic sub-periodic Brugia malayi, remains a persistent challenge in Tangkarason, Beluran. Despite nine Mass Drug Administration (MDA) cycles by 2017 and subsequent targeted treatments, transmission persists. This, consistent with research indicating zoonotic transmission potential, suggests continuous spillover from animal reservoirs. This operational review evaluates the coverage, community acceptance, safety profile, and challenges of Malaysia’s first integrated human-animal MDA. Materials and Methods: In February 2024, an integrated mass drug administration covered 34 localities in Tangkarason. Prior to implementation, a multi-agency townhall meeting to ensure community buy-in and operational readiness. Field activities employed ArcGIS Survey123 for real-time geospatial data capture and monitoring. Multidisciplinary teams comprising public health inspectors, medical staff, and support personnel executed the operation. Adopting a door-to-door strategy, humans received the IDA (ivermectin, diethylcarbamazine, and albendazole) regimen under directly observed treatment (DOT), while domestic and stray animals concurrently received oral ivermectin. Passive adverse event surveillance was conducted for both groups. Results: Implementation faced significant logistical hurdles, mainly attributed to heavy Northeast Monsoon rainfall limiting access to hard-to-reach areas, and the burden of handling aggressive animals without direct veterinary assistance. Despite these challenges, 6,142 residents were successfully registered. Of these, 603 were ineligible (medically unfit, pregnant, breastfeeding or children \<2 years). Data analysis of 5,876 records showed high community acceptance with minimal refusals (n=36). Statistical analysis revealed that acceptance was equitable across gender and age groups (p\>0.05). However, resistance was clustered in Kg. Timpus (p\<0.001), where residents were 7.9 times more likely to refuse treatment (Odds Ratio: 7.88) compared to other areas. Overall epidemiological drug coverage reached 82.9%, with 99.2% coverage among eligible individuals. For the animal component, 1,831 animals (654 dogs and 1,177 cats) were treated. The intervention was well tolerated among both humans and animals, with no serious adverse events reported and only mild, self-limiting symptoms observed. Conclusion: This review demonstrates that the integrated One Health MDA is operationally feasible and safe to implement. However, achieving elimination requires more than just broad coverage; it demands overcoming specific logistical and social barriers. The statistical identification of resistance hotspots (e.g. Kg. Timpus) and the operational strain of managing animal reservoirs highlight the need for targeted strategies. Future interventions must pivot towards precision public health, using geospatial analytics to stratify localities by risk. Concurrently, the Ministry of Health should leverage these findings to advocate for a formalised cross-sectoral policy with veterinary services, ensuring dedicated animal health resources for future operations.},

note = {Type: Poster Presentation; Organisation: 1Beluran Area Health Office, Sabah State Health Department, Ministry of Health Malaysia 2Filariasis Unit, Vector-borne Disease Sector, Disease Control Division, Ministry of Health Malaysia; Corresponding author: Zulhilmi Ahmad Zulkepli, zhilmi.az@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-680,

title = {A Report of Dengue Outbreak at a Military Camp in Batu Pahat},

author = {Rahayu bt Othman1 Wong Liang Tung1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue fever remains a significant public health concern in Malaysia, contributing to high incidence of cases and deaths. Dengue outbreaks can be attributed to a combination of entomological, epidemiological, and environmental factors. Effective control measures are crucial to minimising the number of Dengue cases and deaths. In this outbreak report, we present the Dengue outbreak that occur in a military camp in Batu Pahat district, Johor. Materials and Methods: This Dengue outbreak that was declared in a military camp in Batu Pahat started in end of December 2025 and ended in mid of February 2026. The outbreak involved eight cases, all whom are military personnel working in the camp. The source of the outbreak was originated from another Dengue outbreak in a military camp of neighbouring district. The military personnel who caught the virus during the operation came back to Batu Pahat camp and spread the virus. The elimination of breeding sites was conducted seven times covering an area of 200-meter radius. A total of 15 buildings were checked with coverage of 100%. Results: A total of 680 potential breeding sites was inspected, with 660 being inside of a building and 20 outside of a building. Eight potential breeding sites were found positive for Aedes mosquito larvae. Insecticide space spraying via thermal fogging was conducted for nine times within the 200-meter radius throughout the outbreak period. Ultra-low volume (ULV) fogging was also done to complement thermal fogging. A few sessions of health education and promotions were conducted for all the military personnel regarding Dengue fever and Aedes mosquito control. Despite dedicated efforts to contain the outbreak, the locality still became a Dengue hotspot as the outbreak ended after more than 30 days. Discussion/ Conclusion: This outbreak presented a particular challenge as it is link to another active outbreak in another district. Both outbreaks need to be controlled simultaneously to prevent the spread of the virus. In addition, effective collaboration with the military officers can greatly help in coordinating preventive and control measures. Greater importances should be placed on maintaining cleanliness in and around the buildings to reduce potential breeding sites for Aedes mosquitoes.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Batu Pahat, Batu Pahat, Johor, Malaysia; *Corresponding author: Wong Liang Tung, wongliangtung@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-738,

title = {A Retrospective Study with Spatio-temporal Analysis of Hand-Foot-Mouth Disease Cases in Sibu District, Malaysia in 2025},

author = {Pauline Robert Ero2 Teh Jo Hun2 Loo Tze Yong1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hand-Foot-Mouth disease remains a public health problem in Malaysia, especially in Sibu, Sarawak, where outbreaks occur every now and then. Therefore, this study was carried out to investigate the epidemiology and spatiotemporal pattern of Hand-Foot-Mouth disease cases in the Sibu district for the year 2025. Materials and Methods: Retrospective analysis of secondary data from the Communicable Disease Control Information System, with a total of 1,001 reported cases throughout the year. Spatial analysis using heatmaps and Average Nearest Neighbour was performed using ArcGIS, followed by spatiotemporal clustering analysis using SatScan with 999 Monte-Carlo simulations. Results: The annual incidence rate was 347.6 cases per 100,000 population, with most of whom were children aged less than 12 years. There are seasonality patterns in the epidemic curve reflected by the temporal analysis, with case counts increasing from epidemiological week 11 and peaking at week 35. Our spatial analysis also identified a strong clustering pattern with an ANN ratio of 0.0207, p-value \<0.001, implying evidence of non-random distribution of cases. We also identified 14 clusters; five were statistically significant, including two high-risk clusters in a densely populated urban area. Discussion/ Conclusion: Integration of heatmap and spatiotemporal analyses showed that these higher case density areas coincided with the identified hotspot clusters, indicating that the transmission is driven by close-contact exposure, and corresponded to the epidemiological weeks during school-term periods. Hand-Foot-Mouth disease transmission in Sibu also exhibited distinct temporal and spatial clustering within specific urban areas functioning as hotspots. This highlights the practical relevance of focusing on public health preventive interventions by identifying, targeting these locality-specific, especially at-risk areas and settings, and prior to the peak periods, as a means to mitigate future outbreaks.},

note = {Type: Poster Presentation; Organisation: 1Department Of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. 2Sibu Divisional Health Office, 96000 Sibu, Sarawak, Malaysia.; Corresponding author: Loo Tze Yong, drjasonlootzeyong@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-549,

title = {A Systems Framework for Strengthening Elder Mental Health in Malaysia: Addressing Policy \& Practice Gaps},

author = {Suriyati Bt Abdul Aziz2 Noor Khalili Bin Mohd Ali1 Guganesan Krishnanmoorthy1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia is experiencing a rapid demographic transition with projections estimating 15% of the population will be aged 60 years and above by 2040. Despite the existence of national policies on ageing and mental health, implementation gaps, workforce shortages, urban-rural disparities and unintegrated service delivery limit effective support for older adults. Mental health status in rural areas remains underreported. This paper developed an integrated public health framework to strengthen community-based elder mental health care through systems coordination, primary care integration and equitable service expansion. Materials and Methods: A policy analysis was conducted based on prior scoping review findings and national policy documents. International best practices, including WHO healthy ageing principles, were examined to inform system-level recommendations catered to Malaysia’s health infrastructure. Results: Key gaps identified include fragmented service delivery, limited rural outreach, inadequate geriatric mental health workforce, and weak intersectoral coordination. A systems framework was developed focusing on three core components, namely (1) integration of mental health screening and management into primary care and community services; (2) expansion of community-based outreach programmes including mobile and telehealth services to address rural inequities; and (3) an interministerial governance approach addressing health, social welfare and legal protections for older adults. A phased implementation approach (short-term, mid-term and long-term) outlines scalable projects, workforce development strategies and monitoring indicators. Conclusion: An integrated, equity-centric systems approach is essential to preparing Malaysia’s public health system for population ageing. Strengthening governance coordination, community-based delivery and digital innovation can reduce untreated mental illness, improve caregiver support and enhance dignity and wellbeing among older Malaysians.},

note = {Type: Poster Presentation; Organisation: 1District Health Office Seremban, Seremban, Negeri Sembilan, Malaysia, 2District Health Office Seremban, Seremban, Negeri Sembilan, Malaysia; Corresponding author: Guganesan Krishnanmoorthy, Email: kguganesan@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-530,

title = {Adapting the Gartner TIME Framework for Needs Assessment of Malaysia's MyHDW Migration and Modernisation Strategy},

author = {Rohaizan Abd Kadir Jailani2 Nuraidah Mohd Marzuki1 Mohamad Fadli Kharie1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia's Health Data Warehouse (MyHDW) aggregates health programme data across programmes and divisions within Ministry of Health Malaysia (KKM). MyHDW faces persistent challenges, including legacy infrastructure, schema fragmentation, programme silos, and a growing number of independently developed programme systems operating outside the central data ecosystem. These constraints hinder KKM's transition from a data collection agency into a data intelligence organisation. This study aims to assess data submission maturity and strategic relevance across KKM programmes and to generate an evidence-based module disposition framework to guide MyHDW migration and modernisation planning through 2030. Materials and Methods: A mixed-methods design was employed. A structured questionnaire was distributed to all Programme-in-Charge (PIC) officers responsible for data returns across KKM programmes and divisions, capturing: (i) nature of data outputs and intended stakeholders; (ii) data submission coverage; (iii) data quality; (iv) strategic relevance over five years; and (v) existing or planned independent digitalisation initiatives. Afterwards, Focus Group Discussions (FGDs) later explored barriers, programme readiness, and integration feasibility. Each module was scored across Business Value (output impact, stakeholder dependency, strategic relevance) and Technical Fit (submission coverage, data quality, integration capability with MyHDW) and plotted onto an adapted Gartner TIME (Tolerate, Invest, Migrate, Eliminate) matrix to determine its modernisation pathway. Results: The adapted TIME matrix stratified modules into four dispositions. Invest modules with high Business Value and Technical Fit such as SMRP Inpatient and Daycare were assigned advanced modernisation pathways including API integration, predictive analytics, and generative AI. Tolerate modules were assigned active remediation roadmaps or replatforming pathways. Migrate modules covered two sub-types: programmes with independent systems requiring data pipeline development to ingest data into MyHDW, and programmes requiring co-design or data collection redesign to establish interoperable pipelines. Eliminate modules comprised returns with low submission and no foreseeable strategic utilisation. FGDs confirmed that Technical Fit must be scored from MyHDW's perspective, reflecting data accessibility and integration readiness rather than a programme system's internal quality alone. Conclusion: This study demonstrates that the Gartner TIME framework can be meaningfully adapted for national health data warehouse planning through two key adjustments. Tolerate is reframed as active remediation staging rather than passive acceptance. Migrate is extended beyond platform migration to encompass data relationship migration, drawing independently operated programme systems into a governed, interoperable ecosystem. These adaptations address the fragmented, multi-stakeholder realities of national health informatics in a middle-income country context. The resulting framework provides KKM with a transparent, replicable tool for prioritising MyHDW transformation investments toward a cloud-native, API-driven, and AI-enabled national health data ecosystem by 2029.},

note = {Type: Oral Presentation; Organisation: 1Health Informatics Centre, Planning Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia. 2Planning Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Mohamad Fadli Kharie, m_fadli@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-614,

title = {Advancing Equity in Juvenile Recidivism: A Machine Learning Approach to Risk Assessment},

author = {Manimaran Krisnan2 Abu Bakar Rahman2 Siti Romahani Rahman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Juvenile recidivism is a complex public health challenge with significant implications for youth development, mental health, and long-term societal outcomes. Risk factors are multifaceted, encircling individual behaviour, family environment, peer influence, and exposure to adverse childhood experiences. Traditional risk assessment approaches often rely on linear assumptions, potentially overlooking the complex interactions influencing recidivism. Machine learning offers a technology-driven approach to enhance predictive accuracy while integrating a health equity perspective, enabling the identification of socially patterned determinants. This study aimed to apply machine learning models to predict recidivism risk and identify social and behavioural factors associated with recidivism among juveniles. Materials and Methods: A cross-sectional study was conducted among 313 juveniles from Sekolah Henry Gurney, Melaka. Data were collected using assisted self-administered surveys with structured and validated questionnaires. Variables included sociodemographic characteristics, criminal history, adverse childhood experiences, family environment, peer influence, and psychological distress. Five predictive models were developed: logistic regression, decision tree, random forest, extreme gradient boosting, and support vector machine. Models were trained on a subset of the data and evaluated on a held-out test set. Performance was assessed using area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, F1-score, and Cohen’s kappa. Feature importance analysis was conducted using the random forest model. Results: All models demonstrated acceptable to good discriminative performance. Random forest showed the most consistent performance across evaluation metrics, achieving the highest accuracy (0.74), sensitivity (0.86), F1-score (0.75), and Cohen’s kappa (0.49), indicating strong capability in identifying high-risk juveniles. Extreme gradient boosting achieved the highest accuracy (0.78) but had lower sensitivity (0.64), limiting its utility for targeted intervention. Support Vector Machine performed least favourably (0.68). Feature importance analysis identified frequent offending (≥4 offences) and younger age at first offence as the strongest predictors, followed by family structure (living with parents), paternal education, prior rehabilitation, and peer criminal influence. Adverse childhood experiences and psychological distress contributed moderately, underscoring the multidimensional and socially patterned nature of recidivism risk. Conclusion: These findings demonstrate the potential of machine learning in improving risk stratification for juvenile recidivism. From a health equity perspective, early offending, family structure, and parental education reflect disparities in family support, socioeconomic conditions, and access to protective resources. The contribution of adverse childhood experiences and psychological distress further highlights the role of cumulative disadvantage and unmet mental health needs. The results support a shift toward equity-oriented, holistic rehabilitation strategies. Interventions should emphasise family-based approaches, parental engagement, and educational support. Integration of trauma-informed care and accessible mental health services is essential to address psychosocial vulnerabilities. Peer-based interventions, including mentoring and prosocial engagement, may further reduce recidivism risk. Importantly, machine learning-based models should be implemented transparently and used to complement, rather than replace, professional judgment to ensure fair and equitable decision-making. In conclusion, health equity\textendashinformed machine learning models offer a promising approach for identifying high-risk juveniles and guiding targeted interventions. Integrating technological innovation with public health principles can support more effective, equitable, and evidence-based juvenile justice policies and rehabilitation strategies.},

note = {Type: Oral Presentation; Organisation: 1Pejabat Kesihatan Daerah Temerloh, Pahang, Malaysia. 2Institut Penyelidikan Tingkahlaku Kesihatan, Institut Kesihatan Negara, Selangor, Malaysia. 3Sektor Biostatistik \& Data Repositori, Institut Kesihatan Negara, Selangor, Malaysia. 4Institut Penyelidikan Perubatan, Institut Kesihatan Negara, Selangor, Malaysia. 5Sekolah Henry Gurney, Melaka, Malaysia. 6Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, WP Kuala Lumpur, Malaysia.; Corresponding author: Siti Romahani Rahman, romahanirahman@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-732,

title = {Advancing Universal Oral Health Coverage through an Integrated Framework for Basic Package of Oral Care},

author = {Harsh Priya1 Bharathi. M. Purohit1 Huma Nawaz1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Oral health is increasingly recognized as an essential component of Universal Health Coverage, yet its integration into primary health care remains limited, especially in low-and middle-income countries, leading to persistent inequities in access to essential oral health services. The rising burden of preventable oral diseases highlights the need for scalable, community-based solutions. The Basic Package of Oral Care (BPOC), an integrated service delivery model was proposed by the World Health Organization, to provide essential oral health care in hard-to-reach areas. Despite being introduced for over two decades, there has been a modest uptake and integration of BPOC, impacting its transformative potential. Materials and Methods: A narrative review of the literature was conducted to examine the evidence on BPOC implementation, its alignment with Primary Heath Care and Universal Health Coverage principles, and its contribution to oral health service delivery. Evidence from country experiences and global oral health initiatives was also synthesized to identify implementation gaps. Results: Based on the review findings, an integrated, competency-based framework was proposed to reposition BPOC by systematically linking workforce competencies, service delivery functions, and system-level outcomes. The framework highlights the role of Community Health Workers (CHWs) in delivering basic oral health services and strengthening access to care, particularly among underserved and marginalized populations. Conclusion: Establishing a national, competency-based framework for the delivery of basic oral health services through CHWs has the potential to strengthen oral health systems, substantially expand service coverage, and advance health equity across the world. Embedding this framework within national policies can support sustainable integration of oral health into primary health care and accelerate progress toward Universal Health Coverage.},

note = {Type: Oral Presentation; Organisation: 1 Division of Public Health Dentistry, Centre for Dental Education \& Research, All India Institute of Medical Sciences, New Delhi, India. 2 Department of Orthodontics \& Craniofacial anomalies, Centre for Dental Education \& Research, All India Institute of Medical Sciences, New Delhi, India; Corresponding author: Huma Nawaz, nawazhuma2010@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-771,

title = {AI-Assisted Breast Cancer Screening: Is It Worth The Investment? A Systematic Review of Global Evidence and Public Health Implications},

author = {Hanin Farhana Kamaruzaman1 Low Ee Vien2 Erni Zurina Romli1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: As Artificial Intelligence (AI) is increasingly integrated into breast cancer screening, healthcare payers require evidence of its long-term value. While AI improves accuracy, its cost-effectiveness remains contested across different global health systems. The objective of this review was to systematically examine the available evidence on the long-term cost-effectiveness and health outcomes of AI-assisted breast cancer screening compared to conventional human-read strategies. Materials and Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Ovid MEDLINE, and the CEA Registry up to March 2, 2026. Quality was assessed using the CHEERS-AI checklist. Studies assessing AI-assisted digital mammography (AI-DM) or AI-enhanced digital breast tomosynthesis (AI-DBT) were included. Key outcomes included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Reporting quality was assessed using the CHEERS-AI checklist. Results: Three model-based studies from the United States, Singapore, and Sweden met inclusion criteria. All adopted healthcare system perspectives and lifetime horizons. Findings varied by setting. In the United States, AI-DBT was not cost-effective (ICER ≈ $303,279/QALY). In contrast, a Singapore study found AI-assisted screening to be cost-saving and health-improving (+15.9 QALYs), while AI-standalone increased costs despite greater sensitivity. A Swedish analysis demonstrated that AI-DM was dominant, generating cost savings and additional QALYs with high probability of cost-effectiveness. Across studies, AI reduced false positives and enabled earlier cancer detection, contributing to downstream cost savings. Discussion/ Conclusion: The economic value of AI in breast cancer screening is highly context-specific. While AI may be cost-saving in organized screening programs, high implementation costs may limit its value elsewhere. ASEAN policymakers should prioritize context-specific economic evaluation before large-scale adoption.},

note = {Type: Poster Presentation; Organisation: 1Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia. 2Centre of Health Economics Research, Institute for Health Systems Research, National Institute of Health, Selangor, Malaysia.; Corresponding author: Erni Zurina Romli, zuromli@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-457,

title = {Aligning People, Practice, and Performance: Integrated Care in an Island Health System},

author = {Tengku Mohamad Iskandar Tengku Mohamad Rosman² Devi Shantini A/P Rata Mohan1 Nur Azmiah Zainuddin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Public health systems continue to face persistent gaps in care coordination, continuity, and chronic disease management, particularly in settings characterised by population mobility, geographic separation, and mixed service demands. Langkawi’s public and private health services operate in a unique context shaped by an ageing resident population and transient tourist demand, highlighting the importance of adaptable and well-integrated service delivery across levels of care. This study aims to examine how integrated care is operationalised in routine service delivery within an island health system and to identify insights for improving coordination and continuity of care. Materials and Methods: A qualitative study was conducted using in-depth interviews and focus group discussions. Data were generated through 42 in-depth interviews and 7 focus group discussions, involving a total of 64 participants from primary and secondary care facilities in both the public and private sectors, as well as representatives from agencies involved in health service coordination for Langkawi residents. Relevant document reviews were undertaken for data triangulation. Data were analysed using a framework analysis approach guided by the Rainbow Model of Integrated Care. NVivo 14 software was used to support coding and data management. Member checking was conducted to validate researcher interpretation. Results: Participants described integrated care in Langkawi as involving locally developed adaptations to address coordination, continuity, and chronic disease management in routine service delivery. These adaptations were described as being shaped by performance indicators, service pressures, and leadership operating across district, hospital, and primary care levels. Diabetes care was frequently shared as a prominent example, where services were reorganised to support closer alignment between specialist and primary care services, including the strategic use of shared endocrinology expertise to strengthen management within primary care, with support from district coordination and clinical leadership. Participants described this approach as emphasising shared clinical responsibility, capacity building at the primary care level, and person-centred care principles, particularly in tailoring follow-up and management decisions to patients’ needs and circumstances. It was also shared that the introduction of locally monitored indicators supported sustained implementation and was accompanied by reported improvements in diabetes performance targets over time. Across initiatives, continuity of care was described as being reinforced through professional relationships, flexible service arrangements, and targeted use of digital tools to support information exchange and coordination. Conclusion: The findings highlight how integrated care in Langkawi was shaped through the alignment of people, practice, and performance within existing service delivery structures. Rather than relying on structural reform or digital solutions alone, progress was shaped by how professional relationships, leadership capacity, and performance signals were mobilised to support continuity of care. Central to this success was the cultivation of mutual goals and shared aspirations among healthcare professionals. By aligning diverse teams under a unified purpose, these practitioners were able to transcend institutional silos. These insights suggest that recognising and strengthening existing adaptive practices, underpinned by a collective vision for patient outcomes, may be an important pathway for advancing integrated care.},

note = {Type: Oral Presentation; Organisation: 1Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 2Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, 3Langkawi District Health Office, Ministry of Health Malaysia, 4Hospital Sultanah Maliha, Ministry of Health Malaysia; Corresponding Author: Nur Azmiah Zainuddin, nurazmiah.z@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-528,

title = {An Unexpected Return: Imported Cholera Presenting as a Household Cluster},

author = {Norfazillah Binti Ab Manan1 Siti Hazwani Binti Abidin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Cholera remains a global public health threat, particularly in regions with ongoing transmission, and imported cases pose a risk of secondary spread in non-endemic settings. Increased international travel heightens the likelihood of reintroduction of cholera into countries with otherwise low incidence. In June 2025, a suspected case of cholera was notified in Sepang District, Malaysia, involving an individual returning from travel to India. This investigation aimed to confirm the occurrence of cholera, describe the clinical and epidemiological characteristics of the cases, identify the source of infection and extent of transmission, and evaluate the effectiveness of public health control measures in preventing wider community spread. Materials and Methods: An outbreak investigation was initiated following notification from a tertiary hospital. A suspected case was defined as any individual with acute watery diarrhoea with/or without vomiting that had history from cholera endemic country or those who had epidemiological linkage to cholera case within the defined incubation period, while laboratory-confirmed cases were identified through isolation or detection of Vibrio cholerae strain O1, from stool or rectal swab specimens. Active case detection was undertaken among household members, travel companions, and other close contacts to identify additional symptomatic or asymptomatic individuals. Comprehensive interviews were conducted to obtain detailed information on travel history, timing of symptom onset, and potential exposure sources. Environmental assessments were carried out at the residences of affected individuals and other relevant locations to evaluate sanitation infrastructure and hygiene practices. All specimens were subjected to laboratory confirmation and serotyping at the national reference laboratory to ensure diagnostic accuracy and epidemiological linkage. Results: Two laboratory-confirmed cases were identified among twelve close contacts, resulting in an attack rate of 16.7%. The index case developed acute diarrhoea during return air travel from India and was subsequently admitted after worsening symptoms. A secondary case was detected through active surveillance and experienced mild, self-limiting symptoms. Both cases were confirmed as cholera of the same serotype. All other contacts remained asymptomatic and tested negative. Environmental assessments revealed satisfactory sanitation infrastructure and no evidence of local food or water contamination, supporting classification of the outbreak as an imported infection. Both cases received appropriate antibiotic therapy, achieved microbiological clearance, and recovered fully without complications or mortality. No further cases were detected following implementation of control measures. Conclusion: This case series highlights the potential for imported cholera to result in limited secondary household transmission even in non-endemic settings with adequate sanitation. Early notification, rapid laboratory confirmation, aggressive contact tracing, and prompt clinical management were critical in preventing wider spread. The findings underscore the importance of detailed travel history in patients presenting with acute diarrhoea, heightened clinical suspicion for imported infections, and robust inter-agency coordination. Strengthening pre-travel health education, post-travel surveillance, and early outbreak response remains essential to prevent re-emergence of cholera in low-incidence countries.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Sepang, Selangor, Malaysia; Corresponding author: Siti Hazwani Binti Abidin, dr.sitihazwani@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-783,

title = {Analysing The Effectiveness Of Taxation On Sugar-Sweetened Beverages In Reducing Rates Of Obesity And Type 2 Diabetes: A Systematic Review And Meta-Analysis},

author = {Logapragash Kandasamy2 Kalpana Das1 David Chan Chee Hoong1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The escalating global prevalence of obesity and Type 2 Diabetes Mellitus has led over 50 jurisdictions to implement excise taxes on sugar-sweetened beverages. While the economic impact on purchasing behaviour is thoroughly documented, the downstream epidemiological effects on chronic disease remain contested. This systematic review and meta-analysis evaluate the effectiveness of sugar-sweetened beverages taxation in reducing population-level rates of obesity and Type 2 Diabetes Mellitus. Materials and Methods: We conducted a systematic search of PubMed, Scopus, Embase, Web of Science, and the Cochrane Library for peer-reviewed studies published over a 10-year timeframe up to January 2026, adhering to PRISMA guidelines. Eligible studies assessed national or sub-national sugar-sweetened beverages taxes and reported quantitative outcomes on Body Mass Index, obesity prevalence, or Type 2 Diabetes Mellitus incidence. A random-effects model was utilized to calculate pooled Risk Ratios and Mean Differences, with heterogeneity assessed via the Ι2 statistic. Results: Of 1,402 identified records, 22 studies (14 empirical observational, 8 microsimulation models) met the inclusion criteria. Tax implementation (averaging a 10%\textendash20% price increase) was associated with a 15.2% decline in sugar-sweetened beverages purchasing volume. Meta-analysis demonstrated a statistically significant reduction in obesity prevalence associated with the tax (Pooled Risk Ratio = 0.96, 95% CI: 0.94\textendash0.98, Ι2 = 68%). Furthermore, sugar-sweetened beverages taxation was associated with an 8% relative reduction in the incidence of Type 2 Diabetes Mellitus (Pooled Risk Ratio = 0.92, 95% CI: 0.88\textendash0.97, Ι2 = 54%). Subgroup analyses revealed that health gains were most pronounced in lower-income quintiles and adolescent populations. Conclusion: The findings indicate that the epidemiological benefits of sweetened beverages taxation strongly align with established economic impacts on consumer purchasing behaviour. The pronounced health gains observed in vulnerable demographics, specifically lower-income and adolescent populations, highlight the equity-enhancing potential of such fiscal interventions. However, the moderate heterogeneity across the included studies suggests that local economic contexts, baseline consumption habits, and specific structural tax designs significantly modulate overall policy effectiveness. Fiscal policies targeting sugar-sweetened beverages are an effective public health intervention. They successfully suppress demand for sugary beverages, translating into measurable, statistically significant reductions in population-level obesity and Type 2 Diabetes. Tiered, sugar-density taxes demonstrate the highest efficacy by driving industry reformulation alongside consumer behavioural shifts.},

note = {Type: Poster Presentation; Organisation: 1 Jempol District Health Office, Negeri Sembilan, Malaysia. 2 Perak State Health Department, Perak, Malaysia.; Corresponding author: David Chan Chee Hoong, davidcch10@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-620,

title = {Analysis of Primary Healthcare Utilization and Medical Evacuation Needs in Tioman Island, Pahang: A Case Study},

author = {Mohd Sulaiman Bin Zainal1 Mohd Fazeli Bin Sazali1 Ahmad Aizat Bin Azman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Primary healthcare delivery in remote island settings faces challenges related to accessibility, limited resources, and reliance on medical evacuation (MEDEVAC). Tioman Island, Pahang, serves both local residents and a high volume of tourists, necessitating efficient primary care and referral systems. This study describes healthcare utilisation patterns and medical evacuation needs from Tekek Health Clinic, Tioman. Materials and Methods: A retrospective descriptive study was conducted using clinic and referral data from 2023 to 2025. Variables included sociodemographic characteristics, disease categories, and referral details. MEDEVAC cases (2024\textendash2025) were analysed by mode of transport and speciality referred. Descriptive statistics were applied. Results: A total of 5,580 cases were recorded, with a mean age of 34.31 years (SD 16.5). Most patients were Malay (65.7%), Malaysian citizens (78.3%), and tourists/non-locals (53.0%). The most common conditions were respiratory diseases (20.9%), infectious and parasitic diseases (18.2%), and injuries (18.1%). A total of 303 cases required hospital referral. MEDEVAC was mainly via water ambulance (60.1%), followed by passenger ferry (19.8%), private boats (13.5%), government vessels (4.3%), and helicopter (2.3%). Most referrals were for internal medicine (47.9%), paediatrics (19.5%), and surgery (12.2%). Conclusion: Findings indicate a dual burden of communicable diseases and injuries influenced by environmental factors and tourist activity. High utilisation by non-locals highlights the impact of tourism on healthcare demand. Dependence on water transport reflects logistical constraints, while low helicopter use suggests limited accessibility or cost barriers. Recommendations include strengthening on-site clinical capacity through enhanced diagnostics and telemedicine, standardising MEDEVAC protocols to improve efficiency and inter-agency coordination, and implementing targeted prevention strategies for infections and injuries among tourists. In conclusion, primary healthcare in Tioman Island supports a mixed population with diverse health needs. MEDEVAC remains essential, predominantly via water transport, and strengthening service capacity, evacuation systems, and preventive measures is critical to optimise healthcare delivery in this remote setting.},

note = {Type: Poster Presentation; Organisation: 1Rompin District Health Office, Rompin, Pahang, Malaysia,; Corresponding author: Ahmad Aizat Bin Azman, drmohdfazeli@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-649,

title = {Antifibrotic And Immunosuppressant in Scleroderma and Progressive Fibrosing Interstitial Lung Disease: A Systematic Review},

author = {Nurkhodrulnada ML1 Mohamad Baihaqi MB1 Che Sarida Che Ismail1 and Syaqirah A1.},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Interstitial lung diseases (ILDs) represent a significant disease burden, with non-idiopathic pulmonary fibrosis (non-IPF) types increasingly prevalent. Autoimmune-related conditions such as scleroderma (systemic sclerosis) can develop into a progressive fibrosing phenotype (PPF), leading to worsening lung function, disability, and mortality. Scleroderma is a rare autoimmune disorder characterised by excessive collagen production, often affecting the lungs. Globally, PPF prevalence is estimated at 2.2 to 20.0 per 100,000 in Europe and about 28.0 per 100,000 in the United States, with many ILD patients developing progressive disease. In Malaysia, the absence of a national registry makes prevalence difficult to determine, though local studies highlight its clinical importance. Objective: This technology review was conducted to update the 2020 assessment and evaluate the effectiveness, safety, and economic implications of antifibrotic and immunosuppressant therapies in scleroderma and progressive fibrosing ILD. Materials and Methods: A systematic review was performed following PRISMA guidelines, with searches across Medline, PubMed, Embase, and the Cochrane Library up to 30 September 2025. Twenty-seven studies were included: 12 systematic reviews and meta-analyses, 14 randomised controlled trials, and one cost-effectiveness analysis. Results: Evidence showed multiple therapeutic agents slowed lung function decline in patients with scleroderma associated ILD (SSc-ILD) and progressive fibrosing ILD (PF-ILDs). Antifibrotic therapies, particularly nintedanib, significantly reduced the annual decline in forced vital capacity (FVC), while pirfenidone showed benefit in selected ILD subtypes. Immunosuppressive agents such as rituximab and tocilizumab preserved FVC, with rituximab also improving diffusing capacity for carbon monoxide (DLCO). Mycophenolate mofetil (MMF) stabilised FVC and better tolerated than cyclophosphamide (CYC), which offered modest benefit but was limited by toxicity. Nintedanib and pirfenidone, though effective, were frequently associated with gastrointestinal side effects, particularly diarrhoea, often requiring dose reduction or discontinuation, but they did not significantly increase fatal outcomes compared to placebo. Rituximab and tocilizumab generally demonstrated favourable safety profiles, with mild infusion reactions and infections as the most common concerns. Mycophenolate mofetil was well tolerated for long-term use, whereas CYC carried a higher risk of serious adverse events, especially leukopenia. International guidelines recommend MMF as the preferred first-line therapy due to its safety and efficacy, with CYC conditionally endorsed for induction in severe cases. Nintedanib, rituximab, and tocilizumab are suggested as second-line options for progressive disease, with decisions guided by cost and safety considerations. Cost-effectiveness evidence remains limited, but analyses indicate rituximab is cost-effective compared to cyclophosphamide at a willingness-to-pay threshold of £30,000 per QALY in adults with CTD-ILD, while nintedanib is cost-effective versus usual care in PF-ILD at €80,000 per QALY. A one-year cost-consequence analysis further suggests that biologics offer the most favourable short-term profiles, combining better safety with cost efficiency compared to other options. Conclusion: A substantial body of evidence supports antifibrotic and immunosuppressive therapies in managing SSc-ILD and PF-ILDs. Mycophenolate mofetil is widely regarded as a cornerstone for long-term therapy due to superior tolerability, rituximab and tocilizumab demonstrate strong efficacy and safety among biologics, and antifibrotic agents such as nintedanib and pirfenidone effectively slow disease progression, though careful monitoring is required for gastrointestinal side effects that are typically non-fatal.},

note = {Type: Oral Presentation; Organisation: 1Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Che Sarida Che Ismail, che.sarida@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-527,

title = {Apartment Prices, Self-Rated Health, and Stress: A Fourteen-Year Within-Municipality Analysis in South Korea},

author = {Hyevin Shin1 Hyejung Lim1 Baeksan Yu1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Housing markets are increasingly recognised as social determinants of health, yet longitudinal evidence on whether changes in local housing prices precede changes in population health remains limited. This study examined reciprocal associations between apartment prices and two municipal health indicators, self-rated health and stress, across South Korean municipalities. Materials and Methods: The unit of analysis was the municipality, defined as the city, county, or district administrative unit in South Korea. We assembled annual panel data from 2010 to 2023 by combining nationwide apartment transaction prices with municipality-level indicators of self-rated health and stress. Apartment prices were measured as the annual average apartment transaction price per square meter. Because 2020 marked the onset of the coronavirus pandemic in South Korea and may have altered both housing markets and perceived health, we compared models that constrained cross-lagged effects to remain constant over time with models that allowed these effects to vary across years. We estimated fixed-effects cross-lagged panel models to examine bidirectional relationships while accounting for stable municipality characteristics, autoregressive continuity, baseline covariance, and contemporaneous covariance. Missing data were handled using full information maximum likelihood. Results: In models with constant cross-lagged effects, higher apartment prices were associated with subsequent improvements in self-rated health and reductions in stress. Reverse paths from self-rated health and stress to later apartment prices were not statistically significant. In time-varying models, the positive association between apartment prices and self-rated health was strongest from 2014 to 2017, weakened in 2018 and 2019, and re-emerged after the onset of the pandemic. Self-rated health also showed an unusual upward shift in 2020, which may reflect pandemic-related changes in health perceptions rather than a simple continuation of the prior trend. The association between apartment prices and reduced stress was most evident in 2015 and again in 2020, suggesting that housing-related financial security may have been especially salient at the start of the pandemic. Conclusion: Results suggest that rising apartment prices may function as an area-level determinant of population health, consistent with a housing asset effect rather than strong evidence of reverse causation. They also indicate that the pandemic may have altered the timing and visibility of housing-health links rather than reversing their overall direction. Public health responses to health inequalities may therefore need to treat housing stabilisation and regional equity as health policy, not only economic policy. Future research should examine whether these associations differ between homeowners and renters and whether housing-related health gains are distributed unequally across social groups.},

note = {Type: Oral Presentation; Organisation: 1 Gwangju National University of Education, Korea University , University of Florida; Corresppnding author: Baeksan Yu, yu.baeksan@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-563,

title = {Artificial intelligence-assisted learning and academic performance among future healthcare workforce: A cross-sectional study among nursing and allied health students},

author = {Jaffri Hashim3 Renny Grece Jeplin1 Norni Mualip¹*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Artificial intelligence (AI) is rapidly transforming health professions education and is increasingly influencing the development of future healthcare workforce competencies; however, its impact on measurable academic performance remains unclear. This study aimed to examine the relationship between AI-assisted learning and academic performance among nursing and allied health students. Materials and Methods: A cross-sectional study was conducted among 176 first-semester students in Malaysia. AI-assisted learning was assessed using a structured questionnaire, while academic performance was obtained from standardised examination scores. Data were analysed using descriptive statistics, Pearson correlation, and multiple linear regression. Results: The findings indicated that AI-assisted learning was widely adopted, with consistently high scores across all domains. However, no significant relationship was found between AI-assisted learning and academic performance (p\>0.05), and regression analysis further confirmed that AI-assisted learning did not significantly predict academic outcomes (R² = .021},

note = {Type: Oral Presentation; Organisation: ¹Training Institute, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia; Corresponding author: Norni Mualip, norni.mualip@ilkkm.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-568,

title = {Artificial intelligence-assisted learning behaviour among future healthcare workforce: A cross-sectional study among nursing and allied health students},

author = {Jaffri Hashim1 Renny Grece Jeplin1 Norni Mualip¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Artificial intelligence (AI) is increasingly integrated into health professions education and plays a growing role in shaping learning behaviour among future healthcare workforce; however, patterns of its use remain insufficiently understood. This study aimed to examine artificial intelligence-assisted learning behaviour among nursing and allied health students. Materials and Methods: A cross-sectional study was conducted among 176 students using a structured questionnaire assessing cognitive, efficiency, academic, and adaptive domains. Descriptive and correlation analyses were performed. Results: The findings demonstrated high levels of artificial intelligence-assisted learning behaviour across all domains, with efficiency showing the highest mean score (M = 4.55},

note = {Type: Poster Presentation; Organisation: ¹Training Institute, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia; Corresponding author: Norni Mualip, norni.mualip@ilkkm.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-453,

title = {Assessing the Cost and Glycemic Impact of Empagliflozin in Malaysian Primary Care: A Real-World Cost-Consequence Evaluation},

author = {Fajaratunur Binti A. Sani1 Juwita Asikhin Binti Juma’at1 Tai Chia Woon1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Poor glycemic control among insulin-treated adults with type 2 diabetes mellitus (T2DM) remains a major challenge in Malaysian primary care and is frequently associated with escalating insulin requirements and rising treatment costs. While empagliflozin is known to improve glycemic outcomes, its real-world impact on insulin treatment intensity and medication-related costs in public primary care remains less well described. This study aimed to evaluate real-world glycemic outcomes, insulin deintensification, and estimated medication cost consequences following the initiation of empagliflozin among insulin-treated patients in public primary healthcare clinics (PHCs). Materials and Methods: A multicentre, cross-sectional retrospective observational study was conducted across 14 government PHCs in Johor Bahru Health District. Adult patients with T2DM receiving insulin therapy who initiated empagliflozin and completed at least 6 months of follow-up were included. Pre- and post-treatment clinical parameters, insulin treatment intensity, and insulin-related medication costs were analysed. As most continuous variables were not normally distributed, changes were assessed using the Wilcoxon signed-rank test and summarised using medians and interquartile ranges (IQR). Differences in glycated haemoglobin (HbA1c) outcomes and changes in insulin costs across insulin treatment strategies were evaluated using the Kruskal-Wallis test. Regression analysis was performed to explore predictors of insulin deintensification. All cost values represent estimated annual medication costs derived from standard acquisition prices and median insulin usage patterns rather than exact patient-level expenditure Results: A total of 509 patients were included in the glycemic analyses, with 410 having complete insulin cost data. Following empagliflozin initiation, HbA1c decreased by a median of -1.00% (IQR -0.15 to 2.15). Median HbA1c reduction remained clinically meaningful across insulin treatment strategies, including -0.80% in patients requiring insulin intensification, -1.40% in patients who de-intensified insulin, and −1.60% in patients who maintained their insulin regimen. Significant median improvements were also observed in fasting blood glucose, body mass index, waist circumference, systolic and diastolic blood pressure, triglyceride levels, and high-density lipoprotein cholesterol. Insulin deintensification occurred in 36.6% of insulin-treated patients. Estimated median annual insulin cost changes differed significantly by treatment strategy, with a median increase of MYR154.24 among patients requiring insulin intensification, a median reduction of MYR87.58 among those who de-intensified insulin, and no median change among patients who maintained their insulin regimen. Despite the fixed annual acquisition cost of empagliflozin, patients who de-intensified insulin experienced the lowest estimated net increase in total medication expenditure. Regression analysis demonstrated that a higher baseline insulin dose per kilogram of body weight was independently associated with a greater likelihood of insulin deintensification. Conclusion: In real-world Malaysian primary care, empagliflozin provides clinically meaningful glycemic and cardiometabolic benefits while enabling insulin deintensification and partial medication cost offset in a substantial proportion of insulin-treated patients. These findings support the role of empagliflozin in facilitating individualised, cost-conscious insulin management strategies and highlight its public health value in optimising diabetes care within resource-limited public healthcare systems.},

note = {Type: Oral Presentation; Organisation: 1Pharmacy Unit, Johor Bahru District Health Office, Jalan Abdul Samad, Kolam Ayer, 80100 Johor Bahru, Johor Darul Ta'zim, Malaysia; Corresponding author: Tai Chia Woon, taichiawoon@yahoo.com.sg},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-554,

title = {Assessment Tools for Evaluating Adolescent-Friendly Health Clinic Services: A Scoping Review},

author = {Ku Anis Shazura binti Indera Putera1 Kah Yee Lum1 Muniamal Krishnan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Adolescents face distinct physical, psychological, and social health challenges that require accessible and responsive care. The World Health Organization promotes Adolescent-Friendly Health Services (AFHS) as a global strategy to address these needs. However, existing evidence on AFHS evaluation tools remains fragmented, with limited comprehensive synthesis from healthcare provider and health system perspectives. This lack of standardisation makes it difficult to ensure that assessment tools are applicable across diverse settings, particularly in low- and middle-income countries with differing health system structures and sociocultural contexts. In Malaysia, where adolescents comprise approximately 16% of the population, this gap underscores the importance of understanding whether existing tools are suitable or require contextual adaptation. Without such evaluation, there is a risk that assessment approaches may not fully capture local service delivery realities or the needs of Malaysian adolescents. This scoping review systematically maps and examines assessment tools, evaluation criteria, and measurement approaches used internationally to evaluate AFHS in primary healthcare settings. Materials and Methods: Guided by the Arksey and O’Malley framework and PRISMA-ScR, a search of PubMed, Scopus, ScienceDirect, and Google Scholar (2014\textendash2024) was conducted. The inclusion criteria included primary healthcare clinics providing adolescent-friendly services to adolescents aged 10\textendash19 years. From 11,293 identified records, 41 articles were included in the synthesis. Results: The review identified several tools used to assess Adolescent-Friendly Health Services (AFHS), including the World Health Organization Quality Assessment Guidebook, national benchmarks such as India’s Rashtriya Kishor Swasthya Karyakram (RKSK) and Kenya’s Adolescent and Youth-Friendly Services (AYFS) guidelines, and the YFHS-WHO+ questionnaire. However, no single standardised tool was consistently applied across studies. Evaluation criteria derived from these tools commonly focused on provider competencies (e.g., respect, communication), facility characteristics (e.g., privacy, cleanliness), and service accessibility. Many studies also adopted the Donabedian Model, examining quality across structure, process, and outcome dimensions. Measurement approaches included facility audit checklists, healthcare provider interviews (9 studies), and client exit interviews (12 studies) to assess structural elements, provider perspectives, and user experiences, respectively. Conclusion: Existing Adolescent-Friendly Health Services (AFHS) assessment tools are highly heterogeneous in design and scope. Most tools focus primarily on structural and process domains, with less emphasis on standardised outcome measures, limiting the ability to assess service effectiveness and compare findings across settings. This gap is particularly important in Malaysia, where global tools may not fully reflect local context and needs. Therefore, there is a need to develop or adapt a context-specific instrument that integrates structure, process, and outcome domains to support more comprehensive and meaningful evaluation.},

note = {Type: Poster Presentation; Organisation: 1Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia; Corresponding author: Muniamal Krishnan, muniamal.k@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-725,

title = {Association and determinants of extreme heat exposure and preterm birth: a systematic review and meta-analysis},

author = {Qu Lu1 Zichen Ye1 Jiahui Wang1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Extreme heat is a growing environmental stressor under global climate change, and pregnant women are particularly susceptible. However, the association with preterm birth (PTB) and its potential modifiers remains insufficiently understood. Materials and Methods: We conducted a systematic literature search following PRISMA guidelines across five databases (PubMed, Ovid MEDLINE, Web of Science, Embase, Cochrane Library). The protocol was registered with PROSPERO (CRD420251066785). We included observational studies reporting a quantitative association between gestational exposure to extreme heat defined by percentile thresholds (≥90th percentile or heatwave) and PTB. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the WHO risk of bias tool for epidemiological studies of air quality and health. Analyses were conducted separately for short-term (≤4 weeks before delivery) and long-term (\>4 weeks before delivery) heat exposures. For each, we performed random-effects meta-analyses to pool relative risks (RRs). We also conducted subgroup analyses (by exposure threshold, geographic region, climate zone, study design, and income level), sensitivity analyses, and assessed publication bias. The overall certainty of evidence was appraised using the WHO-adapted GRADE framework. Results: The final analysis incorporated 49 studies conducted across 13 countries, representing a diverse range of climatic and socioeconomic contexts with a total population exceeding 53 million. The results demonstrated a robust association between extreme heat and increased PTB risk for both short-term exposure (defined as ≤4 weeks before delivery) and long-term exposure (defined as \>4 weeks before delivery), with pooled RRs of 1.07 (95% CI: 1.05, 1.09) and 1.27 (95% CI: 1.18, 1.36), respectively. Subgroup analyses revealed that the magnitude of the effect was significantly influenced by several moderators. Regarding exposure intensity, the 95th percentile threshold for long-term exposure yielded the highest risk estimate. Furthermore, the association was more pronounced in studies covering multiple climate zones compared to single-zone regions. A critical window of vulnerability was identified during the third trimester, where long-term heat exposure showed the strongest association with PTB. Notably, the impact of short-term extreme heat was more severe in low- and middle-income countries (LMICs) compared to high-income nations, highlighting an environmental justice dimension. According to the WHO-adapted GRADE framework, the certainty of evidence for both exposure durations was rated as high. Conclusion: This study provides robust evidence that both short- and long-term exposure to extreme heat significantly increases the risk of PTB, with long-term exposure posing a substantially higher risk. The association is modified by factors including exposure timing, temperature threshold, geographic location, and study design. The findings underscore the heightened vulnerability of pregnant women in a warming climate and highlight critical evidence gaps, particularly in low-income and tropical regions. These results urgently call for targeted public health interventions, such as heat-health warning systems and guidance on cooling behaviours during pregnancy, especially in the third trimester, to mitigate the adverse impacts of extreme heat on maternal and infant health.},

note = {Type: Oral Presentation; Organisation: 1School of Health Policy and Management, Chinese Academy of Medical Sciences \& Peking Union Medical College, Beijing, China. 2School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \& Peking Union Medical College, Beijing China; Corresponding author: Jiahui Wang, anniewangjiahui@163.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-484,

title = {Association of Viral Serotype Dominance and Lagged Meteorological Factors with Dengue Transmission Intensity in Selangor, Malaysia},

author = {Asraf Ahmad Qamruddin1 Annabella Ruth Edwin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue fever remains a major public health challenge in the highly urbanised state of Selangor, Malaysia. Epidemic magnitude is shaped by complex interactions between meteorological determinants influencing vector ecology and cyclical shifts in circulating dengue virus (DENV) serotypes that alter population immunity. Although environmental drivers are well established, limited studies have simultaneously quantified their effects alongside dynamic serotype dominance. This study aimed to evaluate the concurrent influence of lagged meteorological factors and DENV serotype shifts on weekly dengue incidence in Selangor. Materials and Methods: A retrospective ecological time-series study was conducted using integrated weekly epidemiological, virological, and meteorological datasets spanning 105 weeks (2024\textendash2025). Epidemiological case data were obtained from the e-Dengue surveillance system. Meteorological variables, including accumulated rainfall, average temperature, and average humidity, were sourced from the Malaysian Meteorological Department. Virological data were derived from the Dengue Virus Sentinel Surveillance system, comprising laboratory-confirmed serotype results submitted by four districts and four sentinel hospitals in Selangor. After excluding five weeks with incomplete observations, 100 weeks were included in the final analysis. To account for overdispersion and potential non-linear environmental effects, a multivariable Negative Binomial Generalised Additive Model (NB-GAM) was applied. Based on the biological vector lifecycle, meteorological variables were evaluated at an 8-week temporal lag. To avoid multicollinearity among proportional serotype variables, the historically predominant DENV-1 was designated as the baseline reference category. Results: The final NB-GAM demonstrated strong explanatory performance, accounting for 54.1% of the null deviance (adjusted R²=0.436). Lagged meteorological factors were significant predictors of weekly incidence. Accumulated rainfall (p\<0.001) and average temperature (p=0.002) showed significant linear positive associations with dengue cases. In contrast, average humidity exhibited a highly significant non-linear association (estimated degrees of freedom = 3.21},

note = {Type: Oral Presentation; Organisation: 1Selangor State Health Department; Corresponding author: Asraf Ahmad Qamruddin, dr.asraf@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-774,

title = {Awareness and Socio-demographic Determinants of Pre-pregnancy Care Services Among Women at Risk of High-Risk Pregnancy in Kulai District},

author = {Nuzul Hazwin Binti Mohd Hanapi2 Nor Adlina Binti Jamonek 2 Naffisah Othman 1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Pre-pregnancy care (PPC) is an essential preventive healthcare strategy aimed at optimizing maternal health before conception and reducing adverse pregnancy outcomes, particularly among women at risk of high-risk pregnancies due to medical, obstetric, or socio-demographic factors. Despite the availability of PPC services in Malaysia, utilization remains suboptimal, often due to poor awareness and limited understanding of service benefits. Objective: This study aimed to assess the level of awareness and perception toward PPC services among women at risk of high-risk pregnancy attending primary care clinics in Kulai District, Johor, and to identify socio-demographic determinants associated with good PPC awareness. Materials and Methods: A cross-sectional survey was conducted among 281 women aged 18\textendash49 years attending selected primary healthcare clinics in Kulai District. Eligible participants included women with one or more recognized risk factors for high-risk pregnancy. Data were collected using a validated structured questionnaire covering socio-demographic characteristics, reproductive history, PPC awareness, perception, and family planning knowledge. Statistical analyses were performed using SPSS, including descriptive analysis, bivariate association testing, and multivariable logistic regression to identify predictors of good PPC awareness. Results: Among respondents, only 45.2% had heard of PPC services, while awareness of family planning was higher at 79.4%. Although baseline awareness of PPC was limited, respondents generally demonstrated positive perceptions regarding the benefits of planned pregnancies, contraception, and maternal health optimization. Significant bivariate associations with good PPC awareness were observed for age group (p=0.001), education level (p=0.002), and prior awareness of family planning (p\<0.001). In multivariable analysis, family planning awareness emerged as the strongest predictor of good PPC awareness (Adjusted OR 53.18, 95% CI: 19.42\textendash145.59, p\<0.001). Higher education and older age groups showed positive trends but were not independently significant after adjustment. Conclusion: Women at risk of high-risk pregnancy in Kulai District generally possess favorable perceptions toward PPC once informed, but practical awareness and service understanding remain insufficient. The substantial gap between perception and awareness suggests that poor service uptake may be driven primarily by inadequate information dissemination rather than negative attitudes. Strengthening PPC promotion through integrated family planning services, targeted health education, and reproductive health counseling is crucial, particularly for younger and lower-awareness populations. Enhancing district-level PPC strategies may improve maternal preparedness, reduce preventable pregnancy complications, and strengthen preventive maternal healthcare outcomes.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Kulai, 21 \& 22, Jalan Kiambang 2, Pusat Komersial Indah, Indahpura, 81000, Kulai, Johor, Malaysia. 2Klinik Kesihatan Kulai, Jalan Pejabat Kerajaan, Taman Kulai, 81000, Kulai, Johor, Malaysia. 3Klinik Kesihatan Senai, Batu 13, Jalan Air Hitam, Kampung Baru Senai, 81400 Kulai, Johor, Malaysia. 4Klinik Kesihatan Kulai Besar, Jalan Air Hitam, 81000, Kulai, Johor, Malaysia.; Correspondence: Naffisah Othman, naffisah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-583,

title = {Barriers to Long-Acting Reversible Contraception Utilisation in Primary Healthcare in Kelantan},

author = {Amirulazman Abu Hassan 3 Nurul Hidayatullaila Sahar 2 Nur Nabila Jusoh1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Long-acting reversible contraception is an effective strategy for preventing unintended pregnancies; however, its utilisation in Malaysia remains low. Understanding barriers from the patient perspective is crucial to informing targeted interventions within primary healthcare. This study aimed to assess perceived barriers to long-acting reversible contraception utilisation and to identify associated factors among patients attending primary healthcare facilities in Kelantan. Materials and Methods: A cross-sectional study was conducted from June to October 2024 among patients attending Maternal and Child Health services in five government health clinics in Jeli District, Kelantan. Perceived barriers were measured using a self-administered questionnaire developed and validated by the research team. Total barrier scores were transformed into percentage scores, with higher scores indicating greater perceived barriers. Descriptive statistics and linear regression were applied for data analysis. Results: A total of 151 patients participated. The mean perceived barrier score was 64.9%, indicating a moderate level of barriers. Among the domains assessed, individual-level barriers recorded the highest mean score (74.0%), followed by health system-level barriers (59.7%) and social-level barriers (53.2%). In multivariable analysis, lower perceived barrier scores were significantly associated with household income above MYR3000 (adjusted β = -4.32; 95% CI: -8.56, -0.08; p=0.046) and higher knowledge scores (adjusted β = -0.11; 95% CI: -0.20, -0.02; p\<0.001). Conclusion: Perceived barriers to long-acting reversible contraception utilisation were moderate, with individual-level factors emerging as the predominant domain. Patients with lower income and poorer knowledge demonstrated higher barrier scores. Thus, targeted interventions for lower-income groups and enhanced health education on long-acting reversible contraception may help reduce these barriers.},

note = {Type: Poster Presentation; Organisation: 1 Pasir Puteh District Health Office, Pasir Puteh, Kelantan, 2 Jeli Health Clinic, Jeli, Kelantan, 3 Jeli District Health Office, Jeli, Kelantan; Corresponding author: Nur Nabila Jusoh, drnabilajusoh@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-754,

title = {Basic Activities of Daily Living as a Superior Early Predictor of Incident Circadian Syndrome: A 4-Year Prospective Cohort Study},

author = {Sun C1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: To examine whether impairment in basic activities of daily living (ACTIVITIES OF DAILY LIVING) predicts the incident risk of circadian syndrome (Circadian syndrome) earlier and more independently than instrumental activities of daily living (INSTRUMENTAL ACTIVITIES OF DAILY LIVING) among middle-aged and older adults in China, and to explore its potential mechanistic implications. Materials and Methods: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011 and 2015, including 10,214 participants aged 45 years and older who were free of Circadian syndrome at baseline. Baseline ACTIVITIES OF DAILY LIVING and INSTRUMENTAL ACTIVITIES OF DAILY LIVING impairment were assessed, and incident Circadian syndrome was identified at follow-up. Modified Poisson regression models with robust error variance were used to estimate the associations of ACTIVITIES OF DAILY LIVING and INSTRUMENTAL ACTIVITIES OF DAILY LIVING impairment with incident Circadian syndrome, with stepwise adjustment for demographic characteristics, health behaviors, social factors, and clinical comorbidities. Sensitivity analyses were conducted using an alternative Circadian syndrome definition that excluded depressive symptoms. Results: During the four-year follow-up, 1,636 participants developed Circadian syndrome. In the fully adjusted model, baseline ACTIVITIES OF DAILY LIVING impairment was associated with a higher risk of incident Circadian syndrome (RR = 1.24, 95% CI: 1.08\textendash1.42},

note = {Type: Poster Presentation; Organisation: 1Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea; Corresponding author: Chuanwen Sun, scw020115@163.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-469,

title = {Beyond Body Mass Index: The Impact of Chrononutrition on Metabolic Phenotypes Among Malaysian Primary Healthcare Workers},

author = {Chong Hui Jing2 Tai Chia Woon1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Metabolic syndrome (MetS) affects 35.9% of Malaysian adults, yet body mass index (BMI)-based screening often misses high-risk cardiometabolic profiles such as the metabolically unhealthy non-obese (MUNO). Distinct metabolic phenotypes, namely metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), MUNO, and metabolically unhealthy obese (MUO) capture cardiometabolic risk heterogeneity beyond BMI alone. Chrononutrition, the alignment of eating patterns with circadian rhythms, is a key determinant of metabolic health. This study examined the prevalence of MetS and these four metabolic phenotypes among Malaysian primary healthcare workers (PHCWs), and evaluated how meal-timing behaviours, such as breakfast skipping and dinner-to-bedtime latency (DTBL), related to MetS and phenotype distribution. Materials and Methods: This cross-sectional, multicentre study was conducted across 14 government clinics in Johor Bahru. Habitual meal-timing behaviours were assessed using structured questionnaires, while clinical parameters were extracted from annual medical records. MetS was defined using the Harmonised Joint Interim Statement (JIS 2009) and the International Diabetes Federation (IDF 2006) criteria. Participants were categorised as MHNO, MHO, MUNO, or MUO based on BMI (obesity ≥27.5 kg/m²) and cardiometabolic risk clustering. Multinomial logistic regression, adjusted for age, gender, and sleep duration, was used to assess associations between chrononutrition patterns and metabolic phenotypes; logistic regression examined MetS and individual components. Results: The study included 955 PHCWs (mean age 36.0 ± 6.8 years; 78.7% female), primarily comprising nurses (31.4%), medical officers (17.9%), and pharmacists (11.3%) working standard daytime hours. Overall MetS prevalence was 13.9%, though 71.4% of participants had at least one metabolic abnormality. Phenotypes distribution was MHNO 49.5%, MUNO 15.0%, MHO 12.3%, and MUO 23.2%. Breakfast skipping (≥3 times/week) significantly differed across metabolic phenotypes (p=0.002), with prevalence highest in MUO (51.8%) compared to the MHO group (38.5%). Late-night eating was most frequent in MHO (38.5%) and least common in MUO group (24.3%), suggesting a stronger role in early adiposity than in advanced metabolic deterioration. Compared with an early dinner with regular breakfast, early dinner combined with breakfast skipping was associated with higher odds of MetS in models adjusted for age, sex, and sleep duration (adjusted OR 1.73; 95% CI: 1.12\textendash2.66), but attenuated after BMI adjustment (aOR 1.54; p=0.076). The same pattern remained independently associated with central obesity (aOR 1.46; 95% CI: 1.05-2.03) and reduced HDL-cholesterol (aOR 1.65; 95% CI: 1.15-2.37). Discussion/Conclusion: Among young Malaysian PHCWs, a 15.0% MUNO prevalence underscores the limitations of BMI-only screening. Chrononutrition patterns characterised by breakfast skipping, particularly following an early evening meal, appear more strongly related to adverse metabolic profiles than late-night eating alone, likely facilitating morning hypercortisolism and subsequent insulin resistance. These findings support workplace interventions that promote regular breakfast consumption and better alignment of daily eating windows with morning metabolism, alongside routine biochemical screening, to prevent progression from metabolically healthy to unhealthy phenotypes in the clinical workforce.},

note = {Type: Oral Presentation; Organisation: 1Pharmacy Unit, Mahmoodiah Health Clinic Johor Bahru, Ministry of Health Malaysia Jalan Mahmoodiah, Johor Bahru, Johor. Malaysia.2Pharmacy Unit, Skudai Baru Health Clinic Johor Bahru, Ministry of Health Malaysia Jalan Mahmoodiah, Johor Bahru, Johor. Malaysia.; Corresponding author: Tai Chia Woon, taichiawoon@yahoo.com.sg},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-760,

title = {Beyond Clinic: Community-Informed Approaches to Addressing Stunting in Malaysia},

author = {Aimi Nadiah Jamel2 Chan Huan Keat2 Peter Gan Kim Soon1* and Mariana Mohd Yusoff1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Stunting remains a persistent public health and equity challenge in Malaysia, despite widespread access to maternal and child health services. Nationally, one in five children under five is stunted, with disproportionately higher prevalence among Orang Asli communities. This disparity underscores the limitations of clinic-based care in addressing the household, community, and structural determinants of child nutrition. This study examined barriers and enablers to optimal maternal and child nutrition across diverse Malaysian contexts and generated community-informed insights to inform the design of a community health worker programme for the First 1,000 Days. Materials and Methods: A qualitative formative study was conducted through six focus group discussions with 51 pregnant women and mothers of children under 24 months from urban, rural, and Orang Asli communities. Maximum variation sampling ensured socioeconomic, geographic, and cultural diversity. Data collection and analysis were guided by the UNICEF 2020 Conceptual Framework on the Determinants of Maternal and Child Nutrition, with attention to immediate, underlying, and basic determinants. Discussions were conducted in Malay, transcribed verbatim, independently coded by two analysts, and analysed thematically. Results: Five interrelated themes emerged. First, stunting was primarily perceived as physical shortness, with limited recognition of its developmental, educational, and intergenerational consequences. Second, while breastfeeding was strongly endorsed, mothers faced challenges in sustaining it due to pain, perceived insufficient milk supply, employment constraints, and inadequate lactation support. Third, complementary feeding represented a critical risk transition, with dietary diversity declining after infancy and practices shaped by caregivers, family influence, food insecurity, and children’s preferences. Fourth, although mothers trusted health services, they reported brief consultations, limited structured nutrition education, language barriers, and inconsistent outreach as constraints to meaningful support. Fifth, participants expressed strong support for a community health worker model that was locally embedded, culturally responsive, linguistically appropriate, and delivered through a hybrid of home visits, group sessions, and digital communication. Conclusions: Stunting prevention in Malaysia requires a shift beyond knowledge-based interventions towards sustained, context-sensitive support at the household level. Effective responses must integrate nutrition counselling with breastfeeding support, culturally appropriate communication, social protection linkages, and improved continuity between clinics and communities. A community health worker model, embedded within primary care, offers a feasible and scalable approach to strengthen the First 1,000 Days agenda by aligning recommended practices with the lived realities of families.},

note = {Type: Oral Presentation; Organisation: 1Health Transformation Office (HTO), Ministry of Health Malaysia, Putrajaya, Malaysia. 2Centre for Clinical Trial (CCT), National Institutes of Health, Setia Alam, Selangor, Malaysia. 3General Practice Clinical Unit, University of Queensland, Herston, Queensland, Australia. 4Perak State Health Department, Ministry of Health Malaysia, Perak, Malaysia.; Corresponding Author: Peter Gan Kim Soon, dr.petergan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-698,

title = {Beyond Cox: Machine Learning Outperforms Traditional Survival Analysis in Cancer Prognosis},

author = {Nor Azham Hakim Darail3 Shridevi Subramaniam2 Evi Diana Omar¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Cox proportional hazards regression has been widely used for survival analysis in oncology for many years, yet its parametric assumptions may limit predictive accuracy in complex clinical datasets. Machine learning methods like XGBoost offer flexible alternatives capable of capturing non-linear relationships without explicit specification. This study compared the discriminative performance and generalizability of XGBoost-based approaches versus traditional Cox regression for cancer survival prediction and identified key prognostic factors. Materials and Methods: We analyzed survival data from 1,670 cancer patients with complete follow-up information. Predictor variables included age, disease staging, tumor grade, chemotherapy, radiotherapy, surgery, and ethnicity. Patients were randomly allocated to training (n=1,336, 80%) and test (n=334, 20%) sets. We implemented three approaches: (1) traditional Cox proportional hazards regression, (2) XGBoost Regression with weighted loss function predicting log survival time, and (3) XGBoost Cox optimizing Cox partial likelihood. Both XGBoost models employed conservative hyperparameters (learning rate 0.05, maximum depth 4, subsample 0.8) to prevent overfitting. Model discrimination was quantified using Harrell's concordance index (C-index) on training and test data. Variable importance was measured using gain metrics. Results: XGBoost Cox demonstrated superior discrimination with test C-index of 0.722, followed by XGBoost Regression at 0.671. Traditional Cox regression achieved training C-index of 0.735 but collapsed to 0.262 on testing, indicating severe overfitting (train-test ratio 2.81 vs 1.12 for XGBoost Cox), representing a 176% improvement with machine learning. Variable importance revealed age as the dominant prognostic factor (34.2% model gain), followed by staging (28.2%), collectively explaining 62.4% of predictive information. Treatment modalities contributed 22.2% collectively, while tumor grade and ethnicity showed moderate importance (9.0% and 6.4%). Both XGBoost implementations maintained stable performance across datasets (C-index difference \<0.10), demonstrating robust generalization. Discussion/Conclusion: Machine learning methods substantially outperformed traditional Cox regression for survival prediction in this cancer cohort. The dramatic performance collapse of Cox regression suggests violations of proportional hazards assumptions or non-linear relationships that gradient boosting captured through flexible tree-based modeling. Age and staging emerged as critical prognostic drivers. The superior stability and discrimination of XGBoost approaches (C-index 0.72 indicates clinically meaningful prediction) support their integration into clinical risk stratification tools. These findings demonstrate that traditional survival methods may be less sufficient for complex oncology datasets, and modern machine learning offers powerful alternatives for precision medicine, though external validation remains essential before clinical deployment.},

note = {Type: Poster Presentation; Organisation: ¹Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor, Malaysia. ² Clinical Research Centre, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia. 3 Breast \& Endocrine Surgery Unit, Department of Surgery, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia. 4Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia.; Corresponding author: Evi Diana Omar, evidiana@crc.moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-594,

title = {Beyond Physical Disability: The Impact of Bedridden Status on Religious Compliance Among Domiciliary Care Patients in Tanah Merah, Kelantan.},

author = {Nik Aida Nik Adib1 Anas Rosedi1 Ahmad Zulfahmi Mohd Kamaruzaman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Chronic conditions such as stroke often lead to a bedridden state, which significantly impacts not only a patient’s physical function but also their ability to fulfill religious obligations. In Tanah Merah, spiritual support for domiciliary patients remains an area requiring deeper understanding to ensure holistic care. This study aimed to determine the demographic profile of domiciliary patients under the Tanah Merah District Health Office and to evaluate the changes in the fulfilment of the five daily prayers (Solat Fardu) before and after patients became bedridden. Materials and Methods: A cross-sectional study was conducted involving all registered domiciliary patients in the Tanah Merah district (n=36). Data were collected through clinical records and interviews. Descriptive statistics were used for demographic profiling, and the McNemar Exact Test was employed to analyse the significance of changes in prayer fulfilment. Besides, Mann-Whitney U and Fisher’s Exact tests were employed to identify associations between demographics and prayer status. Results: There was a statistically significant decline in prayer compliance after patients became bedridden (p \< 0.001). Prior to being bedridden, 88.9% (n=32) of patients performed the five daily prayers, which plummeted to only 16.7% (n=6) post-illness. Statistical analysis revealed that age (p=0.766), gender (p=0.677), economic status (p=0.431), and ADL status (p=0.306) did not significantly influence prayer performance. However, a notable trend was observed in diagnosis; stroke patients were less likely to maintain prayer compared to non-stroke patients (p=0.073). The most significant factor associated with prayer performance was the type of barrier faced (p=0.010), with family support being a critical facilitator, while cognitive impairment ("Terangkat Taklif") and challenges in managing physical impurities (najis) were primary deterrents. Conclusion: Bedridden status poses a severe threat to the spiritual health of patients, with a 72.2% rate of prayer cessation. Public health interventions in domiciliary care should not only focus on physical rehabilitation but also incorporate "Mesra Ibadah" (Syariah-compliant care) training for caregivers. Addressing impurity management and educating families on "Rukhsah" (religious concessions) are essential to maintaining the holistic health of homebound patients.},

note = {Type: Poster Presentation; Organisation: 1 Tanah Merah Health District Health Office, Tanah Merah, Kelantan; Corresponding author: Ahmad Zulfahmi Mohd Kamaruzaman, drzulfahmi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-766,

title = {Beyond Routine Microscopy: Integrating Epidemiological and Molecular Evidence in a Plasmodium vivax Outbreak Investigation among an Indigenous Community in Gua Musang, Kelantan},

author = {Mohamed Hizamudin Mohamed Nor 1 Mohammad Fazrul Mohammad Basir 1 Noorfariza Nordin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Despite sustained malaria control efforts, Plasmodium vivax continues to challenge malaria elimination through relapse, silent circulation, and low-density infections that evade routine microscopy. This study investigated the P. vivax human malaria cluster in Pos Simpor, Gua Musang, by integrating epidemiological, genetic, and molecular evidence to clarify the drivers of ongoing transmission. Materials and Methods: An outbreak investigation was conducted in the indigenous localities of Pos Simpor, Gua Musang, using active and passive case detection, mass blood surveys, microscopy, molecular screening, and parasite genotyping. Peripheral blood samples were collected from clinical cases, asymptomatic contacts, and community members for blood film microscopy. Real-time Polymerase Chain Reaction (RT-PCR) was performed to confirm Plasmodium species and detect submicroscopic P. vivax infections. Positive samples were subsequently referred to the Institute for Medical Research for parasite genotyping. Genotypic profiles of the 2025 cluster isolates were compared with archived isolates from the 2024 outbreak in the same geographical area to explore transmission and relapse patterns. Results: A total of five malaria cases were detected during the outbreak, with most cases aged 20\textendash29 years (n = 4; 80.0%), female (n = 3; 60.0%), detected through active case detection (n = 3; 60.0%), and asymptomatic at diagnosis (n = 3; 60.0%). Concurrent RT-PCR screening identified an additional hidden reservoir of three submicroscopic P. vivax infections (2.1%), all of which were asymptomatic and negative by blood film microscopy (n = 3; 100.0%). One case (n = 1; 20.0%) was identified as a relapse case with documented P. vivax infection during the preceding 2024 outbreak and clinical recurrence in 2025. Genotypic profiling showed that the 2025 recurrent isolate belonged to a distinct genetic lineage from the patient’s 2024 isolate, supporting heterologous relapse. Based on integrated epidemiological and genotypic evidence, four cases (80.0%) were classified as introduced infections, while one case (20.0%) was classified as heterologous relapse. Conclusion: The P. vivax outbreak was driven by a complex interplay of introduced infections, heterologous relapse, and hidden asymptomatic submicroscopic infections. These findings highlight the need to strengthen molecular surveillance and targeted active case detection in remote indigenous communities to interrupt residual P. vivax transmission and support malaria elimination efforts. This evidence directly supports Malaysia’s National Strategic Framework for Prevention of Malaria Re-establishment by reinforcing the importance of strengthened surveillance, early detection, molecular confirmation, and targeted response in receptive and vulnerable localities.},

note = {Type: Poster Presentation; Organisation: 1 Gua Musang District Health Office, Kelantan State Health Department, Malaysia.; Corresponding author: Noorfariza Nordin, drnoorfariza@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-625,

title = {Beyond the Clinic: Leveraging Community Partnerships and Point-of-Care Screening to Identify Hidden NCD Risk in Pontian, Johor, Malaysia.},

author = {Parameswaran Ramachandran 1 Deventhari Ramanaidoo1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Non-communicable diseases (NCDs) remain a leading cause of morbidity, accounting to approximately 74% of all global deaths, with many individuals undiagnosed due to limited engagement with healthcare services, and disproportionately affecting low \textendash and middle income countries. In Malaysia, the 2024 National Health Screening Initiative (NHSI) reported that nearly 79% of participants had at least 1 NCD risk factor, highlighting the extensive burden of NCD in our population. Innovative approaches leveraging community partnerships, people-centered outreach, and point-of-care technologies are needed to close this gap. Point- of- care technologies are portable, rapid diagnostic tools used at the site of care, providing immediate results without needing a laboratory. This study aimed to assess the burden of common NCD and selected cancer risk factors identified through opportunistic community screening as well as usage of innovative technologies, in a district population in Southern West Malaysia. Materials and Methods: A cross-sectional study was conducted during the Hari Bertemu Pelanggan Hospital Pontian program at Dewan Muafakat Pontian on 27 November 2025, through collaboration between healthcare providers, community stakeholders and NGO such as National Cancer Society of Malaysia. A total of 92 participants underwent integrated multi-disease screening using point-of-care technologies and rapid diagnostic tools, including Hepatitis B and C rapid testing, smoking exposure assessment (Smokerlyzer), prostate-specific antigen (PSA) testing for men aged ≥40 years, and clinical breast examination for women. A subset of 76 participants underwent additional NCD risk assessment, including body mass index (BMI), blood pressure, cholesterol, and blood glucose. Descriptive analysis was performed based on the gathered data. Results: Among 92 participants, the population was predominantly female, (n= 64, 69.7%), aged ≥40 years (n= 54, 59.2%), and largely reflective of the local multi-ethnic community. Elevated PSA levels (\>4.0 ng/mL) were detected in (n= 2, 4%), of the participants, while no Hepatitis B or C cases were identified. Elevated carbon monoxide levels were found in (n= 2, 2%), of the population, suggestive of smoking exposure as well as significant number of smokers in the community. Among 76 participants assessed for NCD risk, (n= 45, 59.2%) had abnormal BMI and (n=45, 59.2%) had elevated blood pressure, while (n= 30, 39.5%) and (n=12, 15.8%) had abnormal cholesterol and blood glucose levels, respectively, indicating clustering of cardiometabolic risk. A percentage of more than 50% having abnormal BMI and elevated blood pressure reflects the prevalence of existing NCD risk factors in this community. This is a direct reflection of the health burden in the long term run for the screened population as well as the need for aggressive intervention. Conclusion: Opportunistic community screening in an isolated district revealed a substantial hidden burden of NCD risk factors. Participants with abnormal findings were referred and followed up at local primary care clinics (Klinik Kesihatan). Leveraging community partnerships and point-of-care technologies offers a scalable strategy to reach diverse populations and improve early detection, as well as to improve primary and secondary prevention policies to serve at a community level. Unlike conventional clinic- based screening, this approach delivers integrated health risk assessment in a non-healthcare setting, enabling access to populations who may not routinely seek care. This will indirectly help to reduce the burden of NCD and subsequently the healthcare cost of tertiary prevention.},

note = {Type: Poster Presentation; Organisation: 1Hospital Pontian, Pontian, Johor Darul Ta'zim, Malaysia.; Corresponding author: Deventhari Ramanaidoo, deventhari.ramanaidoo@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-532,

title = {Beyond The Numbers: Unpacking The Five-Year Measles Resurgence In Hulu Langat, Selangor},

author = {1 Norsafinaz Mohamed1 1 Ashvini Jayapalan Areena Yusof},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measles remains a significant public health concern in Malaysia despite the availability of a free national immunisation program. This study aimed to describe the five-year trend of measles in the Hulu Langat district from 2019 to 2023 and identify factors associated with confirmed cases. Materials and Methods: A cross-sectional study was conducted using population-based surveillance data from the Sistem Maklumat Siasatan Measles (SM2). A total of 2,667 cases were analysed. Results: The results showed that notifications and confirmed cases peaked in 2019, followed by a sharp decline during the pandemic years of 2020 and 2021, likely due to movement restrictions and social distancing. However, a dramatic resurgence was observed in 2023, with the incidence rate reaching 54.95 cases per 1,000,000 population. Statistical analysis using multiple logistic regression identified vaccination status and ethnicity as significant predictors of infection. Individuals who were unvaccinated had over five times the odds of being a confirmed measles case compared to those who were fully vaccinated. Additionally, individuals from the Other ethnic group, specifically Bumiputera Sabah and Sarawak, showed significantly higher odds of infection. Most confirmed cases occurred in children under one year of age, a group that often includes infants not yet eligible for their first vaccine dose. Conclusion: These findings emphasise the critical need for maintaining high herd immunity to protect vulnerable groups. Public health efforts should prioritise targeted community outreach and vaccination advocacy, particularly for marginalised populations and ethnic groups with lower vaccine uptake, to achieve national elimination targets.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Hulu Langat, Selangor; Corresponding author: Areena Yusof, areenayusof@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-753,

title = {Beyond the Uniform: High Body Fat Percentage and Associated Occupational Factors Among Police Officers at Police College in Muar, Johor},

author = {Safiah binti Tajuddin3 Muhammad Azizuddin Tokiran2 Siti Khadijah Abdul Kadir 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Achieving an ideal body weight is now a mandatory prerequisite for career progression in Polis Diraja Malaysia (PDRM). Officers must maintain a Body Mass Index (BMI) below 28 kg/m2 to qualify for promotions. Objective: This study investigates the prevalence of high body fat percentage (BF%) among officers in the Police College in Muar and examines how occupational factors impact their ability to achieve the required body composition. Materials and Methods: A cross-sectional study was conducted in Police College, Muar throughout December 2024 using total enumeration sampling, where all working officers who consented were recruited. Body composition was measured using InBody 270s Portable Body Composition Analyzer. A structured questionnaire consisting of demographics, anthropometric, medical history and occupational status was distributed. Occupational data were categorized into work shift (shift vs. non-shift) and side job status (yes vs. no). Data was analyzed using IBM SPSS Statistics (Version 27.0). Multiple Logistic Regression was used for data analysis. Results: A total of 360 officers were included with a mean age of 41.1+ 9.6 years, and 71.6% were males. The prevalence of high BF% was 90.6%. The majority were pre-obese, 40.3% (137) with BMI 23.0 - 27.5 kg/m2. All participants’ results met normal Skeletal Muscle Index (SMI) criteria, which indicated all officers maintain adequate muscle mass. Multivariable analysis showed that SMI (OR=5.46; p\<0.001) is the primary predictor of body fat status among police officers, other than BMI. Univariable analysis, however, showed that officers working day and night shifts have significantly higher BF percentage (Mean Difference = 2.69%},

note = {Type: Poster Presentation; Organisation: 1Klinik Kesihatan Muar, 84000 Muar, Johor Darul Ta'zim, Malaysia. 2Klinik Kesihatan Bakri, 84200 Bukit Bakri, Johor Darul Ta'zim, Malaysia. 3Klinik Kesihatan Parit Bakar, 84000 Muar, Johor Darul Ta'zim, Malaysia. 4Klinik Kesihatan Bukit Pasir, 84300 Bukit Pasir, Johor Darul Ta'zim, Malaysia.; Corresponding author: Siti Khadijah Abdul Kadir, skhadijah.ak@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-506,

title = {Breaking a Persistent Dengue Hotspot Through Administrative Advocacy and Community Engagement: A Case Report from Southern Malaysia},

author = {Mohd Hafiidz Baharudin1 Redzuan Jokiram1 Farha Ibrahim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue continues to pose a major vector-borne public health challenge in Malaysia, particularly in densely populated institutional residential settings where environmental conditions facilitate Aedes breeding and sustained transmission. In October 2025, a dengue hotspot lasting more than 30 days was identified in the Kluang district, Johor, involving an institutional residential area consisting of high-rise housing blocks and terraced houses accommodating enforcement personnel and their families. Such institutional compounds present unique operational challenges for outbreak control due to limited access to closed premises, the presence of unoccupied housing units for a long period, and environmental structures that may serve as potential mosquito breeding habitats. This case report describes the outbreak investigation, environmental risk factors identified during field assessments and coordinated administrative and community interventions implemented to control the hotspot and prevent further transmission. Materials and Methods: A field outbreak investigation was conducted by the Vector Control Unit of Kluang District Health Office following notification of dengue cases within the institutional residential compound. Epidemiological investigation included case verification, case listing, and spatial mapping of cases within 100\textendash400 metre radii to determine clustering patterns and transmission dynamics. Environmental and entomological assessments were carried out through systematic premise inspections to identify potential Aedes breeding habitats within residential blocks and surrounding environments. Vector control interventions included source reduction, larviciding, mist blower spraying, and targeted health promotion activities among residents. Administrative advocacy and coordination were undertaken with institutional leadership to facilitate access to residential units, particularly unoccupied premises, and to support joint vector control operations. Enforcement actions were implemented under the Destruction of Disease-Bearing Insects Act 1975 (Act 154) where breeding sites or environmental risk factors were identified. These included issuance of compound notices and enforcement directives requiring elimination of mosquito breeding habitats, removal of water-holding containers, and remediation of environmental conditions contributing to Aedes proliferation. Results: A total of 14 dengue cases were detected between 16 September and 4 November 2025 from the hotspot locality, involving residents across all four residential blocks within the compound. Entomological inspections identified a substantial number of Aedes breeding habitats, including discarded containers, poorly maintained drainage areas, unoccupied housing units, and poorly managed unauthorised backyard poultry enclosures. A total of 438 residential premises were successfully inspected, representing 92.0% coverage of the entire compound. Overall, 91 Aedes mosquito breeding sites were detected and eliminated during Dengue control operations. Enforcement measures under the Destruction of Disease-Bearing Insects Act 1975 (Act 154) were implemented, including four compound notices issued for premises with confirmed breeding sites, as well as an additional 89 enforcement notices under Section 5 and two notices under Section 8 requiring corrective environmental actions and removal of potential breeding containers. Integrated control measures were implemented through coordinated operations led by the district health office in close partnership with the institutional administration, following targeted advocacy and strategic engagement to strengthen outbreak response. These collaborative efforts facilitated improved total access coverage to residential premises and institutional support for control activities, including repeated premise inspections, search and destroy activities, larval source reduction, mist blower spraying, larviciding, environmental clean-up campaigns, targeted health promotion activities, and the development of new administrative residential policies to strengthen dengue prevention and control. Following sustained vector control and enforcement measures, the outbreak was successfully contained on 17th of October 2025, with no additional dengue cases reported subsequently. Conclusion: This outbreak demonstrates that persistent dengue hotspots in institutional residential settings can be effectively controlled through strong administrative advocacy, strategic enforcement, and coordinated community engagement. Strengthening enforcement under the Destruction of Disease-Bearing Insects Act 1975 (Act 154), improving access to closed premises, and ensuring institutional accountability for environmental management are critical for effective control. Early engagement between district health offices and institutional leadership, supported by routine internal vector surveillance and structured environmental management policies, can enhance rapid outbreak response and sustain dengue prevention in similar high-risk settings.},

note = {Type: Poster Presentation; Organisation: 1 Kluang District Health Office, Johor State Health Department, Ministry of Health Malaysia; Corresponding author: Farha Ibrahim, drfarha.ibrahim@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-720,

title = {Breaking silos to build knowledge: Interprofessional education intervention as a catalyst for learning diabetes prevention strategies among Malaysian University students},

author = {Tatiyana Mandal2 9 Diya Rajasekhar Chinta1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Lifestyle induced non-communicable diseases, particularly type 2 diabetes mellitus (T2DM), is rapidly increasing in Southeast Asia, with risk behaviours often established during adolescence and early adulthood. Early adoption of healthy practices, such as balanced nutrition, physical activity, stress management, and health literacy, can reduce long-term disease burden. Interprofessional education (IPE) supports lifestyle disease prevention through collaborative, learner-centred approaches integrating biomedical and population health perspectives. Universities and educational institutions are well-suited strategic venues to promote the prevention of lifestyle-induced diseases during this formative stage. This study implemented a team-based IPE diabetes prevention activity among graduate students at Manipal University College Malaysia and evaluated its impact on students’ knowledge, attitudes, and practices, the quality of diabetes prevention guides, and reflective essays. Materials and Methods: A quasi-experimental pre\textendashpost study was conducted between November 2025 and January 2026. Participants were students from Medicine, Dentistry, Allied Health Sciences, and Foundation in Science programmes. Data included KAP questionnaires (pre-test n = 66; post-test n = 59), content analysis (762 topic-level observations) of 18 diabetes prevention guides created by 18 interprofessional student groups, and thematic analysis of 59 reflective essays using a 14-theme framework using Atlas.ti.25, QualCoder tools. Appropriate descriptive, inferential, and non-parametric statistical tests were applied for the relevant data. Results: Knowledge and practice scores improved significantly (knowledge d = 0.635; practices d = 0.703; both p \< 0.001), with a large overall KAP effect size (d = 0.933). Attitude scores increased non-significantly. Content and depth analysis of diabetes prevention guides showed high task completion (99.2%) with variable depth, emphasizing weight management, sleep, and stress. Reflections predominantly highlighted knowledge gains, teamwork, and nutrition awareness, while emotional empathy and digital health were less evident. Conclusion: This IPE activity produced meaningful improvements in diabetes-related knowledge and practices, supporting its role as an effective and integrated strategy to inculcate preventive health education of lifestyle-induced non-communicable diseases such as diabetes, while indicating areas for enhancement in empathy and digital health competencies among students.},

note = {Type: Poster Presentation; Organisation: 1Department of Pharmacology, Manipal University College Malaysia, Melaka, Malaysia. 2Department of Basic Medical Sciences, MAHE, India, 3Center for Foundation \& General Studies, Manipal University College Malaysia, Melaka, Malaysia.4Department of Microbiology, Manipal University College Malaysia, Melaka, Malaysia, 5Department of Physiology, Manipal University College Malaysia, Melaka, Malaysia, 6Department of Internal Medicine, Manipal University College Malaysia, Melaka, Malaysia, 7Department of Oral Biology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia, 8Department of Community Medicine, Kasturba Medical College, MAHE, India, 9MAHE-MFILIPE, FAIMER regional institute, Manipal Academy of Higher Education, Manipal, MAHE, India.; Corresponding author: Diya Rajasekhar Chinta, diya.chinta@manipal.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-773,

title = {Breaking the Chain: Two-Year Outcomes of Single-Dose Rifampicin for Leprosy Prevention in Kampung Sawah Batu.},

author = {Mohd Fahmi Bin Ismail1 Narish Kumar Davendran1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Single-dose Rifampicin is a recommended post-exposure prophylaxis to prevent leprosy among contacts of patients. This study evaluates the implementation, screening yield, and two-year prophylactic effectiveness of a single-dose Rifampicin administration program conducted in Kampung Sawah Batu, Pekan, Malaysia. The intervention was deployed in three batches throughout 2022 and 2023. Materials and Methods: A community-based contact tracing and screening initiative was conducted, targeting a registered population of 845 individuals. Participants were clinically screened for leprosy symptoms and contraindications to Rifampicin. Eligible individuals were administered single-dose Rifampicin, while those with contraindications were exempted. All cohorts\textemdashincluding those who accepted, rejected, or were absent during the drive\textemdashwere actively followed up for two years to monitor for incident leprosy cases. Results: Of the 845 individuals tracked (which included 20 previously known cases), 643 successfully received single-dose Rifampicin. A total of 135 individuals were exempted due to being under 2 years old (n=38), recent Rifampicin consumption (n=36), suspected leprosy (n=29), pregnancy (n=27), kidney disorders (n=3), and active Tuberculosis (n=2). Initial screening of the 29 suspected cases revealed 27 individuals with skin lesions and 2 with both lesions and loss of sensation. Additionally, 29 individuals rejected the intervention, and 18 were not found during the single-dose Rifampicin drives. During the two-year follow-up, the single-dose Rifampicin-accepted cohort (n=643) demonstrated strong early protection, with 0 incident cases in the first year and 5 cases emerging in the second year. In stark contrast, incidence was higher and occurred earlier in the unprotected cohorts: the "rejected" group (n=29) yielded 3 new cases (1 in year one; 2 in year two), and the "not found" group (n=18) yielded 4 new cases (2 in year one; 2 in year two). Conclusion: The administration of single-dose Rifampicin is a highly feasible and effective prophylactic intervention in endemic communities. The data demonstrates a clear protective effect, significantly delaying and reducing the proportional incidence of leprosy in the compliant cohort compared to those who refused or were absent. However, the emergence of cases in the second year among single-dose Rifampicin recipients highlights the necessity of continuous, long-term surveillance and the potential need for repeated screening cycles in high-risk clusters.},

note = {Type: Poster Presentation; Organisation: 1Pekan District Health Office, Pahang, Malaysia.; Corresponding author: Narish Kumar Davendran, mohd.fahmi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-684,

title = {Bridging Infection Prevention and Control System Gaps in Primary Healthcare: Insights from a Statewide Assessment in Kedah, Malaysia},

author = {Mazwin Mahmood3 Mohd Nazrin Jamhari2* Nur Hafizah Nordin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Infection prevention and control (IPC) is a key component of safe and high-quality healthcare delivery and is essential in reducing healthcare-associated infections and protecting both patients and healthcare workers. In primary healthcare settings, variations in resource availability, workload, and system capacity may influence the level of IPC implementation, potentially affecting consistency in practice. Understanding these variations at scale is important to inform targeted system strengthening and evidence-based policy development. This study aimed to assess IPC system readiness across primary healthcare facilities in Kedah and to identify priority areas for improvement. Materials and Methods: A statewide cross-sectional assessment was conducted involving Klinik Kesihatan, Klinik Desa, Klinik Komuniti, and Klinik Kesihatan Ibu dan Anak. Data were collected using the WHO Assessment Tool on Infection Prevention and Control (IPC) Minimum Requirements for Primary Health Care Facilities, which comprises 26 indicators across eight core components. Each facility was scored on a 26-point scale, and data were reviewed and duplicates were removed prior to descriptive analysis, with findings further interpreted using a strengths, weaknesses, opportunities, and threats framework to identify system-level gaps and opportunities. Results: The results showed that a total of 256 facilities were included, with overall IPC readiness being high, reflected by a mean score of 24.4 and a median score of 25, although scores ranged from 15 to 26, indicating variability in system performance across facilities. A total of 87 facilities (34.0%) achieved full compliance (26/26), comprising 29 Klinik Kesihatan, 57 Klinik Desa, and 1 Klinik Komuniti. Lower scores (15\textendash20) were predominantly observed among Klinik Desa, with only three Klinik Kesihatan scoring 20, highlighting disparities between facility types. Facilities scoring below 22 (less than 85% compliance) were classified as suboptimal and were more likely to experience constraints related to workforce capacity, competing service demands, infrastructure limitations, and monitoring gaps. Discussion/ Conclusion: These findings suggest that while IPC systems in Kedah primary healthcare are generally well established, gaps in system readiness persist, particularly in lower-capacity facilities. Addressing these gaps will require a more coordinated system-level approach, including strengthening workforce capacity, ensuring continuity of training, enhancing monitoring and supervision mechanisms, and optimising service delivery processes such as triage and patient flow. Strengthening these components is critical to achieving more consistent, equitable, and resilient IPC performance across the primary healthcare system.},

note = {Type: Poster Presentation; Organisation: 1Kedah State Health Department, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia; Corresponding author: Nur Hafizah Nordin, drnrhafizah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-781,

title = {Bridging Knowledge to Practice: Effectiveness of a Hearing Conservation Program Among Palm Oil Mill Workers \textendash A Pilot Study},

author = {2 Rama Krishna Supramanian1 Gowri Mutthumanickam1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Occupational noise-related hearing disorders (ONRHD) remain a significant occupational health issue among palm oil mill workers who are exposed to excessive noise. This study determines the effectiveness of a tailored Hearing Conservation Program in improving the knowledge, attitude, and practise among palm oil mill workers in Malaysia. Materials and Methods: The Hearing Conservation Program’s information, instruction, and training component consists of a training module that incorporates a hearing loss simulator, pamphlet, and posters. This is a single-group pilot study conducted among 30 palm oil mill workers. The sociodemographic data, including age, nationality, race, gender, education level, and job category, were collected. The knowledge, attitude, and practise scores were assessed at baseline and 3-month post-intervention using a validated questionnaire. A paired sample t-test was used to compare mean differences. Effect size was calculated using Cohen’s d. Results: The mean age of participants was 36.30 years (SD = 11.98). Most participants were Malaysian (n=26, 86.70%), male (n=22, 73.30%), and of Indian ethnicity (n=17, 56.70%). They had at least a secondary-level education (n=24, 80.00%) and belonged to the non-supervisory job category (n=27, 90.00%). On the outcome evaluation, there was a significant improvement in the knowledge, attitude, and practise scores with p-value \< 0.001 following the intervention. The mean difference for knowledge was 2.63 (SD 2.81, 95% CI 1.58, 3.68), attitude 9.33 (SD 11.21, 95% CI 5.15, 13.52), and practice 8.47 (SD 4.56, 95% CI 6.76, 10.17). The effect sizes were large for knowledge (d = 0.94,95% CI 0.50, 1.36) and attitude (d = 0.83,95% CI 0.41,1.24), and very large for practice (d = 1.86, 95% CI 1.26, 2.45), indicating substantial practical impact. Conclusion: The Hearing Conservation Program significantly improved workers’ knowledge, attitude, and practice. These findings support the implementation of structured training programs as part of a Hearing Conservation Program in occupational settings to prevent ONRHD.},

note = {Type: Poster Presentation; Organisation: 1Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia. 2Occupational Safety, Health and Environment (OSHE) Unit, Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. 3Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.; Corresponding author: Gowri Mutthumanickam, dr_mgowri@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-683,

title = {Bridging The Digital Patient Divide: Development and Validation of a Patient Satisfaction Questionnaire for Virtual Consultation Services in Malaysian Government Health Clinics},

author = {Mohamad Rodi Isa1 Khalid Ibrahim1 Nasim Kuthoose1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measuring patient satisfaction is fundamental to evaluating healthcare quality, particularly as digital transformation reshapes service delivery across the Asia Pacific region. Patient satisfaction reflects how well healthcare services meet individuals' expectations and perceived needs, serving as a critical indicator of service acceptability and effectiveness. Standardised questionnaires remain the primary method for assessing patient satisfaction. In Malaysia, the Ministry of Health conducts satisfaction surveys evaluating primary care services, yet these remain centred on conventional face-to-face consultations. Following the rapid expansion of virtual consultation services across government health clinics after the pandemic, a significant measurement gap has emerged. No validated, culturally adapted instrument exists to assess patient satisfaction with virtual consultations in the Malaysian public healthcare setting, particularly in Malay. This study aimed to develop and validate a Malay language patient satisfaction questionnaire for virtual consultation services in Malaysian government health clinics. Materials and Methods: This instrument development study followed a systematic framework comprising five iterative phases. Phase one involved item development through literature review and expert group discussions to generate items across theoretically derived domains. Phase two involved content validation by a nine-member multidisciplinary expert panel, followed by face validation with ten patients experienced in virtual consultations. Items were revised or removed based on validation indices across successive versions. Phase three employed exploratory factor analysis to identify the underlying factor structure. Phase four assessed internal consistency and temporal stability through test-retest analysis. Phase five established the final measurement model through confirmatory factor analysis and verified domain distinctiveness through discriminant analysis. Results: 52 items were generated across five domains, integrating the Technology Acceptance Model and the SERVQUAL Framework. The domains are Perceived Usefulness, Reliability, Responsiveness, Assurance and Empathy. Content and face validation yielded excellent validity indices after deleting 22 items and mildly modifying the remaining 15 items. 30 items entered exploratory factor analysis. However, the analysis revealed only a three-factor structure, with strong factor loadings, after deleting five items with low loadings. Empathy and Assurance remain intact, while others are combined and relabelled as Service Effectiveness. Internal consistency was high across all domains, with reliability coefficients ranging from 0.93 to 0.97. Test-retest analysis confirmed temporal stability for all retained items except for one, which was deleted. Confirmatory factor analysis of 24 items established a well-fitting second-order measurement model after deleting 4 items and correlating 6 items. The discriminant analysis confirmed that the domains were empirically distinguishable. The final validated instrument comprises 20 items across three domains. Conclusion: The transformation from five theoretically proposed domains to three empirically derived factors highlighted the need for population-specific, culturally grounded patient satisfaction instruments rather than the uncritical adoption of tools developed in dissimilar contexts. The resulting domains reveal the truth about satisfaction, which encompasses physical encounters as well as mental and emotional aspects. This instrument empowers patients to voice their satisfaction systematically with virtual healthcare. It also equips healthcare managers with a psychometrically sound tool to drive quality improvement and supports Malaysia’s national digital health agenda by providing an evidence-based mechanism for monitoring satisfaction with teleconsultation.},

note = {Type: Oral Presentation; Organisation: 1 Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia. 2 Klang District Health Office, Selangor State Health Office, Selangor, Malaysia.; Corresponding author: Nasim Kuthoos, nasimkuthoose@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-767,

title = {Bridging the Gap in Dual Epidemic Care: A Ten-Year Analysis of TB-HIV Treatment Outcomes and Predictors in Terengganu (2015\textendash2024)},

author = {Mohd Anuar Bind Abd Rahman² Shamsul Bahri B. Mohd Zin¹ Mohamad Hazni Bin Abd Rahim¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Tuberculosis and HIV co-infection remains a formidable dual epidemic, presenting complex clinical challenges. Despite ongoing national efforts, achieving optimal treatment success among this vulnerable cohort remains a critical hurdle. Understanding long-term treatment outcomes and their associated factors is essential to strengthening integrated TB-HIV control strategies. Therefore, this study aimed to evaluate the 10-year treatment outcomes and identify the clinical and sociodemographic predictors of unsuccessful outcomes among TB-HIV co-infected patients in Terengganu, Malaysia. Materials and Methods: A retrospective cohort study was conducted using data on TB\textendashHIV co-infected patients registered in the National TB Registry (NTBR) in Terengganu from 2015 to 2024. Socio-demographic and clinical characteristics were analysed. Treatment outcomes were categorised as successful (cured/treatment completed) or unsuccessful (death, treatment failure, lost to follow-up). Logistic regression was performed to identify predictors of unsuccessful TB treatment outcomes, with adjusted odds ratios (AOR), 95% confidence intervals (CI), and p-values reported. Results: Among 7,489 TB cases, 9.7% were HIV-positive. The majority were male (89%) and unemployed (59%). Overall, 54% achieved treatment success while 46% had unsuccessful outcomes. Non-initiation of highly active antiretroviral therapy (HAART) was strongly associated with poor treatment outcomes (AOR = 0.547, 95% CI: 0.349\textendash0.857},

note = {Type: Poster Presentation; Organisation: ¹Tuberculosis and Leprosy Division, Terengganu State Health Department, Malaysia. ²Public Health Division, Terengganu State Health Department, Malaysia.; Corresponding author: Mohamad Hazni Bin Abd Rahim, haznirahim@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-545,

title = {Bridging the Gap in Health Security: A Whole-of-Society Partnership for Typhoid Cluster Management in Marginalised Rohingya Communities in Kelantan},

author = {Wan Soliha Wan Mohd Hanafi2 Mohd Syiham Rosli1 Mohd Azimullah Abdullah Zakaria1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: On 24 December 2025, a typhoid fever cluster was declared among Rohingya refugees in Kota Bharu, Kelantan. The outbreak presented a significant public health challenge, marked by a high case fatality rate (27.3%) and a vulnerable population arriving through irregular migratory channels. These informal entry points bypassed standard health screenings, necessitating a response that prioritised community trust and multi-agency coordination to prevent a wider health crisis. This study describes the multi-sectoral partnership strategies employed to manage and contain the outbreak. Materials and Methods: A "Whole-of-Society" partnership framework was deployed, integrating the Kelantan State Health Department with academic institutions, enforcement agencies, and NGOs. Internally, an integrated public health and clinical collaboration was established between Public Health Physicians, Infectious Disease (ID) Physicians, Family Medicine Specialists (FMS), and Pathologists to develop a unified SOP for standardised field screening and comprehensive outbreak management. This was facilitated by the advanced laboratory capabilities of the Kota Bharu National Public Health Laboratory (MKAK), Hospital Raja Perempuan Zainab II (HRPZ II), USM INFORMM, and the Institute for Medical Research (IMR). Externally, the response leveraged the Malaysian Relief Agency (MRA) and Masyarakat Rohingya Kelantan (MRK) for community mobilisation to overcome linguistic and trust barriers during Active Case Detection (ACD). Simultaneously, the Royal Malaysia Police (PDRM), Immigration Department (JIM), and Prison Department facilitated mandatory screening within detention settings to halt institutional and community transmission. Results: ACD reached 1,386 individuals (including 961 community members and 352 detainees). The cluster comprised 11 confirmed cases and 16 carriers. Pulsed-Field Gel Electrophoresis (PFGE) analysis proved the cluster was "clonally related" with concurrent cases in Northern Malaysia indicating an imported source from endemic regions. Through this partnership, 100% of cases and carriers were successfully isolated and treated under a unified guideline. The intervention ensured zero secondary transmission to the local Malaysian population and achieved outbreak control within the targeted timeframe. Conclusion: Managing infectious diseases in vulnerable, non-citizen populations requires a strategic shift from "Enforcement to Engagement." By unifying medical and public health expertise with academic research, NGO-led community trust, and inter-agency cooperation, Kelantan established a resilient health security framework. The successful containment of the cluster by 18 February 2026 underscores that a "People-Partnership" model is essential for safeguarding both marginalised groups and the general public against imported health threats.},

note = {Type: Poster Presentation; Organisation: 1Communicable Disease Control Unit, Kelantan State Health Department, 2Kota Bharu National Public health Laboratory, Kelantan State Health Department; Corresponding author: Mohd Azimullah Abdullah Zakaria, drazimullah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-495,

title = {Bridging the Gap to Elimination: Evaluating the Measles Surveillance System in Pahang},

author = {Wan Abdul Rahim Wan Muhamad2 Sahrol Azmi Termizi1 Roslaili Khairudin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Despite Malaysia’s national Measles Elimination Program (MEP), the state of Pahang continues to experience fluctuating measles incidence, with outbreaks among vulnerable populations. The Measles Surveillance System (MSS) is the cornerstone of the MEP, responsible for detecting, tracking, and enabling a response to measles cases. An effective surveillance system is critical to achieving elimination goals. This study aimed to evaluate the performance of the existing MSS in Pahang to identify its strengths and weaknesses and provide recommendations for improvement. Materials and Method: A mixed-methods evaluation was conducted across various levels of the healthcare system in Pahang, including the State Health Department, a District Health Office, and public and private healthcare facilities. The evaluation framework was adapted from the CDC and WHO guidelines. Data was collected through primary sources, including self-administered questionnaires and key informant interviews, and secondary data review of e-notis and e-measles (SM2) records from January to December 2023. The system's structure, core and support functions, and key attributes including usefulness, timeliness, data quality, sensitivity, acceptability, simplicity, flexibility, and stability- were assessed. Results: The MSS in Pahang has a strong structure and was found to be highly useful and acceptable among healthcare personnel. Key timeliness indicators were met, with 84% of cases notified within 24 hours and 98.6% investigated within 48 hours. However, significant weaknesses were identified. The system's sensitivity for case detection was critically low at 25%. Data quality in the initial e-notis system was poor, with crucial variables such as "clinical features" and "date of onset" being only 28.6% and 58.1% complete, respectively. Timeliness for viral sample collection (71%) and outbreak mopping-up activities (50%) fell below performance targets. Conclusion: The measles surveillance system in Pahang is well-structured and valued by its users but is undermined by critical operational deficiencies. The extremely low sensitivity and poor data quality at the initial notification stage severely limit its effectiveness and jeopardize the state's progress toward measles elimination. Urgent, targeted interventions focusing on improving case definition adherence, enhancing data completeness in the e-notis system, and addressing timeliness gaps are essential to strengthen the system's capacity to effectively guide public health action.},

note = {Type: Poster Presentation; Organisation: 1Pahang State Health Department, Kuantan, Malaysia, 2Terengganu State Health Department, Kuala Terengganu, Malaysia; Corresponding author: Roslaili Khairudin, drroslaili@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-535,

title = {Bridging the Gap: Ethnic Disparities and Staging Challenges in Colorectal Cancer Incidence in Kuala Lumpur and Putrajaya},

author = {Waramlah Ramlan1 Mazni Fathinah Nabilah Mazlan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Colorectal cancer (CRC) is one of the leading causes of cancer morbidity and mortality worldwide and represents a growing public health concern in urban Malaysia. Understanding the epidemiological patterns of CRC is important to identify high-risk groups and improve early detection strategies. This study aims to examine the incidence, demographic distribution, and staging patterns of colorectal cancer in Kuala Lumpur and Putrajaya. Materials and Methods: A descriptive analysis was conducted using registry data of colorectal cancer cases reported between 2012 and 2016 in Kuala Lumpur and Putrajaya. A total of 946 cases were analysed. Data were stratified by sex, age group, and ethnicity (Malay, Chinese, and Indian). Incidence rates were assessed using crude rate (CR), age-standardised rate (ASR), and cumulative risk (CumR). Clinical severity was evaluated based on reported staging (Stage I\textendashIV). Results: Among the 946 cases, 59.7% occurred in males and 40.2% in females. Colorectal cancer was the most common cancer among males and the second most common among females. The highest incidence was observed among the Chinese population for both sexes. The lifetime risk for males was approximately 1 in 57, with Chinese males showing the highest risk (1 in 52), followed by Malays (1 in 53) and Indians (1 in 80). Among females, the overall lifetime risk was 1 in 79, with Chinese females having a higher risk (1 in 75) compared with Malays (1 in 79) and Indians (1 in 126). The incidence increased with age and peaked at 75 years for males and 73 years for females. Staging information was available for approximately 30% of cases. Of these, a large proportion were diagnosed at late stages (Stage III and IV), accounting for 71.1% of cases in males and 67.3% in females. Conclusion: The findings highlight a substantial burden of colorectal cancer in Kuala Lumpur and Putrajaya, with notable ethnic disparities and a high proportion of late-stage diagnoses. The results suggest potential gaps in early detection and screening uptake within the population. Strengthening colorectal cancer screening programmes, improving public awareness of early symptoms, and enhancing the completeness of clinical staging data are essential steps to facilitate earlier diagnosis and improve cancer outcomes in this population.},

note = {Type: Poster Presentation; Organisation: 1State Health Department of Federal Territory of Kuala Lumpur and Putrajaya, Ministry of Health Malaysia; Corresponding author: Mazni Fathinah Nabilah Mazlan, drmaznifn@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-729,

title = {Bridging the Healthcare Gap: Impact of a Mobile NCD Subsidiary Service on Indigenous (Orang Asli) Communities in Bandar Tenggara},

author = {Siti Ruziana Roslan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Indigenous communities in Malaysia face significant health inequities due to geographical isolation and cultural barriers, leading to poor management of non-communicable diseases (NCDs). This study evaluates the impact of a targeted mobile health intervention designed to improve chronic disease outcomes in these underserved populations. To evaluate the effectiveness of the NCD Subsidiary Service in enhancing detection rates, treatment adherence, and clinical outcomes among the Orang Asli community under the supervision of Klinik Kesihatan Bandar Tenggara. Materials and Methods: A retrospective study was conducted analysing health data from January to June 2025. The study compared outcomes of 192 adult participants from Kg Pasir Intan and Kg Sayong Pinang before and after the 2024 intervention. Primary indicators included detection rates, follow-up adherence, and NCD complications. Results: Post-intervention data revealed significant improvements across all key parameters. The mortality rate significantly decreased from 33.3% to 0.0% (p \< 0.01), while the defaulter rate fell from 38.9% to 8.3% (p \< 0.05). Active follow-up increased from 33.3% to 75.0% (p\<0.01). Earlier detection was observed in the 19\textendash45 age group, shifting the clinical profile from complex "triple morbidity" to earlier, single-disease presentations. Mean Fasting Blood Sugar (FBS) levels improved from 7.8 mmol/L to 6.7 mmol/L (p \< 0.05). Conclusion: Mobile health interventions utilizing community-centred health mobile service team are a strategic approach to reducing public health gaps. Such programs effectively improve disease control, empower marginalized communities, and prevent premature NCD-related mortality.},

note = {Type: Poster Presentation; Organisation: 1Bandar Tenggara Health Clinic, 81900 Kota Tinggi, Johor Darul Ta'zim, Malaysia.; Corresponding author: Siti Ruziana Roslan, drsitiruziana_r@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-723,

title = {Budget Impact of Colorectal Cancer Screening Using iFOBT in Malaysia: Cohort or Community Intervention Approach?},

author = {Ahmad Termidzi Mohd Azhar1 Muhammad Irfan Abdul Jalal1 Natrah Mohd Saad1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related incidence and mortality in Malaysia, with a significant proportion of cases detected at late stages (III and IV). While Malaysia has implemented an opportunistic CRC screening programme since 2014, CRC incidence continues to rise steeply, highlighting a lack of evidence regarding the cost-effectiveness and budget impact of population-based screening to guide policy decisions. This study aims to assess the budget impact of implementing cohort and community approaches for CRC screening using immunochemical faecal occult blood testing (iFOBT), comparing them to the current opportunistic screening strategy in Malaysia. Materials and Methods: A budget impact analysis (BIA) was conducted over a 5-year time horizon from a healthcare provider's perspective. The hypothetical cohort included average-risk Malaysians aged 50 to 75 years. A customized cost calculator based on the UK-NICE template was used to project the expenses of three specific scenarios: (I) the current practice of selective opportunistic CRC screening at government health facilities, (II) a cohort approach based on the Malaysian Cohort (TMC) screening programme, and (III) a community-based approach. Outcome uncertainty, particularly regarding input parameters like screening uptake and population size, was evaluated using one-way sensitivity analysis. Results: The cost of the current selective opportunistic screening strategy is projected to increase by 176% over five years, from RM51,642,849 to RM142,986,950. In contrast, while the cohort approach has an initial cost three times higher than the current strategy (RM154,952,729), it exhibits a much lower 5-year budget growth of only 34% (reaching RM208,261,327). The community-based approach was the most expensive, climbing 78% over five years to reach nearly RM440 million. Crucially, the cohort approach is highly effective, detecting 5.4 times more CRC cases than the opportunistic strategy (e.g., 13,557 cases vs. 2,478 cases in Year 1). Assuming constant costs, the cohort approach costs RM 11,429 per detected CRC case, compared to RM 20,840 for the current strategy, offering consistent savings of approximately RM 9,411 per case. Discussion/Conclusion: Despite the high initial upfront investment required, the cohort approach facilitates significantly higher screening uptake and identifies more CRC cases at an earlier stage. Early detection translates to substantial long-term cost savings by circumventing the high treatment expenses associated with late-stage CRC. To optimize healthcare resources and reduce CRC mortality, policymakers should prioritize a gradual, phased scaling-up of the cohort approach utilizing iFOBT, paired with sustainable funding and strategic public awareness campaigns.},

note = {Type: Poster Presentation; Organisation: 1Public Health Development Division, Ministry of Health, WP Putrajaya, Malaysia.; Corresponding author: Natrah Mohd Saad, drnatrahsaad@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-462,

title = {Building a Sustainable International Medical Collaboration Platform for Health Promotion: Practical Experience from a Tertiary Healthcare System in Asia},

author = {Hsiu-Chu Chen2 Wu-Shou Chang1 Yi-Fang TSAI1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Strengthening international collaboration has become an essential strategy for advancing health promotion and healthcare capacity, particularly in the Asia-Pacific region. Healthcare institutions increasingly play a critical role not only in clinical service delivery but also in cross-border knowledge exchange, workforce development, and public health outreach. This study aims to describe the practical experience of establishing a sustainable international medical collaboration platform led by a tertiary healthcare system in Taiwan, focusing on health promotion, capacity building, and long-term partnership development across multiple regions. Materials and Methods: Using an implementation-focused descriptive approach, we reviewed international health promotion and collaboration activities conducted by the International Medical Centre of a multi-hospital healthcare system between 2024 and 2025. Activities included international institutional visits, academic exchanges, public health promotion events, telemedicine initiatives, and the signing of memoranda of understanding (MOUs). Key performance indicators included the number of international visits, collaborative agreements, educational activities, and continuity of partnerships. Qualitative synthesis was used to identify enabling factors and operational challenges. Results: The collaboration platform facilitated engagement with healthcare institutions, universities, and organisations across Southeast Asia, East Asia, Africa, and Europe. Outcomes included multiple bilateral MOUs, international professional exchanges, health promotion forums, and pilot telemedicine initiatives supporting cross-border consultation and public health outreach. Key strengths included strong institutional leadership, multidisciplinary coordination, and alignment with national health promotion policies. Challenges involved resource limitations, cross-cultural communication, and sustaining engagement beyond initial visits. Continuous online communication and structured follow-up mechanisms were identified as critical for maintaining collaboration momentum. Conclusion: A healthcare institution-led international collaboration platform can effectively support regional health promotion and capacity building when grounded in practical implementation, long-term partnership strategies, and blended models of in-person and digital engagement. The experience presented may serve as a transferable reference for healthcare systems seeking to expand their international public health impact in the Asia-Pacific region.},

note = {Type: Poster Presentation; Organisation: 1Chang Bing Show Chwan Memorial Hospital, 2Show Chwan Health Care System; Corresponding author: Yi-Fang TSAI, showteresa@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-731,

title = {Cancer Screening Program in Rural Community: A Multi-Modal Breast Cancer Screening in Tanjung Sedili},

author = {Ahmad Nazmi Bin Zaini1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Comprehensive early breast cancer screening is often significantly hampered by structural constraints in rural populations. Furthermore, because thick breast tissue is more common in Asian cohorts, standard breast cancer screening methods like Clinical Breast Examination (CBE) and mammography frequently produce incomplete diagnostic results. This study assesses an early detection program carried out in partnership with MAKNA (National Cancer Council Malaysia), which established a multi-modal screening triage pathway in the rural community of Tanjung Sedili in order to address these health inequities. Materials and Methods: A cross-sectional, community-based screening initiative was deployed for 201 asymptomatic women (mean age 49.8 ± 8.2 years) in Tanjung Sedili. The collaborative program utilized a sequential diagnostic protocol: primary screening with CBE and digital mammography, followed by targeted diagnostic ultrasonography (USG) triage for participants with ambiguous mammographic findings (BI-RADS 0) or abnormal CBE presentations. Outcomes were categorized using the American College of Radiology BI-RADS classification. Results: Primary screening via CBE demonstrated extremely low sensitivity, with 98.5% (n=198) of physical examinations interpreted as normal. Digital mammography yielded definitive classifications for the majority, with 67.8% returning BI-RADS 1 and 17.1% returning BI-RADS 2. However, a critical 14.1% (n=28) were categorized as BI-RADS 0 due to heterogeneous dense parenchyma obscuring potential lesions. The deployment of targeted USG triage successfully resolved 100% of these ambiguous cases. Supplemental USG accurately down-staged benign proliferative lesions to BI-RADS 3 (58.3% of the triaged subset) while successfully isolating clinically actionable, highly suspicious lesions (BI-RADS 4A and 4C) in 16.7% of the recalled cohort. Conclusion: In rural regions like Tanjung Sedili where health facilities is limited, collaborations with MAKNA are crucial to closing healthcare disparities. This study demonstrates that in populations with thick breasts, solitary CBE or mammography leaves a substantial diagnostic deficiency. In situations when clinical resources are scarce, supplemental USG triage efficiently decreases missed diagnoses, clarifies unclear findings, and expedites early cancer therapy.},

note = {Type: Poster Presentation; Organisation: 1Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Ahmad Nazmi Bin Zaini, ahmadnazmi87@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-727,

title = {Caregiving Burden and Mental Health Among Informal Caregivers of Elderly Patients with Chronic Diseases in Primary Care},

author = {Syazwani Dzulkifli3 Nimelesh A/L Balanthiren2 Nor Adiani Mohd Hadzir1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: As Malaysia’s population ages, informal caregivers have become the invisible backbone of chronic disease management. Yet, this essential role often imposes a psychological toll that remains under-recognised in primary care. Evidence on the underlying factors of caregiving burden and its mental health consequences in local settings is limited. This study aimed to quantify caregiving burden, identify its key determinants, and examine its relationship with anxiety and depression among informal caregivers. Materials and Methods: A cross-sectional study was conducted among 291 informal caregivers across four primary care clinics in Johor Bahru. Participants were recruited via stratified random sampling. Data were collected using validated instruments: the Zarit Burden Interview (ZBI) for caregiver burden, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, the Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms, and the Lawton Instrumental Activities of Daily Living (IADL) scale for functional status of elderly patients. Descriptive analyses characterised the sample. Associations were examined using Chi-square and independent t-tests, while logistic regression identified predictors of significant caregiving burden. Results: Caregivers had a mean age of 43.75±12.64 years; most were female (60.8%), married (66.7%), and children of the care recipient (68.7%). A substantial proportion were socioeconomically vulnerable (70.8%) and lacked caregiving support (84.2%). Caregiving intensity was high, averaging 13.87±8.28 hours/day, with 85.9% providing care for over two years. Approximately 40.9% of caregivers reported significant burden. Patient dependency emerged as the dominant predictor of caregiving burden. Lower IADL scores were strongly associated with higher burden (p=0.001) and independently predicted significant strain (OR=0.787, 95% CI: 0.714, 0.868, p\<0.001). In contrast, sociodemographic factors and caregiving duration showed no significant associations, challenging conventional assumptions about caregiver vulnerability. Crucially, caregiving strain demonstrated a robust association with anxiety (χ²=33.623, p\<0.001), but not depression (χ²=0.660},

note = {Type: Poster Presentation; Organisation: 1Klinik Kesihatan Skudai Baru, Johor Bahru, Johor Darul Ta'zim, Malaysia. 2Klinik Kesihatan Taman Universiti, Johor Bahru, Johor Darul Ta'zim, Malaysia. 3Klinik Kesihatan Kempas, Johor Bahru, Johor Darul Ta'zim, Malaysia. 4Klinik Kesihatan Sultan Ismail, Johor Bahru, Johor Darul Ta'zim, Malaysia.; Corresponding author: Nor Adiani Mohd Hadzir, adiani_hadzir@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-576,

title = {Childhood Vaccination Advocacy Through Social Media: Perspective from the Public in Kuala Pilah},

author = {Noraliza Binti Radzali1 Muhammad Khairul Ridhuan Abdul Wahid1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Public support for childhood vaccination is important for strengthening community health communication, especially through social media. This study examined attitudes toward childhood vaccination, perceived barriers, vaccination perception, and willingness to advocate childhood vaccination through social media among the public in Kuala Pilah. Materials and Methods: A cross-sectional study was conducted using a developed self-administered questionnaire. Data collection was carried out from 10 January 2026 to 28 February 2026 among individuals in Kuala Pilah who attended clinics and health carnivals organised by Kuala Pilah District Health Office. The initial dataset contained 542 records. After excluding 2 respondents who were not Malaysian, 540 respondents were included in the final analysis. The questionnaire covered sociodemographic characteristics, attitudes toward childhood vaccination, perception of childhood vaccination, perceived barriers to advocacy, and willingness to advocate childhood vaccination through social media. Descriptive statistics were used to summarise respondent characteristics. Chi-square test, Fisher exact test, and multivariable logistic regression were used to identify factors linked to the study outcomes. Results: Among the 540 respondents, 81.1% demonstrated a negative attitude toward childhood vaccination, and 81.5% reported high perceived barriers. Regarding vaccination perception, 68.3% were supportive, 19.1% were hesitant, and 12.6% were opposed. Overall, 64.6% were willing to advocate childhood vaccination through social media. Respondents without tertiary education had higher odds of negative attitudes and non-supportive vaccination perception, and lower odds of willingness to advocate through social media. Healthcare workers and unemployed respondents had lower odds of negative attitudes compared to non-healthcare workers. High perceived barriers were strongly associated with negative attitudes. Willingness to advocate was higher among respondents with positive attitudes and supportive vaccination perception. Conclusion: Although most respondents were willing to advocate childhood vaccination through social media, negative attitudes and high perceived barriers remain prevalent. Targeted strategies are required to improve vaccine literacy, reduce misconceptions, and strengthen public confidence in disseminating accurate childhood vaccination information through social media.},

note = {Type: Poster Presentation; Organisation: 1 Kuala Pilah District Health Office, Ministry of Health Malaysia, Kuala Pilah, Negeri Sembilan, Malaysia; Corresponding author: Muhammad Khairul Ridhuan Abdul Wahid, khairulridhuan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-541,

title = {Circadian Pattern of In-Hospital Deaths: Does the Hour of Death Matter? A 10-Year Retrospective Study, Hospital Jasin (2016\textendash2025)},

author = {Syahrulazman Azlan1 Basil Fauzi1 Aizat Sofian1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The timing of death is not random. Circadian biology, staffing patterns, and care delivery rhythms collectively influence when patients die in hospital. Understanding the temporal distribution of in-hospital mortality is crucial for health system planning, including nurse-to-patient ratios, resuscitation readiness, and after-hours medical coverage. While circadian mortality patterns are well-documented internationally, local evidence from Malaysian tertiary hospitals remains scarce. This study aimed to describe the 24-hour and day-of-week distribution of in-hospital deaths, examine whether death timing differed by cause of death category and location of death, and identify clinically significant peak mortality periods to inform staffing and resource decisions. Materials and Methods: A retrospective cross-sectional study was conducted using a hospital mortality registry of 2,694 deaths recorded at Hospital Jasin from 2016 to 2025. Each record contained time of death coded into four broad time-of-day categories (Morning, Afternoon, Night, Late Night) and 24 hourly slots. Data were analysed using IBM SPSS Statistics. Frequency distributions were computed for all temporal variables. Causes of death were recoded into six broad categories (Cardiac, Respiratory, Trauma/External, Sepsis, Cancer, Others). A chi-square test of independence was performed to determine whether the distribution of deaths across time-of-day periods differed significantly by cause of death category and by location of death (Ward, ED, Forensic). A one-way ANOVA was used to compare mean hourly death counts across the four time-of-day periods. Day-of-week analysis was conducted using frequency tables. Statistical significance was set at p \< 0.05. Results: Deaths were distributed across all four time periods: Afternoon (n = 718, 26.7%), Morning (n = 683, 25.4%), Night (n = 677, 25.1%), and Late Night (n = 616, 22.9%). The peak single mortality hour was 12 p.m. \textendash 1 p.m. (n = 136, 5.0%), while the nadir occurred at 2 a.m. \textendash 3 a.m. (n = 87, 3.2%). Significant variation in temporal distribution was observed by location (χ² = 24.7, p\<0.001): Ward deaths peaked in Late Night (26.4%), while ED deaths peaked during Night hours (28.7%). By cause, Trauma/External deaths were highest in Morning hours (31.4%), whereas Cardiac and Respiratory deaths were more evenly distributed across all periods. Day-of-week analysis revealed Saturday had the highest death frequency (n = 404, 15.0%) and Thursday the lowest (n = 357, 13.3%), though differences were modest. Conclusion: This study confirms a discernible circadian pattern of in-hospital mortality, with the midday peak and late-night ward surge carrying important operational implications. The late-night predominance of ward deaths likely reflects reduced staffing and delayed clinical response during overnight hours \textemdash a recognised phenomenon in patient safety literature. The morning clustering of trauma deaths corresponds with peak road activity and injury presentation to ED. Notably, the relatively uniform distribution of cardiac deaths across all hours challenges assumptions about nocturnal cardiac risk in this population. These findings provide an evidence base for reviewing after-hours staffing models, early warning system activation thresholds, and critical care protocols.},

note = {Type: Poster Presentation; Organisation: 1Forensic Medicine Unit, Hospital Jasin},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-670,

title = {Close to Home, Close to Danger: Investigating the Inverse Relationship Between Commute Distance and Injury Among Healthcare Workers in Pejabat Kesihatan Daerah Kuala Krai.},

author = {Hazura MZ1 Ahmed Farrasyah MK1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Workplace accidents and dangerous occurrences pose significant risks to healthcare personnel, particularly in district health settings. Identifying specific demographic and spatio-temporal factors associated with injury severity is critical for developing effective Occupational Safety and Health (OSH) interventions. This study aimed to analyze the factors associated with injury outcomes among staff at the Pejabat Kesihatan Daerah (PKD) using historical incident data. Materials and Methods: A retrospective cross-sectional study was conducted using a database of 45 reported incidents. The primary outcome was injury status (injured vs. non-injured). Independent variables included age, gender, mechanism of incident, time of occurrence, and commute distances. Data were analysed using descriptive statistics and Logistic Regression analysis to identify significant predictors of injury. Results: Of the 45 incidents, 67% resulted in injuries, with road accidents (82.2%) being the most common mechanism. Logistic regression revealed that "Distance from Home to Work" was a statistically significant predictor of injury status (p=0.048). A negative association was observed, indicating that staff with shorter overall commutes were more likely to sustain injuries during an incident compared to long-distance commuters. Age showed a positive trend toward higher injury risk (OR: 1.08},

note = {Type: Oral Presentation; Organisation: 1Pejabat Kesihatan Daerah Kuala Krai, Kelantan, Malaysia.; Corresponding author: Ahmed Farrasyah M, drahmedfarrasyah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-764,

title = {Clustering of Cardiometabolic Risk in a Screened Population: Evidence from National Health Screening Initiative 2025 in Terengganu, Malaysia},

author = {Muhammad Shamzuri Mohd Saidi Amri1 Nur Azura Md Atan1 Siti Mariam Jaafar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Non-communicable diseases (NCDs) remain a leading cause of morbidity and premature mortality in Malaysia, driven by modifiable cardiometabolic risk factors. Population-based screening enables early detection of risk accumulation and interruption of disease progression. This study describes the epidemiological profile, risk clustering, and early glycaemic transition among adults screened under the National Health Screening Initiative (NHSI) 2025 in Terengganu. Materials and Methods: A cross-sectional analysis was conducted using NHSI 2025 screening data in Terengganu. Adults aged ≥18 years were included. Descriptive epidemiological analysis was performed to summarise sociodemographic characteristics, NCD risk stratification, and prevalence of key risk factors, including hypertension, hyperglycaemia, dyslipidaemia, overweight, obesity, and smoking. Glycaemic outcomes were further classified into prediabetes and diabetes based on confirmatory diagnosis. Results: A total of 49,245 individuals were analysed. Females comprised 61.8% of participants, with the largest proportion aged 30\textendash39 years (29.8%). Risk stratification showed 67.8% classified as at risk of NCD, 17.6% as healthy with risk factors, and only 1.6% as metabolically healthy. Prevalence of major risk factors was substantial: raised blood pressure (16.5%), elevated blood glucose (11.3%), elevated cholesterol (19.3% among those tested), overweight (31.7%), obesity (32.3%), and current smoking (7.8%). These findings indicate significant clustering of cardiometabolic risk factors. Adults aged 30\textendash49 years consistently demonstrated the highest burden across all risk domains, suggesting early concentration of risk in economically productive age groups. Among individuals with elevated blood glucose (n=5,547), confirmatory outcomes showed 3.2% diagnosed with diabetes mellitus and 1.1% with prediabetes, indicating early transition along the glycaemic continuum. Conclusion: NHSI 2025 findings reveal a high burden and clustering of modifiable cardiometabolic risk factors in Terengganu, with disproportionate impact among adults aged 30\textendash49 years. The observed early glycaemic transition underscores a critical window for intervention. However, the low proportion of confirmed diagnoses relative to screening abnormalities suggests potential gaps in follow-up and continuity of care. Strengthening post-screening pathways and targeted risk-based interventions is essential to prevent progression to overt NCDs and reduce long-term population health burden.},

note = {Type: Poster Presentation; Organisation: 1Terengganu State Health Department, Malaysia.; Corresponding author: Siti Mariam Jaafar, dr.sitimariam@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-547,

title = {Community-Based Frailty Screening in an Elderly Religious School: Insights from the GeKo Outreach Program at Pondok Bukit Gading},

author = {Affan Aufa Zainuddin1 Anas Rosedi¹ Nik Aida Nik Adib¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The Geriatric Care Outreach (GeKo) Integrated Service Delivery model is a primary care initiative designed to address frailty and geriatric syndromes among older adults in Malaysia. To extend its reach into community-based settings, a one-day screening programme was conducted at Pondok Bukit Gading, a religious residential institution for older adults. This initiative aimed to determine eligibility for GeKo enrolment and to identify unmet health needs requiring multidisciplinary referral. Materials and Methods: A total of 62 elderly residents were screened using standardised GeKo assessment tools. Eligibility criteria included age ≥60 years, a Clinical Frailty Scale (CFS) score between 4 and 7, and the presence of at least one geriatric syndrome. Functional status and frailty were further assessed using the Malay version of the Pictorial Fit-Frail Scale (PFFS-M). Sociodemographic characteristics, comorbidities, and geriatric syndromes were descriptively analysed. Results: There were 47 (75.8%) out of the 62 participants who met the eligibility criteria for GeKo enrolment. All participants were Malay (62 (100.0%)), with a predominance of females (51 (82.3%)). Socioeconomic vulnerability was evident, with 60 (96.8%) reporting a monthly income below MYR1500, 46 (74.2%) having primary or no formal education, and 45 (72.6%) being widowed or divorced. Additionally, 32 (51.6%) were living alone. A high burden of health conditions was observed, including multimorbidity (35 (56.5%)), polypharmacy (21 (33.9%)), chronic pain (15 (24.2%)), and falls or instability (10 (16.1%)). Based on identified needs, multidisciplinary referrals were initiated, including Occupational Therapy (42 (67.7%)), Physiotherapy (39 (62.9%)), Pharmacy (34 (54.8%)), and Counselling services (29 (46.8%)) Conclusion: This community-based outreach effectively identified a high proportion of older adults eligible for GeKo services, particularly those with early-stage frailty. The findings highlight a substantial burden of geriatric syndromes and socioeconomic vulnerability within this population. The programme facilitated timely referral to multidisciplinary care, demonstrating the feasibility and value of integrating frailty screening within community settings to enhance access to comprehensive geriatric care.},

note = {Type: Poster Presentation; Organisation: ¹Tanah Merah District Health Office, Tanah Merah, Kelantan; Corresponding author: Nik Aida Nik Adib, drnikaida@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-716,

title = {Comparative Analysis of Hospital Business Models in Malaysia: Public, Private and Teaching Hospital \textemdash Implications for Health System Equity and Sustainability},

author = {Ahmad Hafiz Mohamad¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia's healthcare system is anchored by two established pillars, government-subsidised public hospitals under the Ministry of Health (MOH) and profit-driven private hospitals, with university teaching hospitals emerging as a functionally distinct third model. Despite their growing prominence, systematic comparative analyses of business models across these three institutional types remain limited in the Malaysian health systems literature. This study aims to: (1) compare the financing structures, value propositions, governance frameworks and key activities of MOH public hospitals, private hospitals (KPJ Healthcare Bhd and IHH Healthcare Bhd), and Sultan Ahmad Shah Medical Centre @IIUM (SASMEC @IIUM) as a teaching hospital; (2) assess each model's positioning along the equity\textendashefficiency spectrum; and (3) identify strategic opportunities for SASMEC in expanding occupational health services targeting the Gebeng\textendashKuantan industrial corridor, in alignment with the conference theme of closing the public health gap through partnership. Materials and Methods: A comparative Business Model Canvas (BMC) framework was applied across nine standard dimensions. The Walt and Gilson Policy Triangle provided a complementary policy analysis lens. All data were sourced exclusively from publicly available repositories: annual reports of KPJ Healthcare Bhd and IHH Healthcare Bhd (Bursa Malaysia disclosures, 2024), MOH Malaysia Health Facts 2024, CIMB Securities Malaysia Healthcare Thematic Report (2025), Qoala Malaysia Healthcare Cost Guide (2024), and the SASMEC @IIUM Strategic Plan 2021\textendash2022. A relative index (scale 1\textendash10, anchored to industry aggregates) was constructed for six comparative dimensions, cost affordability, innovation and R\&D, equity access, revenue margin, capacity growth, and brand positioning, to enable structured comparison without disclosure of institution-specific data. Results: Three distinct business model profiles were identified. MOH public hospitals operate an equity-driven, high-subsidy model (~90% government financing) with tertiary bed utilisation exceeding 85%, but face structural constraints including a nursing shortfall of over 6,000 and chronic waiting times. Private hospitals (KPJ/IHH) are profit-driven, KPJ recorded revenue of RM3.92 billion and net profit of RM354 million in 2024, driven by fee-for-service, insurance panels and medical tourism, the latter commanding a margin premium exceeding 20%. SASMEC @IIUM occupies a unique hybrid position, drawing on KPT grants, a 25-year PFI concession, clinical fee income, and unrealised Islamic social finance potential (Zakat and Waqf). As Malaysia's sole hospital certified under MS 1900:2014 (Shariah-Based Quality Management System), SASMEC scored highest in the innovation/R\&D dimension (index 7\textendash9/10) among teaching hospitals. Its cost-affordability index of 4\textendash6 against private hospitals' 8\textendash9 positions it as a viable mid-market alternative. Aggregate public data reveal procedure cost gaps of 3\textendash400× between public and private sectors, with occupational health screening representing an underserved niche targetable by SASMEC's Occupational Health and Wellness Clinic (OHWC). Conclusion: SASMEC @IIUM demonstrates the characteristics of a Social Enterprise model with the potential to bridge the equity\textendashefficiency gap in Malaysia's dual public\textendashprivate health system. Leveraging its Shariah-compliant brand, academic research platform, and geographic proximity to the Gebeng industrial estate (260+ registered companies), SASMEC can diversify revenue through targeted occupational health services while sustaining its public health mission. Priority strategic actions include: formalising Islamic social finance mobilisation (Zakat and Waqf) for indigent patient care, resolving community-level brand positioning confusion between free (public) and expensive (private) perceptions, and establishing structured specialist referral pathways as the East Coast region's academic tertiary centre. This study contributes a replicable analytical framework for evaluating teaching hospital sustainability applicable across the Asia-Pacific region.},

note = {Type: Poster Presentation; Organisation: ¹ Ministry of Health Malaysia, WP Putrajaya, Malaysia; Corresponding author: Ahmad Hafiz bin Mohamad, drahmadhafiz@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-494,

title = {Concentrated Dengue Burden in Persistent High-Risk Localities: A Spatiotemporal Analysis of Seberang Perai Tengah (2021\textendash2025)},

author = {Farzaana Adam1 Lavanyah Sivaratnam1 Mohd Ikhwan Azmi1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue transmission in Seberang Perai Tengah, remains a persistent public health challenge. However, dengue burden is not evenly distributed across localities. Understanding where transmission repeatedly concentrates is essential to guide more targeted and sustained control strategies. This study aimed to identify and characterise persistent high-risk localities contributing to concentrated dengue burden in Seberang Perai Tengah from 2021 to 2025. Materials and Methods: A retrospective cohort study was conducted using all confirmed dengue cases notified in Seberang Perai Tengah from 2021\textendash2025 (n = 5,926). Locality-level case data were analysed using a spatiotemporal approach. A composite risk index incorporating cumulative case burden and persistence across years was developed to rank localities. Areas were stratified into five risk levels (Low, Moderate, High, Very High, and Highest Risk [top 20%]). Spatial mapping was used to visualise clustering patterns, and Pareto analysis quantified the concentration of cumulative dengue burden across ranked localities. All analyses were conducted using. All analyses were conducted using R version 2026.01.1. Results: Dengue burden in Seberang Perai Tengah demonstrated clear spatial concentration rather than uniform distribution. Localities classified as Highest Risk formed identifiable spatial clusters within the urban corridor. Approximately 81% of total dengue cases were concentrated within the top 15 ranked localities. These areas consistently contributed to dengue burden across multiple years, indicating persistent high-risk transmission zones. Conclusion: Dengue burden in Seberang Perai Tengah is concentrated within a subset of persistent high-risk localities. Spatiotemporal risk stratification provides a practical framework for prioritising sustained, locality-focused interventions beyond routine outbreak response. Integrating risk-based targeting into district dengue control planning may enhance the effectiveness and efficiency of dengue control efforts.},

note = {Type: Poster Presentation; Organisation: 1Seberang Perai Tengah District Health Office, 14000 Bukit Mertajam, Pulau Pinang; Corresponding email: ikhwanazmi69@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-654,

title = {Congenital Pulmonary Tuberculosis In An Infant Clinically Diagnosed without Epidemiology Link and Absence of Laboratory Confirmation: A Diagnostic Dilemma},

author = {Muhammad Irfan1 * and Nurjuliana1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Congenital tuberculosis (TB) remains a rare but potentially fatal condition, often presenting significant diagnostic challenges due to nonspecific clinical features and low microbiological yield. We report the case of a preterm infant, born at 35 weeks, who was clinically diagnosed with congenital pulmonary tuberculosis despite repeatedly negative laboratory investigations. Materials and Methods: The infant was born via caesarean section following a pregnancy complicated by a maternal urinary tract infection and threatened preterm labour. The neonate developed early respiratory distress requiring neonatal intensive care support. Extensive investigations were conducted to identify the underlying aetiology; multiple microbiological tests\textemdashincluding tracheal aspirate acid-fast bacilli (AFB) smears, GeneXpert, TB PCR, and gastric lavage cultures\textemdashconsistently returned negative results. Screening for other infectious causes, including viral and bacterial pathogens, was also unremarkable. Results: Despite the absence of microbiological confirmation, clinical suspicion of congenital TB remained high due to the infant’s persistent respiratory compromise and the lack of alternative diagnoses. Notably, the infant demonstrated significant clinical improvement following the initiation of anti-tuberculosis therapy, including successful extubation, weaning to room air, and eventual discharge with good growth and improved chest X-rays. Epidemiological investigation did not reveal a direct maternal source of infection. The mother tested negative for both latent and active TB through AFB smears (urine and sputum), IGRA, and urine TB culture. The only potential exposure identified was a paternal grandfather with a history of smear positive pulmonary TB who had completed treatment a year prior to the infant’s birth, however, no definitive transmission link could be established. Critical points in the maternal history include resolved pneumonia, recurrent UTIs, and contact with an index case of TB (her father-in-law). Conclusion: This case underscores the limitations of current diagnostic modalities for congenital TB, particularly in neonates where microbiological confirmation is often elusive. It highlights the importance of clinical judgment and therapeutic trials in suspected cases, especially when there is a positive clinical response to anti-TB treatment. In conclusion, congenital tuberculosis should be prioritised in the differential diagnosis of neonates presenting with unexplained, refractory respiratory distress, even in the absence of definitive laboratory confirmation or clear epidemiological links. Given that microbiological yields in infants are frequently compromised by low diagnostic sensitivity, this case underscores the necessity of clinical judgment and the life-saving potential of empirical anti-tuberculosis therapy in neonates who fail to respond to standard antimicrobial regimens. Furthermore, the reliance on clinical and radiological findings as demonstrated by the initiation of treatment despite negative PCR and culture results, raises critical questions regarding the optimal duration of therapy and the extent of public health interventions. Ultimately, this case highlights a significant surveillance dilemma, whether clinically diagnosed TB warrants comprehensive contact investigation and social screening, a decision with profound implications for infectious disease control and maternal-child health protocols.},

note = {Type: Poster Presentation; Organisation: 1Timur Laut District Health Office, 11600 George Town, Pulau Pinang, Malaysia.; Corresponding author: Muhammad Irfan, muhammad.irfan5367@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-672,

title = {Content and Face Validity of a Knowledge, Attitudes, and Practices Questionnaire on Measles and Immunisation},

author = {Siti Nor Shuhada Mustfar1 Nurnajayati Omar1 Nur Akmal Ismail1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: A valid and reliable questionnaire is essential to assess knowledge, attitudes, and practices (KAP) regarding measles and immunisation, as well as to establish baseline KAP levels and evaluate the effectiveness of immunisation programmes in Terengganu. Therefore, this study aimed to evaluate the content and face validity of a newly developed KAP questionnaire on measles and immunisation for the community. Materials and methods: This cross-sectional study was conducted in two phases. The first phase involved content validity assessment by six experts. The content validity index (CVI) and content validity ratio (CVR) were calculated to evaluate the relevance, clarity, simplicity, and necessity of each item. The second phase involved face validity assessment among ten parents, where the face validity index (FVI) was used to assess item clarity and comprehensibility. Results: The questionnaire demonstrated high scale-level indices, with S-CVI/Ave, S-CVR/Ave, and S-FVI/Ave values of 0.95, 0.89, and 0.85, respectively. After removing several items with low item-level CVR (I-CVR), the S-CVR/Ave improved to 0.98. Some items were revised based on feedback but retained within their respective constructs. Discussion/ Conclusion: In conclusion, the high CVI, CVR, and FVI scores indicate strong agreement among experts and respondents regarding the relevance, necessity, and clarity of the questionnaire items, supporting its suitability for assessing community KAP on measles and immunisation, particularly among parents.},

note = {Type: Poster Presentation; Organisation: 1Public Health Division, Terengganu State Health Department, Terengganu, Malaysia.; Corresponding author: Nur Akmal Ismail, dr.nurakmalismail@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-579,

title = {Cost-Effectiveness Analysis Of Nasopharyngeal Carcinoma Screening Using Epstein-Barr Virus-Based Testings Among High-Risk Population in Sarawak},

author = {Zafar Ahmed2 Winnie Johnny1 Theresa Lona Abel1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Nasopharyngeal carcinoma (NPC) is an Epstein\textendashBarr virus (EBV)\textendashassociated cancer with a high incidence in Sarawak, Malaysia, particularly among adults aged 40\textendash59 years and the Bidayuh ethnic group. Over 70% of NPC cases in Malaysia are diagnosed at advanced stages, resulting in poor survival outcomes and high treatment costs. Although EBV-based screening has shown promise in endemic regions, NPC screening has not been implemented in Malaysia due to limited local economic evidence. This study aimed to evaluate the cost-effectiveness of EBV-based NPC screening strategies among adults aged 40\textendash59 years in Sarawak, comparing outcomes between the general population and the high-risk Bidayuh subgroup. Materials and Methods: A full economic evaluation using cost-effectiveness analysis was conducted from the healthcare provider perspective. Decision-analytic decision tree models compared four strategies: no screening, EBV serology screening, plasma EBV DNA polymerase chain reaction (PCR) screening, and combined EBV serology plus EBV DNA PCR screening. Two models were applied: a Screening Model estimating NPC cases detected and a Screening plus Treatment Model estimating NPC deaths averted. Direct medical costs covering screening, diagnostic confirmation, treatment, and follow-up were included and reported in Malaysian Ringgit (MYR). Model inputs were obtained from local hospital costing data, Sarawak cancer registry reports, national clinical guidelines, published literature, and expert consultation. A 5-year time horizon and 3% annual discount rate were applied. Outcomes were assessed using average cost-effectiveness ratios (ACER), incremental cost-effectiveness ratios (ICER), and net monetary benefit (NMB) at a willingness-to-pay threshold of MYR144,636.03 (three times Malaysia’s gross domestic product per capita). Results: In the general population aged 40\textendash59 years in Sarawak (N ≈ 602,800), EBV serology screening detected 71 NPC cases compared with no screening, but incurred substantially higher costs, with an ICER of MYR319,229.00 per case detected and a negative net monetary benefit, indicating that population-wide screening was not cost-effective. Plasma EBV DNA PCR and combined EBV-based screening strategies detected slightly more cases but at markedly higher costs (ICERs of MYR61.7 million per case detected and MYR22.7 million per case detected, respectively), resulting in economic dominance by EBV serology. In the Screening plus Treatment Model, EBV serology screening averted up to 67 NPC deaths in the general population but remained above the cost-effectiveness threshold. Conversely, in the high-risk Bidayuh subgroup within the same age group (N ≈ 47,621), EBV serology screening was cost-effective, with an ICER of MYR99,475.00 per NPC case detected and an ICER of MYR139,649.00 per NPC death averted, both below the willingness-to-pay threshold and yielding positive net monetary benefits. More intensive screening strategies provided marginal gains in effectiveness but at disproportionate incremental costs. Conclusion: Universal EBV-based NPC screening is not cost-effective in Sarawak. However, targeted EBV serology screening among high-risk Bidayuh adults aged 40\textendash59 years is cost-effective and substantially improves early detection and survival outcomes. These findings support a risk-stratified approach to NPC screening and provide actionable evidence to inform targeted screening policy in high-incidence populations in Malaysia.},

note = {Type: Oral Presentation; Organisation: 1 Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak. 2 School of Communities and Education, Faculty of Health and Wellbeing, Northumbria University, United Kingdom.; Corresponding author: Theresa Lona Abel, waknana@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-570,

title = {Counting the Cost of Care: A Time-Driven Activity-Based Costing Analysis of Leptospirosis Rapid Testing in Primary Health Clinics},

author = {Sarah Saizan1 Zulkifli Mohd Noor 1 Hazura Mat Zubir 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Leptospirosis amounts to a significant public health concern in Malaysia, especially in flood-prone regions such as Kuala Krai. While rapid diagnostic testing in primary health clinics enables prompt treatment, the actual provider costs have not been clearly established. This study aimed to estimate the unit cost per patient for leptospirosis rapid testing in clinics using Time-Driven Activity-Based Costing (TDABC). Materials and Methods: A cross-sectional costing study was conducted in selected primary health clinics within the Kuala Krai District. The TDABC methodology involved mapping the clinical workflow according to standard operating procedures, followed by time-and-motion observations of healthcare staff during routine patient management. The duration of each activity was recorded, and capacity cost rates (CCR) were calculated for each staff category based on salary and practical working capacity. Direct costs, including consumables and diagnostic materials, were obtained from clinic stores, pharmacies, and procurement records. The total cost per patient was estimated by combining staff time costs and direct consumable costs. Results: The estimated total cost per patient for leptospirosis rapid testing was MYR62.20, comprising MYR18.32 for consumables and MYR43.88 for staff wages, with staff cost identified as the main cost driver. From 2023 to 2025, a total of 718 patients underwent leptospirosis rapid testing at primary health clinics in Kuala Krai District. Based on the estimated unit cost, this corresponds to approximately MYR44,659.60 worth of diagnostic services delivered at the primary care level. This reflects a substantial volume of services provided through decentralised testing. Conclusion: The evidence indicates that the cost of leptospirosis rapid testing in primary health clinics is predominantly driven by staff time rather than consumable items. This points to the importance of optimising workflow efficiency and staff utilisation to enhance the cost-effectiveness of service delivery. The application of TDABC offers a practical and accurate approach for estimating real-world healthcare costs and identifying key cost drivers. These results provide evidence to inform resource allocation, budgeting, and service planning at the district level. Future research should explore strategies to improve efficiency and assess cost variations across different healthcare settings.},

note = {Type: Oral Presentation; Organisation: 1 Pejabat Kesihatan Daerah Kuala Krai, Kelantan, Malaysia; Corresponding author: Sarah Saizan, drsarah.saizan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-752,

title = {COVID-19 Vaccine Booster Hesitancy in Malaysian Cancer Patients: A Multicenter Study on the Role of Safety Concerns and Informational Uncertainty},

author = {Shahrul Aiman Soelar 2 2 Ibtisam Ismail 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Cancer patients are at elevated risk of severe COVID-19, and booster vaccination is recommended as immunity wanes; however, uptake remains suboptimal. This study estimated the prevalence of COVID-19 vaccine booster hesitancy and its associated factors among adult cancer patients in Northern Malaysia. Materials and Methods: A multicentre cross-sectional study using convenience sampling was conducted between March and July 2025 among 404 adult oncology patients attending three tertiary hospitals in Northern Malaysia. Participants completed a structured bilingual questionnaire assessing sociodemographic and clinical characteristics, knowledge, and perception constructs informed by the Health Belief Model. Results: Overall, 43.3% of participants had not received a booster dose (mean age 53.7 ± 11.59 years). Lack of confidence in booster safety was strongly associated with hesitancy (AOR 13.59, 95% CI 4.43\textendash41.65), as was the need for additional government information (AOR 6.89, 95% CI 1.79\textendash26.45). Belief in effectiveness against emerging variants (AOR 0.06, 95% CI 0.02\textendash0.15) and adherence to government recommendations (AOR 0.03, 95% CI 0.01\textendash0.07) were associated with booster acceptance. Sociodemographic characteristics, cancer stage, treatment type, and knowledge level were not independently associated with booster hesitancy. Conclusion: COVID-19 vaccine booster hesitancy was common among cancer patients and was primarily associated with concerns about vaccine safety and informational uncertainty rather than sociodemographic or knowledge-related factors. Integrating treatment-specific vaccination counselling within oncology care may help improve booster uptake in this medically vulnerable population.},

note = {Type: Poster Presentation; Organisation: 1 Department of Community Health, Pusat Kanser Tun Abdullah Ahmad Badawi, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia. 2Clinical Research Centre, Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, 05460 Alor Setar, Kedah, Malaysia.},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-685,

title = {Decentralisation of Urological Services: Evaluating the Impact of District-Level Extracorporeal Shock Wave Lithotripsy (ESWL) on Renal Stone Management in Kedah},

author = {Farah Wahidah Ishak2 Muizz Zaffan Zainol2 Mohd Azri Mohd Suan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Previously, the management of renal stones in Kedah heavily relied on Ureteroscopy (URS) and Percutaneous Nephrolithotomy (PCNL) at Hospital Sultanah Bahiyah, where wait times for these highly skilled procedures often exceeded four months. To address this bottleneck and close the healthcare access gap, an Extracorporeal Shock Wave Lithotripsy (ESWL) service was introduced and decentralised to Hospital Yan, a district hospital, in March 2023. The objective of this study is to evaluate the operational success, geographic catchment, and clinical safety of this decentralised ESWL model. Materials and Methods: A retrospective observational study was conducted on patients undergoing ESWL at Hospital Yan between March 2023 and December 2025. Data regarding procedure volume, patient demographics, wait times, initial stone characteristics, geographic origin, and final clinical disposition were extracted and analysed using descriptive statistics. Results: A total of 1,607 ESWL procedures were performed across 513 patients. The annual procedure volume was 520 in 2023, peaking at 713 in 2024, and 374 in 2025. The patient cohort had a mean age of 55.3 years (SD=13.0) and was predominantly male (57.9%). The median wait time to secure a first ESWL appointment was highly efficient at 31.0 days (IQR=23.75). Patients presented with a mean initial stone size of 11.3 mm (SD=4.99). Geographic catchment mapping revealed a wide regional impact; while only 2.7% of patients resided in Yan, this district hospital successfully absorbed caseloads from major districts including Kota Setar (30%), Kubang Pasu (15%), and Kuala Muda (14%), extending its reach to out-of-state patients from Perlis (8.8%), Penang (0.6%), and northern Perak (1.4%). On clinical outcomes, a significant proportion of patients (42.3%) required no further treatment and were successfully discharged from the urology service following successful ESWL procedures performed by trained medical officers. Furthermore, the decentralised model proved highly safe, with only two reported complications requiring hospitalisation following ESWL procedures. Conclusion: The decentralisation of ESWL to a district hospital successfully transformed urological care delivery in Kedah. By strategically relocating advanced medical technology away from congested tertiary centres, this partnership model provided timely, safe access to care for the broader state and regional population. Achieving an efficient 31-day median wait time-a reduction from the historical 4-month wait time for tertiary surgical intervention, maintaining a near-zero severe complication rate, and successfully discharging over 40% of patients without surgical escalation, this model exemplifies effective health care management and serves as a highly scalable blueprint for bridging urban-rural disparities in specialist healthcare.},

note = {Type: Oral Presentation; Organisation: 1Clinical Research Center, Hospital Sultanah Bahiyah, Alor Setar, Kedah. 2Hospital Yan, Yan, Kedah. 3Urology Unit, Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah. 4Hospital Sultan Abdul Halim, Sungai Petani, Kedah.; Corresponding author:Mohd Azri Mohd Suan, azrisuan@crc.moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-665,

title = {Decentralising Non-Communicable Disease Care in Rural Malaysia: A Pilot Model for Integrated Elderly Services at Klinik Desa Parit Amil, Batu Pahat},

author = {83000 Batu Pahat Kalsom S¹; 1Batu Pahat District Health Office Siti Kamariah M¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Achieving Universal Health Coverage in rural Malaysia is frequently impeded by geographical and logistical barriers that create a pronounced service gap for aging populations. Historically, the Klinik Desa framework has been dedicated to maternal and child health services, leaving geriatric patients with chronic conditions to navigate distant primary health centres for specialised management. This study evaluates a transformative pilot model at Klinik Desa Parit Amil, which transitioned from a narrow-scope facility into an integrated one-stop centre. The primary objective was to assess the feasibility of decentralizing comprehensive non-communicable disease management to the community level, thereby addressing health inequities and enhancing clinical accessibility for the rural elderly. Materials and Methods: The initiative adopted a multi-sectoral partnership framework, aligning the District Health Office with local grassroots leaders to facilitate population mapping and community mobilization. A multidisciplinary clinical team, comprising family medicine specialists, medical officers, pharmacists, and allied services was deployed from the main health clinic to deliver specialised care within the Klinik Desa Parit Amil infrastructure. A core component of the intervention was the strategic planning for technology-enabled workflows, with the intended integration of electronic medical records and digitised prescription management systems. This planned digital synchronization aimed to ensure long-term clinical continuity and real-time data transparency across the primary care network. Simultaneously, nursing personnel underwent rigorous upskilling in chronic disease clinical pathways to ensure high-standard frontline care delivery. Results: The localised screening program successfully identified a significant cohort of previously undiagnosed chronic conditions, underscoring the model’s efficacy in early clinical intervention. The integration of specialised services led to a statistically significant improvement in follow-up compliance among elderly patients, many of whom had previously defaulted due to transport-related barriers. Furthermore, the model achieved a substantial reduction in patient out-of-pocket expenditure and a marked decrease in clinic transit and wait times compared to the conventional referral system. Discussion/Conclusion: This patient-centric approach demonstrated that specialised clinical expertise can be effectively decentralised through strategic resource reallocation, significantly mitigating the physical and financial burdens on a vulnerable demographic. The evolution of Klinik Desa Parit Amil into an integrated chronic disease hub represents a high-impact healthcare management strategy for closing systemic public health gaps. By optimizing underutilised infrastructure through planned digital health synchronization and robust community-based partnerships, the healthcare system can achieve a more equitable and operationally resilient primary care delivery. This pilot serves as a definitive management blueprint for decentralizing chronic disease services, demonstrating that a synergy of technological integration and workforce upskilling can successfully bring high-quality care to remote populations.},

note = {Type: Poster Presentation; Corresponding author: Siti Kamariah M, drsitikamariah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-782,

title = {DEMOGRAPHIC PROFILING OF PREP CLIENTS IN KEDAH: IDENTIFYING THE SOCIOECONOMIC REACH},

author = {Azlina. A. 2 Sharifah Saffinas S.S.1 Farah I.A.1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The success of Malaysia’s HIV prevention strategy depends on the effective engagement of high-risk individuals. In Kedah, the expansion of Pre-exposure Prophylaxis (PrEP) services across primary healthcare clinics aims to provide equitable access to life-saving biomedical interventions. However, a critical question remains regarding the socioeconomic diversity of those who are successfully reached and enrolled in the program. Understanding the demographic profile of these clients is essential to determine if current outreach efforts are inclusive or if they inadvertently favor specific groups with better social resources. This study aims to describe the profile of clients enrolled in PrEP services in Kedah, focusing specifically on their educational attainment and employment status. Materials and Methods: A descriptive cross-sectional analysis was conducted using the MyHCC (My HIV Care Cascade) database. The study analyzed N=292 clients who were successfully enrolled and initiated on PrEP across Kedah between 2023-2025. Data on employment status (Employed, Unemployed, Student) and highest education level (Primary, Secondary, Tertiary) were extracted. Descriptive statistics were used to map the distribution of the enrolled population, providing insights into the reach of current public health strategies in the northern region. Results: The findings indicate that the program has predominantly reached individuals with higher socioeconomic stability. Out of the 292 clients enrolled, the majority were employed (64.0%), followed by the unemployed (19.6%) and students (16.4%). In terms of educational background, the program was most successful in enrolling those with tertiary education (68.5%), followed by secondary education (25.7%). Alarmingly, individuals with only a primary education background represented the smallest fraction of the enrolled group at 5.8%. This suggests that while the service is available, it is currently being utilized mainly by those with higher formal education and stable incomes. Conclusion: The results reveal a potential "access gap," where PrEP enrolment is skewed towards clients with higher health literacy and financial security. The high percentage of tertiary-educated and employed clients suggests that current strategies\textemdashlikely clinic-based or digital\textemdashare more effective for those with better social resources. The low enrolment rate among individuals with primary education (5.8%) is a significant public health concern, as these groups often face higher vulnerabilities but may remain unreached due to stigma or lack of awareness. This disparity highlights the need for a shift from passive clinic-based enrolment to active, community-led outreach to ensure equity in HIV prevention. While PrEP enrolment in Kedah is steadily increasing, there is a clear socioeconomic imbalance in the client profile. The program is effectively reaching those with stable employment and higher education but is missing the most marginalized segments of the population. To achieve truly equitable HIV prevention, Kedah’s health initiatives must intensify community-based outreach and peer-led strategies specifically designed to reach and enrol individuals from lower educational and unemployed backgrounds.},

note = {Type: Poster Presentation; Organisation: 1Unit HIV/STI/Hepatitis C, Public Health Division, Kedah State Health Department, Malaysia. 2Kubang Pasu District Health Office, Kedah, Malaysia.; Corresponding author: Dr Sharifah Saffinas binti Syed Soffian, drshsaffinas@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-516,

title = {Dengue Surveillance and Outbreak Evaluation in Selangor: A 2025 Review},

author = {Qamruddin AA1 Abd Hamid H1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue has been an important public health issue in Malaysia. Selangor, being the most densely populated state in Malaysia, consistently contributes the majority of cases nationwide. This study aims to compare weekly dengue incidence in Selangor throughout 2025, analyse socio-demographic profiles of reported cases and evaluate outbreak control measure performance in 2025 against 2024. Materials and Methods: A cross-sectional descriptive study was conducted using secondary data of all dengue cases registered in Selangor from the national dengue monitoring system (eDengue System) for the years 2024 and 2025. Data from eDengue System were extracted and analysed using Microsoft Excel. Results: In 2025, Selangor recorded a total of 23,565 dengue cases, including 9 fatalities. The cases peaked in the first half of the year and declined after the 24th epidemiology week (EW24). The majority of cases were Malaysians (85.9%) with unequal distribution across ethnicity (66.6% Malays, 18.9% Chinese, 13.2% Indian) and gender (60.1% males, 39.9% females). Most cases were young adults and adults aged 16\textendash60 years (75.1%), followed by children below 15 years old (16.5%) and those aged 60 years and above (8.5%). Additionally, 60.9% of patients sought treatment from private facilities. Outbreak occurrences also saw a significant overall 68.7% decrease, with 2773 outbreaks in 2025 compared to 8865 outbreaks in 2024. There was a median of 135 active outbreaks each week in 2025. Dengue Outbreak Control Index (DOCI), defined as outbreaks controlled within 14 days, improved from 84.2% in 2024 to 87.5% in 2025. Conclusion: This study highlights the importance of accurate data input for surveillance to allow prevention and control activities to be planned and carried out more efficiently and effectively. A drop in cases reported in 2025 compared to 2024 (60,364 cases) proved the cyclical transmission of dengue that is observed every four to five years. Nevertheless, targeted and integrated vector management contributed to the significant 60.9% drop in cases and improved DOCI. Students and the working-age population were among those disproportionately affected, indicating the need to prioritise targeted awareness and control strategies among this age group. More than half of patients sought treatment from private facilities, underscoring the important role of private practitioners in diagnosing dengue and managing patients presented with fever.},

note = {Type: Poster Presentation; Organisation: Vector-Borne Disease Control Unit, Selangor State Health Department, Ministry of Health, Malaysia; Corresponding author: Haneem binti Abd Hamid, haneem@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-456,

title = {Design of a Blood Taking Table to Enhance Safety and Ergonomics in Venepuncture},

author = {Mohd Normazlan Husain1 3 Hemanath Sinnathamby1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Needle stick injury is a recognised occupational hazard among healthcare workers performing venepuncture. Contributing procedural risks include cross-body sharps disposal, under-table sharps bin placement, and sharing a sharps bin, which may compromise ergonomic safety and increase the likelihood of accidental sharps injuries. The objective of this innovation is to develop a structured blood taking table that optimises material organisation, sharps handling, and ergonomic workflow during venepuncture to reduce identified procedural risk factors for needle stick injury. Materials and Methods: A dedicated blood-taking table was designed and assembled using a flat, stable work surface with clearly demarcated blood-taking stations. The layout incorporates individual sharps disposal containers positioned at table level within direct reach, segregated consumable storage using labelled modular drawers, allocated space for sterile trays, kidney dishes, and specimen racks, and surface protection barriers to support aseptic practice. The design eliminates the need for under-table sharps bins, reduces cross-body movements, and minimises the sharing of equipment between operators, with placement of consumables and sharps containers following a linear workflow from preparation to disposal. Although formal evaluation and outcome measurements have yet to be conducted, the assembled blood taking table constitutes a practical organisational and engineering control intended to improve workflow clarity, ergonomic safety, and sharps handling practices during venepuncture. Future assessment is planned to evaluate feasibility, user feedback, and impact on NSI risk reduction.},

note = {Type: Poster Presentation; Organisation: 1. Pejabat Kesihatan Daerah Gombak, 2. Pejabat Kesihatan Daerah Sepang, 3. Jabatan Kesihatan Negeri Selangor; Corresponding author: Hemanath Sinnathamby (dr_hemanath@moh.gov.my)},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-693,

title = {Determinants Of HFMD Preventive Practices Among Childcare Providers In Dungun District, Terengganu: A Cross-Sectional Study},

author = {Mohd Hafiz Baharudin1 Ahmad Nabeil Alias2 Nurul Salsabila Mokhtar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hand, Foot and Mouth Disease (HFMD) remains a significant public health concern in early childcare settings due to its high transmissibility through close contact and contaminated surfaces. Although knowledge and hygiene guidelines are widely promoted, gaps in implementation may contribute to continued transmission. This study aimed to determine the association between provider knowledge, preventive practices, and environmental hygiene with the occurrence of HFMD cases in childcare premises in Dungun District, Terengganu. Materials and Methods: A cross-sectional study was conducted in May 2025 among 384 childcare providers selected using stratified random sampling, with mukim as strata. Data were collected using a structured and validated Malay-language questionnaire assessing knowledge, preventive practices, and environmental hygiene. The main outcome was the occurrence of at least one HFMD case in the premises within the past 12 months (verified with CDC data where applicable). Descriptive statistics were presented as frequencies and percentages. Associations between independent variables and HFMD occurrence were analysed using Chi-square and Fisher’s Exact tests. Results: A total of 310 respondents participated (response rate: 80.7%), with 41.3% reporting at least one HFMD case in the past year. Risk categorisation showed 27.7% low, 47.7% moderate, and 24.5% high risk premises. Knowledge levels were generally high, with 96.8% correctly identifying HFMD symptoms and transmission modes; however, only 72.9% had received formal HFMD training. Preventive practices such as disinfection (93.5%) and symptom gatekeeping (81.3%) were commonly reported. Nonetheless, key gaps were identified, including low adherence to non-sharing practices for toys (5.2%) and bedding (27.1%), inadequate bedding hygiene (40.0%), and inconsistent labelling of personal items (60.0%). Significant protective factors (p\<0.05) included knowledge of HFMD transmission, use of parental declaration forms, non-sharing of personal items, proper towel storage, twice-daily disinfection, and correct disinfectant usage. Discussion/ Conclusion: Despite high levels of knowledge among childcare providers, this study demonstrates that knowledge alone does not consistently translate into optimal preventive practices. Critical gaps were observed in behaviour-related and environmental control measures, particularly those requiring consistent enforcement such as non-sharing policies and hygiene monitoring. The findings suggest that structural and system-level factors such as lack of formal training, inconsistent supervision and absence of standardized protocols which may influence implementation. Importantly, practices that are more structured and policy-driven such as declaration forms and scheduled disinfection showed stronger protective associations, highlighting the importance of institutional enforcement over individual awareness alone. While knowledge of HFMD among childcare providers is high, inconsistencies in preventive practice implementation persist. Strengthening structured interventions such as formal training, standardized hygiene protocols, and stricter enforcement of infection control measures is essential to reduce HFMD transmission in childcare settings. These findings support the need for integrated, system-based approaches to improve prevention at the facility level.},

note = {Type: Poster Presentation; Organisation: 1Dungun District Health Office, Terengganu, Malaysia. 2 Rompin District Health Office, Pahang, Malaysia.; Corresponding author: Nurul Salsabila Mokhtar, nurul.salsabila@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-499,

title = {Determinants of Poor Patient Safety Engagement Among Adult Inpatients in Malaysian Tertiary Hospitals: Implications for Healthcare Quality Management},

author = {Intan Idiana Hassan2 Mohd Ismail Ibrahim1 Ab Farid Fajilah Ab Aziz1 and Mohd Hanif Mohd Nawawi1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Patient safety engagement has emerged as a critical strategy for improving healthcare quality and preventing adverse events in hospital settings. Active patient participation in safety practices may help reduce preventable harm during hospitalisation. However, evidence on determinants influencing patient safety engagement remains limited, particularly in low- and middle-income healthcare settings such as Malaysia. This study aimed to determine factors associated with poor patient safety engagement among adult inpatients in Malaysian tertiary hospitals. Materials and Methods: A multicentre cross-sectional study was conducted among 1064 adult inpatients recruited from four tertiary hospitals in Malaysia between January and April 2025. Patient safety engagement was measured using a validated eight-item scale. Descriptive statistics were used to describe engagement levels, followed by multiple logistic regression to identify factors independently associated with poor engagement. Results: Overall, 36.5% of participants demonstrated poor patient safety engagement. Multivariable analysis showed that poor engagement was significantly associated with older age (AOR = 1.02, 95% CI: 1.00, 1.03) and being unmarried, divorced or widowed (AOR = 1.40, 95% CI: 1.02, 1.93). Clinical factors were also associated with poor engagement, including admission to medical (AOR = 1.72, 95% CI: 1.08, 2.72) and orthopaedic departments (AOR = 1.63, 95% CI: 1.06, 2.50), as well as having chronic disease(s) (AOR = 1.91, 95% CI: 1.39, 2.63). In addition, moderate or low knowledge and awareness of patient safety practices (AOR = 1.59, 95% CI: 1.19, 2.14), lack of participation in patient safety education programmes (AOR = 1.54, 95% CI: 1.07, 2.21), preference for visual health information (AOR = 1.50, 95% CI: 1.06, 2.12), cultural beliefs related to socioeconomic decision-making (AOR = 2.01, 95% CI: 1.30, 3.12), and moderate or low perceived impact of cultural beliefs on patient safety engagement (AOR = 1.77, 95% CI: 1.32, 2.39) were significantly associated with poor engagement. Conclusion: Poor patient safety engagement remains a substantial concern among hospitalised patients. Interventions aimed at strengthening patient safety literacy, improving patient\textendashprovider communication, addressing cultural influences on healthcare decision-making, and expanding patient safety education programmes may enhance patient participation and support safer hospital care.},

note = {Type: Oral Presentation; Organisation: 1Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia, 2School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; Corresponding author: Ab Farid Fajilah Ab Aziz, abfarid21@student.usm.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-455,

title = {Determining Epidemic Thresholds and Moving Average for Dengue Surveilance in Kinta District, Malaysia},

author = {Mohd Zarin Alias1 Gregory Xavier1 Zulaikha Abdul Razak1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue fever, a vector-borne viral disease, is a major public health concern in tropical countries. To efficiently control dengue, a continuous surveillance system has to be in place together with an effective preparedness plan for different levels of epidemic thresholds. This study aims to identify the best method of surveillance to forecast any rise in cases and subsequent outbreaks in Kinta district. With such forecasting, public health control activities can be better planned and enhance preparedness response by levels. Materials and Methods: This study utilised retrospective data from Kinta district, covering from the first epidemiological week of 2018 until the 52nd epidemiological week of 2025. Data were sourced from the Ministry of Health’s E-Dengue system, which records confirmed dengue cases. Information collected included the number of cases per epidemiological week. The analysis employed three methods, including the endemic channel, moving average, and recent mean, with data processed using Excel spreadsheets. Results: Kinta, being a densely populated district with frequent dengue outbreaks, demonstrated promising forecasting results using the epidemiologic threshold calculations (endemic channel, 13-week moving average, and recent mean). These approaches effectively identified outbreak thresholds, aiding in timely detection and intervention. Conclusions: Simple and practical methods, such as the endemic channel, recent mean, and moving mean, are well-suited for urban districts like Kinta to forecast future trends in the number of cases. However, these methods require consistent updates to threshold graphs to maintain accuracy over time.},

note = {Type: Oral Presentation; Organisation: 1 Kinta District Health Office, Jalan Aman, Kampung Bendera, 31000 Batu Gajah, Perak, Malaysia; Corresponding author: Zulaikha Abdul Razak, dr.zulaikha@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-651,

title = {Determining The Association of Green Building Features on Workplace Satisfaction of Healthcare Workers in Hospital Jasin},

author = {Milagros M. Spanoghe 2 2 Nur Safani Basri 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The Malaysian Ministry of Health has implemented Green Building Initiatives since 2016, with several public hospitals achieving international and national green building certifications such as Leadership in Energy and Environmental Design (LEED), Green Building Index (GBI) and MyCREST. Despite well documented energy and cost savings, limited research has examined how green building features influence healthcare workers' workplace satisfaction, particularly in certified hospitals.This study addresses this gap by investigating the association of green building features on workplace satisfaction among healthcare workers at Hospital Jasin, a LEED-certified facility. Materials and Methods: A cross-sectional study was conducted with 200 healthcare workers at Hospital Jasin using a validated workplace satisfaction questionnaire. The instrument measured satisfaction across eight indoor features (safety, physical condition, spaciousness, finishes and furniture, air quality, lighting, waste disposal, thermal comfort) and three outdoor features (accessibility, outdoor amenities, green environment). Data were analysed using descriptive statistics, independent t-tests, one-way ANOVA, and multiple regression analysis. Demographic variables including gender, role, years of working, and employment tenure relative to the 2021 LEED certification were also examined as the independent variables. Results: High levels of workplace satisfaction were reported, with 78.0% of respondents expressing positive overall satisfaction (mean=4.03±0.76). The 3R sustainability program received the highest satisfaction rating (mean=4.17±0.72). No significant demographic differences in satisfaction were found across gender, role, years of service, or pre-post certification employment (p \> 0.05). Regression analysis revealed that indoor features explained 79% of satisfaction variance (F(8,191)=90.858, p\<0.001, R²=0.792), with waste management, thermal comfort, safety, air quality, finishes, and building quality emerging as significant predictors. External features explained 44% of variance, contributing only marginally to the combined model (R²=0.806), 80% of variance. Conclusion: Green building features, particularly indoor environmental quality elements, demonstrate exceptionally strong associations with healthcare worker satisfaction. The absence of demographic differences indicates that green design benefits are equitably perceived across all staff groups. These findings provide empirical evidence supporting the expansion of green building certification as a standard requirement in healthcare facilities, with implications for staff well-being, retention, and quality of patient care.},

note = {Type: Poster Presentation; Organisation: 1Quality Unit, Hospital Jasin, Malacca, Malaysia. 2College of Public Health, University of the Philippines Manila, Philippines.; Corresponding author: Nur Safani Basri, nursafanibasri@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-557,

title = {Developing Strategies to Improve Prison Healthcare Access in Malaysia (MyPri_Care): An Implementation Research Protocol},

author = {Nur Azmiah Z¹ Nur Hidayati AH¹ Wong MF¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Prison health remains a critical yet under-resourced component of public health, particularly in low- and middle-income countries. In Malaysia, beyond prison overcrowding and constrained healthcare capacity, service delivery is further challenged by the co-occurrence of tuberculosis (TB), Hepatitis C, and substance use disorders. These conditions interact as a syndemic, complicating clinical management, increasing healthcare burden, and exacerbating health inequities among incarcerated populations. The implications extend beyond prison settings, posing risks to community health. Despite ongoing government efforts to strengthen resources and improve service delivery, the quality of care remains a concern among policymakers. Addressing these challenges requires a systems-based approach grounded in implementation research, ensuring effective adoption and sustainability of interventions in real-world prison settings. This study aims to identify barriers and facilitators and develop context-specific strategies, including digital health solutions, to improve TB, Hepatitis C care and subatance-use. Materials and Methods: This study employs a multi-centre, multi-method implementation research design guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. It is conducted across six prisons and their corresponding Ministry of Health (MOH) facilities in Kedah, Melaka, Perak, Johor, and Selangor. Study sites were selected based on overcrowding indices and disease burden, while MOH facilities were identified according to established referral linkages. Ethical approval was obtained from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID-24-01947-UUG), with additional approval from the Prison Department. Phase I (Exploration) employs a multi-method approach comprising secondary data analysis, document review, qualitative interviews, and observational assessments. Secondary data from national surveillance systems (CD e-Notification, NTBR, and MyHCC) and prison health records will be analysed to assess disease burden and care cascades. Document review follows the READ approach, guided by PICO criteria and stakeholder input to map care processes and identify service delivery gaps. Qualitative data will be collected through a minimum of 30 in-depth interviews and 9 focus group discussions with multi-level stakeholders, including policymakers, prison officers, and healthcare providers. Semi-structured guides will explore barriers, facilitators, and implementation readiness. Observational assessments will capture contextual factors, including workflow, interactions among the actors in prison settings Phase II (Preparation) involves co-creation workshops using Nominal Group Technique to prioritise and operationalise strategies derived from Phase I. Quantitative data will be analysed descriptively using STATA BE 18, while qualitative data will undergo inductive and deductive framework analysis using ATLAS.ti. Cross-checking of data and Triangulation across methods and data sources will enhance analytical rigour. Results: Phase I is expected to generate epidemiological insights into TB and Hepatitis C, including timeliness across the care continuum, and to identify system-level barriers and facilitators to healthcare access. Phase II will produce consensus-driven, context-specific implementation strategies, including practical toolkits and operational protocols. Conclusion: This study applies a theory-informed implementation science approach to address critical gaps in prison healthcare access in Malaysia. By integrating empirical evidence with stakeholder engagement, it aims to generate actionable and scalable strategies to improve healthcare delivery and health outcomes in resource-constrained prison settings, with broader public healthcare system implications.},

note = {Type: Poster Presentation; Organisation: ¹ Centre for Health Policy Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, ² Centre for Health Economy Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, ³ Centre for Health Equity Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, ⁴ School of Pharmacy, Monash University Malaysia, ⁵ Head of Medical Department, Hospital Serdang, Ministry of Health Malaysia, ⁶ Head of Specialty for Internal Medicine, Ministry of Health Malaysia, ⁷ Health Clinic Tapah, Perak, Ministry of Health Malaysia, ⁸ Kajang Female Prison, Prison Department Malaysia, ⁹ Treatment Section, Headquarters, Malaysian Prison Department, ¹⁰ Tuberculosis Sector, Disease Control Division, Ministry of Health Malaysia, ¹¹ Institute of Respiratory Medicine, Ministry of Health Malaysia.; Corresponding author: Wong Min Fui @ Esther Wong, dr.estherwong@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-678,

title = {Development and Validation of a Household-Based Instrument for Sewage Disposal and Health Effects in Kelantan, Malaysia},

author = {Wan Mohd Zahiruddin Wan Mohammad1 Ahmad Filza Ismail1 Mohd Aslam Ariffin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Inadequate household sewage management remains a significant public health concern in developing regions, contributing to environmental contamination and increased risk of waterborne diseases. This study aimed to develop and validate a knowledge, attitude, and practice (KAP) questionnaire on household sewage management and health effects among households in Kelantan, Malaysia. Materials and Methods: A cross-sectional study was conducted using a multi-stage random sampling method involving 440 household respondents from two districts in Kelantan. The questionnaire underwent content and face validation, followed by pilot testing. Knowledge items were analysed using Item Response Theory (IRT), while attitudes and practice domains were evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach’s alpha and composite reliability. Results: The final questionnaire demonstrated excellent content validity (S-CVI/Ave \>0.90) and face validity (S-FVI/Ave \>0.90). IRT analysis retained all knowledge items with acceptable discrimination and difficulty parameters. EFA revealed a four-factor structure for attitude and a three-factor structure for practice domains. CFA supported the model with acceptable fit indices (CFI \> 0.90, TLI \> 0.90, RMSEA \< 0.08). The reliability coefficients ranged from 0.76 to 0.88 across domains. Overall, respondents demonstrated moderate knowledge, positive attitudes, and variable practices. Factors significantly associated with good practices included education levels, household income, and prior exposure to sanitation programs (p \< 0.05). Conclusion: The questionnaire demonstrated acceptable validity and reliability for assessing household knowledge, attitude, and practice on sewage disposal. Findings indicate that sewage-related behaviour is multidimensional and context-dependent. The instrument can support identifying behavioural gaps and guide targeted environmental health interventions, particularly in settings reliant on on-site sanitation. Further validation in diverse populations is recommended.},

note = {Type: Poster Presentation; Organisation: ¹Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.; Corresponding author: Mohd Aslam Ariffin, aslam.a@student.usm.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-593,

title = {Diagnostic Performance of the Generalised Anxiety Disorder-2 (GAD-2) Questionnaire as a Screening Tool for Detecting Anxiety in the Community in Sarawak},

author = {Mohamad Saizam Bin Said1 Nurdalila Binti Zainal ‘Abidin1 Nur Azimah Binti Azman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Anxiety disorders are among the most common mental health conditions and contribute substantially to the global burden of disease. Early detection is important to facilitate timely intervention and referral for appropriate care. Brief screening tools are particularly useful in large-scale community settings where rapid assessment is required. The Generalised Anxiety Disorder-2 (GAD-2) questionnaire is a short screening instrument derived from the Generalised Anxiety Disorder-7 (GAD-7) scale. This study aimed to evaluate the diagnostic performance of the GAD-2 questionnaire in detecting anxiety symptoms among the community in Sarawak, using the GAD-7 as the reference standard. Materials and Methods: A cross-sectional community-based screening study was conducted in Sarawak in 2025 as part of routine mental health screening activities. Participants completed the GAD-2 questionnaire, which assesses the frequency of two core anxiety symptoms over the past two weeks. A cut-off score of ≥3 was used to indicate a positive screening result. Participants also completed the GAD-7 questionnaire, with a score of ≥10 used to indicate probable anxiety disorder and serving as the reference standard. Diagnostic performance measures including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using a 2×2 contingency table. Results: A total of 2,346 participants were included in the analysis. Based on the GAD-7, the prevalence of anxiety was 15.7%. Using a cut-off score of ≥3, the GAD-2 correctly identified 356 true positive cases and 1,790 true negative cases, while 187 were false positives and 13 were false negatives. The GAD-2 demonstrated a sensitivity of 96.5% and specificity of 90.5%. The positive predictive value was 65.6%, while the negative predictive value was 99.3%. Conclusion: The GAD-2 questionnaire demonstrated excellent sensitivity and high specificity in detecting anxiety symptoms in the community. Its very high negative predictive value indicates that individuals who screen negative are highly unlikely to have clinically significant anxiety. These findings suggest that the GAD-2 is a practical and efficient tool for large-scale community screening programmes. When used as an initial screening tool followed by further assessment with the GAD-7, it may facilitate early identification and timely referral for mental health care.},

note = {Type: Poster Presentation; Organisation: 1Non-Communicable Disease Control Section, Sarawak Health State Department, Sarawak, Malaysia; Corresponding author: Nur Azimah Binti Azman, azimah.may@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-592,

title = {Diagnostic Performance of the Whooley Questionnaire for Community Depression Screening in Sarawak},

author = {Mohamad Saizam Bin Said1 Nurdalila Binti Zainal ‘Abidin1 Nur Azimah Binti Azman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Depression is one of the most common mental disorders globally and represents a significant public health concern. In Malaysia, depression contributes substantially to the burden of disease and may negatively affect an individual's emotional well-being, social functioning, and quality of life. Individuals experiencing depression often present with persistent sadness, loss of interest in daily activities, fatigue, and, in severe cases, suicidal thoughts. Early identification of depression is crucial to ensure timely intervention and appropriate referral for treatment. In primary care settings, brief screening tools are useful for identifying individuals who may require further psychological assessment. The Whooley questionnaire is a simple two-item screening tool designed to identify possible depression by assessing low mood and loss of interest over the past month. Due to its simplicity and ease of administration, it has been used by the Ministry of Health Malaysia in primary healthcare settings, including in Sarawak. This study aimed to evaluate the diagnostic performance of the Whooley questionnaire in detecting depression among community members in Sarawak. Materials and Methods: A cross-sectional study was conducted using data collected from mental health screening activities in primary care settings in Sarawak. Individuals aged 13 years and above who participated in the screening programmes were included in the analysis. Depression screening was initially conducted using the Whooley questionnaire. Individuals who screened positive were further assessed using the Patient Health Questionnaire-9 (PHQ-9), where a score of 10 or above was considered indicative of clinically significant depressive symptoms. The diagnostic performance of the Whooley questionnaire was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using PHQ-9 as the reference standard. Results: A total of 2,699 individuals participated in the screening programme. Of these, 433 individuals screened positive on both the Whooley questionnaire and PHQ-9, while 653 screened positive on Whooley but negative on PHQ-9. Additionally, 15 individuals screened negative on Whooley but positive on PHQ-9, and 1,598 screened negative on both tools. The Whooley questionnaire demonstrated high sensitivity (96.7%) and moderate specificity (71.0%). The positive predictive value was 39.9%, while the negative predictive value was 99.1%. Conclusion: The findings indicate that the Whooley questionnaire is an effective screening tool for early detection of depression in community settings due to its high sensitivity and very high negative predictive value. The tool is particularly useful for identifying individuals who may require further mental health assessment. However, individuals who screen positive should undergo additional evaluation using validated diagnostic instruments such as the PHQ-9 to confirm the presence of depression. Strengthening community-based mental health screening using brief tools such as the Whooley questionnaire may improve early detection and facilitate timely access to mental health services.},

note = {Type: Poster Presentation; Organisation: 1Non-Communicable Disease Control Section, Sarawak Health State Department, Sarawak, Malaysia; Corresponding author: Nur Azimah Binti Azman, azimah.may@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-728,

title = {Differentially methylated region analysis of lung function and asthma in the abdominal obesity population},

author = {Meng-Chih Lin23 Hung-Chen Chen2 Tsen-Hsin Tai1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Obese asthma patients tend to have worse asthma symptoms, greater asthma severity, and poor response to currently available treatments. However, the biological mechanisms underlying this distinct asthma phenotype remain unclear. This study aims to identify differentially methylated regions (DMR) associated with lung function and asthma among individuals with abdominal obesity. Materials and Methods: DNA methylation data from approximately 1,500 whole-blood samples of East Asian adults in the Taiwan Biobank (discovery cohort) were obtained using the Infinium MethylationEPIC microarray. We conducted DMR analyses for lung function impairment (FVC (%) \<0.8, FEV1 (%) \< 0.8；FEV1/FVC\< 0.7) stratified by abdominal obesity status (waist circumference \>90 cm for men, \>80 cm for women). DMRs associated with impaired lung function (false discovery rate [FDR] \< 0.05) exclusively in the abdominal obesity group were included in the gene set enrichment analysis. The top two DMRs with the largest difference were validated using targeted bisulfite sequencing in the Taiwan Adults Asthma Cohort Study (N=192). Results: We identified 15, 19, and 21 non-intergenic DMRs associated with impairment of FVC, FEV1, and FEV1/FVC, respectively, exclusively in individuals with abdominal obesity. These DMRs were enriched in inflammatory pathways, such as cytokine production, MAPK1, AKT, and NF-kappaB signaling. Hypomethylation of the two leading DMRs, located in TM4SF1 and MUC4, were consistently associated with lung function impairment. In the validation cohort, hypomethylation of TM4SF1 remained associated with lung function impairment in individuals with abdominal obesity. In contrast, methylation levels of MUC4 were positively associated with the risk of difficult-to-treat asthma in the abdominally obese population. Conclusion: These findings suggest that DNA methylation may contribute to the biological heterogeneity of asthma in individuals with abdominal obesity and may provide insights into obesity-specific mechanisms underlying lung function impairment and treatment response.},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 3Division of Pulmonary and Critical Care Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.; Corresponding author: Tsen-Hsin Tai, sharon020227@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-606,

title = {Digital Communication Overload and Its Association with Burnout and Anxiety Among Healthcare Workers in Public Hospitals in Klang Valley},

author = {Catherine Thamarai Arumugam¹ Victor CW Hoe 2 Hairina Binti Mazlan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Digital communication has become integral to healthcare delivery, improving coordination through mobile instant messaging platforms such as WhatsApp, Telegram, and Microsoft Teams. However, the increasing volume, frequency, and urgency of digital interactions have led to Digital Communication Overload (DCO), a psychosocial condition characterised by cognitive and emotional strain due to persistent connectivity and expectations of immediate response. In Malaysia, rapid digitalisation in healthcare has intensified reliance on these platforms, without clear governance for communication. This study aims to adapt the Malay version of the Digital Communication Overload Scale (DCOS) and examine its association with burnout and anxiety among healthcare workers (HCWs) in public hospitals in the Klang Valley. Materials and Methods: A three-phase sequential mixed-methods study will be conducted guided by the Job Demands\textendashResources (JD\textendashR) model. Phase I involves translation and cultural adaptation of the DCOS into Malay following established guidelines. Phase II comprises a cross-sectional study involving 572 HCWs selected using stratified random sampling from public hospitals under the Ministry of Health (MOH) in the Klang Valley. Data will be collected through a self-administered online questionnaire incorporating the DCOS, Oldenburg Burnout Inventory (OLBI-M), and Generalised Anxiety Disorder scale (GAD-7). Data will be analysed using descriptive statistics and multivariable regression. Phase III includes qualitative focus group discussions with purposively selected participants to explore coping mechanisms, using thematic analysis. Results: Higher levels of DCO are anticipated among HCWs working in high-acuity settings and those frequently engaged in after-hours communication. DCO is expected to show significant positive associations with burnout and anxiety, consistent with evidence linking communication overload and technostress to psychological distress among healthcare professionals. Qualitative findings are expected to identify individual and organisational coping strategies that help mitigate the psychological impact of DCO. Conclusion: This study is expected to provide evidence on the psychological and organisational implications of digital communication among healthcare workers. The findings will inform the development of policies on digital communication management, workload regulation, and mental health support to enhance workforce resilience and well-being.},

note = {Type: Poster Presentation; Organisation: 1Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, 2Centre of Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.; Corresponding author: Hairina Binti Mazlan, hairinabintimazlan@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-538,

title = {Digital Social Listening as a Catalyst for Public Health Reform: A Case Study of Acute Gastroenteritis Cluster in Pulau Redang},

author = {Mohd Ridzwan bin Abdul Rani1 Zatil Zahidah binti Mohd Sharani1 Effah Leiylena binti Yaacob1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Traditional public health surveillance often faces "reporting lag" in remote tourism destinations. In July 2024, a significant cluster of Acute Gastroenteritis was identified in Pulau Redang. While formal reports were limited, a surge of informal complaints appeared on digital platforms, suggesting that digital "social listening" could serve as a critical early warning tool. To evaluate the effectiveness of digital social listening (online user reviews) compared to traditional surveillance in detecting an outbreak and to analyse the resulting multi-agency regulatory actions. Materials and Method: A retrospective descriptive study analysed data from July 21 to August 18, 2024. Sources included formal complaints (n=9), clinical records, and qualitative data from online user reviews. The digital timeline was mapped against official Active Case Detection to measure "Lead Time". Post-outbreak investigation reports from the National Water Services Commission and other agencies were analysed to determine systemic consequences. Results: Digital reviews identified an outbreak by July 21, three days before the first formal report. While formal complaints suggested 21 cases, online user reviews provided real-time evidence of larger clusters (e.g., 35/38 symptomatic). Active Case Detection later confirmed 51 cases. The investigation identified a leaking septic tank from a neighbouring resort contaminating a private "boring" water source 1.3km away, which was used for food and ice production. Conclusion: The outbreak triggered a wide-scale inter-agency verification exercise in 2025 involving the National Water Services Commission and other inter-agency partners (including the local council and state water utility). This audit revealed that 63% (7/11) of inspected resorts used "mixed" water systems, illegally blending treated public water with untreated groundwater or hill water to compensate for low pressure. Most resorts lacked standardised raw water treatment Standard Operating Procedures or records, and several maintained sewage systems dangerously close (less than 30 meters) to groundwater sources. Digital social listening offers higher sensitivity and faster detection than traditional passive surveillance in tourism settings. However, detection must be followed by robust multi-agency enforcement. The investigation concluded that systemic reliance on unmonitored private water sources is a primary public health risk. Consequently, regulators are now mandating the separation of water systems and accelerating the over MYR100 million submarine pipe project to provide stable, treated water to the island by late 2025.},

note = {Type: Oral Presentation; Organisation: 1Kuala Nerus District Health Office, Terengganu, Malaysia.; Corresponding author: Effah Leiylena binti Yaacob, dreffah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-503,

title = {Diphtheria outbreak in a Malaysian Correctional Facility: Epidemiological and Genomic Insights into Containment Challenges in Closed Settings},

author = {Mohamad Aiman M. Junaid1 Mohamad Syafiq Hassan1* Farha Ibrahim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Correctional facilities represent high-risk environments for the transmission of communicable diseases. This vulnerability is primarily driven by structural factors such as overcrowding and poor ventilation, alongside institutional challenges including shared living spaces and limited capacity for robust infection control measures. In July 2025, a cluster of diphtheria was detected in one of the correctional facilities in Southern Malaysia, raising concerns about outbreak containment in custodial settings in Malaysia. Methods and Materials: A comprehensive outbreak investigation was conducted involving active case detection, extensive contact tracing across the correctional facility and hospital settings, laboratory confirmation, mass prophylaxis, and environmental assessment. Confirmed cases were defined based on the presence of clinical manifestations consistent with diphtheria together with laboratory confirmation, including isolation of toxigenic Corynebacterium diphtheriae with positive polymerase chain reaction (PCR) and Elek test results. Molecular relatedness among isolates was assessed using pulsed-field gel electrophoresis (PFGE). Results: Three confirmed cases were identified among 214 exposed inmates (attack rate: 1.4%). The index case developed severe respiratory diphtheria and died from multiorgan failure during tertiary hospitalisation. Two additional cases were detected among close cell contacts, including one asymptomatic carrier. However, no secondary transmission was detected among 89 healthcare workers and five (5) ward patients exposed during the index case’s clinical care. PFGE revealed a high genetic similarity (96.8\textendash100%) between the three isolates and strains. Environmental assessments revealed critical containment challenges, including overcrowded cells, inadequate ventilation, the sharing of personal items, delayed disinfection, and the absence of effective isolation during the incubation period. As part of the containment strategy, chemoprophylaxis with oral Erythromycin or Azithromycin was administered to close contacts among inmates, healthcare workers, and patients, with selection based on medication availability. However, the implementation of large-scale contact tracing and mass prophylaxis proved operationally complex due to frequent inmate movement and significant resource constraints. Conclusion: This outbreak highlights the persistent vulnerability of correctional facilities to severe communicable diseases and the operational challenges of timely containment in closed settings. Strengthening prison-based surveillance, early isolation protocols, immunisation coverage, environmental controls, and inter-institutional coordination is essential to prevent future outbreaks and limit onward transmission.},

note = {Type: Poster Presentation; Organisation: 1 Communicable Disease Control Unit, Kluang District Health Office, Ministry of Health Malaysia, 2Johor State Health Department Public Health Division, Malaysia; Corresponding Author: Mohammad Syafiq Bin Hassan, dr.syafiqhassan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-529,

title = {Disease After Disaster: Norovirus-Associated Gastroenteritis in a Flood Evacuation},

author = {Norfazillah Binti Ab Manan1 Siti Hazwani Binti Abidin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Acute gastroenteritis is a common cause of morbidity during humanitarian emergencies, particularly in post-disaster settings where overcrowding, shared sanitation facilities, and compromised hygiene practices facilitate rapid disease transmission. Norovirus is a leading cause of acute gastroenteritis outbreaks due to its high infectivity and low infectious dose. Following flooding in Sepang, one of the districts in Selangor, in November 2025, multiple cases of acute gastroenteritis were reported among flood evacuees housed in a temporary evacuation centre. This investigation aimed to confirm the outbreak, describe its epidemiological characteristics, identify the mode of transmission, and assess the effectiveness of implemented control measures. Materials and Methods: An outbreak investigation was conducted by the district health authority once they received a notification. A case was defined as any individual who resided in the temporary evacuation centre and developed diarrhoea and/or vomiting with or without fever within the defined exposure period. Active and passive case detection were performed through interviews, review of medical records, and notification from nearby healthcare facilities. Epidemiological data including symptom onset, exposure history, and accommodation details were collected. Environmental assessments were conducted to evaluate sanitation facilities, water supply, and food preparation processes. Clinical samples were obtained from symptomatic cases for laboratory testing, and water samples were analysed to exclude contamination. Results: A total of seventeen cases were identified among twenty-six exposed individuals, yielding an attack rate of 65.4%. All cases experienced diarrhoea and abdominal pain, while vomiting was reported in over half of the cases. Multiple family clusters were identified, all linked by residence in the same evacuation centre and shared use of communal facilities, particularly toilets and common areas. Laboratory testing confirmed Norovirus infection in several cases, while water quality testing and food premise inspections did not reveal any violations or contamination. The epidemiological pattern was consistent with person-to-person transmission, likely initiated by an index case who developed symptoms prior to admission to the evacuation centre and subsequently transmitted infection through shared facilities. Control measures including health education, enhanced environmental disinfection, isolation advice for symptomatic individuals, and intensified surveillance were implemented promptly. All cases were managed as outpatients, recovered fully, and no hospital admissions or deaths were reported. Conclusion: This outbreak demonstrates the high vulnerability of temporary evacuation centres to rapid Norovirus transmission following natural disasters. Person-to-person spread facilitated by shared sanitation facilities was the most likely mode of transmission. Early detection, expansion of case definitions, and coordinated multi-agency response were crucial in containing the outbreak. The findings highlight the need for strengthened infection prevention measures, adequate provision of hygiene resources, structured placement of evacuees, and ongoing surveillance during disaster response to reduce the risk of similar outbreaks in the future.},

note = {Type: Poster Presentation; Organisation: ¹ Pejabat Kesihatan Daerah Sepang, Selangor, Malaysia; Corresponding author: Siti Hazwani Binti Abidin, dr.sitihazwani@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-619,

title = {Drivers of Dengue Outbreaks in Batu Pahat: The Interplay of Socio-demographic, Housing, and Behavioral Determinants},

author = {Muhammad Hasni Md Haripin1 Norfadzlina Hani Abd Rashid1 Rahayu Othman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue fever remains a significant public health threat in Batu Pahat, Johor. Understanding why certain localities transition into outbreak areas is crucial for targeted intervention. This study aimed to identify the multidimensional predictors encompassing socio-demographics, housing characteristics, and behavioural determinants that drive dengue outbreaks in this district. Materials and Methods: A cross-sectional study was conducted among residents in both outbreak and non-outbreak localities in Batu Pahat between January and February 2026. Data were collected through online Google Forms using validated structured self-administered questionnaires assessing sociodemographic, housing characteristics, and behavioural components, including knowledge, attitude and preventive practice. Multivariate logistic regression analysis was used to identify independent predictors of dengue outbreak. Results: A total of 699 residents participated in this study. Multiple logistic regression revealed that the odds of residing in a dengue outbreak locality were significantly higher among Chinese residents (AOR=9.86},

note = {Type: Poster Presentation; Organisation: 1Batu Pahat District Health Office, Johor, Malaysia; Corresponding author: Rahayu Othman, rahayuothmanphj@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-459,

title = {Dynamic Endemic Channel Approach for Dengue Surveillance In Malaysia},

author = {Mohd Kamarulariffin Kamarudin1 Nur'ain Mohd Ghazali1 Sarbhan Singh1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue remains a major public health challenge in endemic countries, including Malaysia, where timely outbreak detection is critical for effective response. Endemic channels are widely used surveillance tools to monitor deviations from expected transmission levels; however, many existing approaches rely on fixed thresholds that may not adequately reflect temporal variability or disruptions from extraordinary events such as pandemics. Hence, this study aimed to develop and validate a dynamic approach to estimate annual dengue endemic channels to strengthen national surveillance capacity. Materials and Methods: National weekly dengue surveillance data spanning from 2014 to 2023 were analysed using time-series methods to identify reference dengue outbreak periods based on sustained increases in two consecutive weekly reported case counts. This enabled binary classification of weeks as outbreak or non-outbreak. Subsequently, for a target year, endemic channels were constructed using retrospective yearly historical averages of dengue cases, which were then applied with varying dispersion thresholds (±0 to ±2 at 0.25 intervals), resulting in multiple endemic channel configurations. The performance of these endemic channels was evaluated against predefined outbreak reference periods using multiple validation metrics to assess classification accuracy and the balance between sensitivity and specificity, in order to identify the best-performing endemic channel. To support real-time application, the validated approach was subsequently integrated into an automated, web-based surveillance system designed to generate yearly endemic channels as new data become available. Results: The dynamic endemic channel approach demonstrated improved performance compared with conventional static thresholds across multiple evaluation metrics. Accounting for atypical transmission periods, including pandemic-related disruptions, influenced threshold stability and classification performance. Excluding anomalous periods resulted in more consistent endemic patterns that aligned with expected seasonal trends. The automated system successfully generated timely, interpretable outputs suitable for routine surveillance use. Conclusion: This study demonstrates the feasibility and value of a validated, dynamic endemic channel approach for dengue surveillance at the national level. By improving outbreak signal detection and reducing reliance on fixed thresholds, the approach supports more responsive and evidence-informed public health decision-making. Integration into an automated digital platform enhances scalability and operational readiness, offering a practical framework for strengthening dengue surveillance in endemic settings.},

note = {Type: Oral Presentation; Organisation: 1Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam 40170, Malaysia, Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; Corresponding author: Sarbhan Singh, lssarbhan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-653,

title = {Early Containment of Dengue Transmission: Lessons Learnt from a Low Incidence Rate District in Selangor, Malaysia},

author = {Kawselyah Juval1 Kartik KS1 Zulhaimi Wahid1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue fever remains a major public health burden in Malaysia, with Selangor consistently recording the highest state-level incidence nationally. Within Selangor, the Sabak Bernam district recorded an incidence rate of 47.7 per 100,000 population in 2025, consistently among the lowest in the state. This low burden may be attributed to effective dengue control activities at the district level, yet this has not been formally documented. This study aimed to explore the association between timely vector control response, in accordance with National Vector Control Key Performance Indicators, and dengue containment in Sabak Bernam from 2021 to 2025. Materials and Methods: A retrospective descriptive analytical study was conducted using secondary data extracted from the national electronic dengue surveillance system (eDengue). Between January 2021 and December 2025, a total of 593 dengue cases were notified in Sabak Bernam. Data on the locality of dengue transmission were examined, with residential premises, schools, and places of worship identified as the main localities of exposure. The time taken from case notification and registration to the initiation of vector control activities was measured, namely Destruction of Breeding Places (Pemusnahan Tempat Pembiakan) and Thermal Space Spraying (Semburan Ruang Termal). Compliance with national vector control KPIs was assessed for both single-case and outbreak-response categories. The proportion of cases that escalated into an outbreak was also determined as an indicator of the overall effectiveness of vector control response. Results: Over the five years, 593 dengue cases were recorded in Sabak Bernam, of which 475 cases (80.1%) remained as isolated single cases and 118 cases (19.9%) escalated into 29 outbreaks. Of these, 351 cases had an identified breeding site, with residential premises being the primary location, accounting for 311 cases (88.6%). Vector control response was prompt and consistent throughout. Destruction of Breeding Places within three days was completed in 100% of cases, while Thermal Space Spraying within 24 hours was achieved in 96.4% of single cases and 96.1% of outbreak cases, both exceeding the national minimum threshold of 80%. The effectiveness of this containment was evident, as only 15 cases (4.8%) of the 311 residential cases escalated into an outbreak. Conclusion: Sabak Bernam’s low dengue burden appears closely linked to the concentration of transmission in residential settings and prompt vector control response. Residential premises accounted for the majority of cases with an identified breeding site, making household-level intervention the most critical point of action. High compliance with national KPI across all five years demonstrates a reliable and sustained response system. Prompt completion of both activities within stipulated timeframes likely interrupted the vector breeding cycle, limiting secondary transmission and preventing outbreak escalation. This study demonstrates that low dengue incidence in a rural district is not incidental but rather the result of disciplined, timely, and targeted vector control at the household level. Sabak Bernam's experience affirms that effective dengue containment is achievable through consistent compliance with national vector control Key Performance Indicators.},

note = {Type: Oral Presentation; Organisation: 1 Sabak Bernam District Health Office, Selangor State Health Department, Malaysia.; Corresponding author: Zulhaimi Wahid, dr.zulhaimi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-505,

title = {Early Mental Health Outcomes at 1 and 3 Months Following the Putra Heights Methane Gas Explosion: A Community Surveillance Study},

author = {Md Ghazali M.F.1 Mohamed Hanan},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: On 1 April 2025, a methane gas pipeline explosion in Putra Heights, Selangor, caused extensive property damage and displacement of residents. In response, Psychological First Aid (PFA) and Mental Health and Psychosocial Support (MHPSS) interventions were rapidly implemented to address the psychological needs of affected communities. This study aimed to evaluate and compare the prevalence of depression and anxiety symptoms among affected Primary Household Respondents at 1 month and 3 months following the disaster. Materials and Methods: A prospective mental health surveillance study was conducted using telephone interviews via the MHPSS line. At 1-month post-disaster, 701 Primary Household Respondents were screened using validated tools: the Whooley questions for depression and the Generalised Anxiety Disorder-2 (GAD-2) screening tool for anxiety. Individuals who screened positive were provided early psychosocial interventions, including Psychological First Aid, counselling support, or referral to appropriate healthcare facilities when necessary. These individuals were subsequently targeted for follow-up assessment at 3 months to monitor psychological recovery and evaluate changes following the interventions. Results: At 1 month, 11% (n=77) of the 701 Primary Household Respondents screened positive for depressive symptoms, while 5.4% (n=38) screened positive for anxiety symptoms. At the 3-month follow-up, 30 individuals with previously identified symptoms were successfully contacted. Among this cohort, positive Whooley screenings decreased from 15 cases at 1 month to none at 3 months, while positive GAD-2 screenings decreased from 9 cases to none. All individuals who completed follow-up demonstrated psychological improvement with no persistent symptoms of depression or anxiety, suggesting improvement following the psychosocial interventions implemented during the post-disaster period. Conclusion: Early psychosocial interventions, including Psychological First Aid, counselling, and referral to appropriate healthcare services, may help mitigate acute psychological distress following disasters. These findings highlight the importance of integrating Mental Health and Psychosocial Support into disaster preparedness and response strategies.},

note = {Type: Poster Presentation; Organisation: 1 Petaling District Health Office, 2Department of Public Health Medicine, National University of Malaysia.; Corresponding author: Mohd Fathulzhafran bin Mohamed Hanan, dr.fathulzhafran@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-560,

title = {Effect of Targeted Education on Knowledge and Attitude towards Safe Antihypertensive Prescribing in Public Primary Care Clinics in Malaysia: A Quasi\textendashExperimental Study},

author = {Faizah Aziz2 Mohd Ali’ Imran1 Nurzakiah Mohd Zaki1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: While hypertension is frequently managed in public primary care clinics in Malaysia, appropriate pharmacological management is critical for achieving optimal blood pressure control. However, prescribing medication errors and inappropriate drug combinations remain key challenges in primary care and often arise due to gaps in knowledge of current clinical guidelines. To evaluate the effectiveness of a targeted educational intervention in improving knowledge of hypertension pharmacotherapy and promoting safe prescribing practices among primary care providers. Materials and Methods: A quasi-experimental study was conducted in March 2026 involving medical doctors and pharmacists from five primary care clinics under the Cheras Health District Office. Participants attended a 60-minute educational session covering guideline-based hypertension management, antihypertensive drug selection, and identification of potential drug interactions. Knowledge was assessed using a 10-item multiple-choice questionnaire administered before and after the session. Attitudes toward safe antihypertensive prescribing were evaluated using a Likert-scale survey. Changes in scores were analysed using a paired t-test. Results: Forty-four primary care providers participated in the education session and completed both pre- and post-intervention assessments. The majority were female (86.4%), with 50% being medical doctors, 9.1% family medicine specialists, and 40.9% pharmacists. Mean knowledge scores increased significantly from 8.23±1.82 pre-intervention to 9.50 ± 0.85 post-intervention (p\<0.001). Attitudes toward safe prescribing also improved significantly following the educational session (p\<0.005). Conclusion: The targeted educational session significantly enhanced both knowledge and attitudes towards safe antihypertensive prescribing among primary care providers. Future larger-scale and longitudinal studies are needed to confirm these findings and to further evaluate the feasibility of integrating educational modules as a strategy for medication error prevention and quality improvement for patient safety.},

note = {Type: Poster Presentation; Organisation: 1Cheras Health District Office, Kuala Lumpur, Ministry of Health Malaysia, 2Bandar Tun Razak Health Clinic, Kuala Lumpur, Ministry of Health Malaysia; Corresponding author: Nurzakiah Mohd Zaki, drzakiah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-769,

title = {Effect of the Pharmacy Integrated Community Care (PICC) Programme on Glycaemic and Blood Pressure Control among Type 2 Diabetes Mellitus Patients in Felda Pemanis, Segamat: A Quasi-Experimental Study},

author = {Ismah Mansurah Z1 Farah1 Ghazi M.S1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Felda Pemanis, a rural federal land settlement in Segamat, Johor, bears a disproportionately high burden of non-communicable diseases (NCDs) including Type 2 Diabetes Mellitus (T2DM), hypertension, and dyslipidaemia \textemdash consistent with national NHMS trends identifying rural populations as more heavily affected. Poor disease control in this community is driven by suboptimal medication adherence, limited health literacy, and unmanaged polypharmacy. The Pharmacy Integrated Community Care (PICC) PEMANIS programme was established as a structured, multidisciplinary intervention to address these gaps through clinical monitoring and health coaching at the primary care level. To evaluate the effectiveness of the PICC PEMANIS programme in improving glycaemic control and systolic blood pressure among T2DM patients at Klinik Kesihatan Pemanis over four structured monthly sessions. Materials and Methods: A quasi-experimental pre-post interventional study was conducted. Twenty patients with T2DM registered under the National Diabetes Registry (NDR) at Klinik Kesihatan Pemanis were recruited based on predefined inclusion criteria, namely a baseline HbA1c greater than 7.0% and willingness to participate in all programme sessions. Patients were excluded if they failed to complete a minimum of three sessions, had uncontrolled mental health conditions, or were already enrolled in the Diabetes Medication Therapy Adherence Clinic (DMTAC). Each of the four structured group sessions lasted approximately one hour and covered medication reconciliation, healthy lifestyle modification encompassing dietary guidance and physical activity promotion, and targeted diabetes self-management education. HbA1c and systolic blood pressure were recorded at baseline and upon completion of the programme. Statistical analysis was performed using SPSS version 29, with the paired samples t-test applied to assess pre- and post-intervention differences. The level of statistical significance was set at p \< 0.05, and data cleaning was conducted prior to analysis. Results: A total of 20 participants completed the programme, comprising 9 males (45%) and 11 females (55%), with a mean age of 53.40 years. At enrolment, all participants demonstrated moderate-to-poor glycaemic control, with a mean baseline HbA1c of 10.60% \textemdash markedly above the recommended target of less than 7.0%. Following the intervention, a statistically significant reduction in HbA1c was observed, with a mean decrease of 0.985% (95% CI: 0.096\textendash1.874},

note = {Type: Poster Presentation; Organisation: 1Segamat District Health Office, 85000 Segamat, Johor Darul Ta'zim, Malaysia. 2Universiti Malaya, 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Corresponding author: Ghazi M.S, drghazieahmad@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-452,

title = {Effectiveness of Community-Based Integrated Diabetic Care Approach on Glycaemic Control in Poorly Controlled Type 2 Diabetes: A Prospective Comparative Study in Johor Bahru, Malaysia},

author = {Tai Chia Woon1 Mohamad Syafuad Yahya1 Loganathan Salvaraji1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia faces a substantial diabetes burden, with Johor state recording a prevalence of 19.7%, exceeding the national average. Only 32.97% of patients with diabetes in Johor’s public health clinics achieve optimal glycaemic control (HbA1c ≤6.5%). The Community-Based Integrated Diabetic Care (CBIDC) was established as a community-based, multidisciplinary intervention to address suboptimal diabetes outcomes through structured patient-centred care. Materials and Methods: A prospective comparative study was conducted over nine months involving 42 adults with poorly controlled type 2 diabetes mellitus (HbA1c \>7%) from government health clinics in Johor Bahru. Participants were randomly assigned to either the CBIDC intervention group (n=21) or the control group (n=21). The CBIDC intervention comprised four monthly modules covering healthy lifestyle practices, diabetes education, medication management, and complication awareness, delivered by a multidisciplinary team of doctors, pharmacists, dietitians, and physiotherapists. Clinical measurements and individualised consultations were provided at each session. The primary outcome was HbA1c reduction, analysed using non-parametric tests due to non-normal distribution. Result: Baseline characteristics were comparable between groups. The CBIDC group demonstrated a significantly greater mean HbA1c reduction than the control group (1.97% vs 0.90%},

note = {Type: Poster Presentation; Organisation: 1Johor Bahru District Health Office, Ministry of Health Malaysia.; Corresponding Author: Loganathan Salvaraji (drloganathan@moh.gov.my)},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-640,

title = {Elegance Bound: Kebaya and the Social Costs of Conformity among Malaysian Women \textendash A Systematic Review and Meta-Analysis},

author = {Norfazilah Ahmad Azimatun Noor Aizuddin¹ Nurul Ainie Anwar2},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Obesity has been a persistent and challenging issue and remains a major public health concern worldwide, including in Malaysia, which has led to obesity-associated diseases, such as noncommunicable diseases (NCDs), and an increase in healthcare expenditures. The economic burden of obesity in Malaysia is growing, particularly among women. Despite multiple weight loss interventions, data on associated costs remain fragmented. Kebaya, an elegant traditional garment, can create an elegant and stunning silhouette for women, which can be a potential motivational tool in weight loss interventions to motivate women to lose weight. This study aims to synthesise the costs associated with various weight management interventions among Malaysian women and kebaya as potential effective motivational tools for interventions. Materials and Methods: We conducted a systematic review and meta-analysis of studies published between 2008 and 2024 examining the direct costs of weight loss interventions in Malaysian women. Databases including PubMed, Scopus, Embase, Cochrane, Web of Science were searched. A random-effects model was used to pool cost estimates, and heterogeneity was assessed via I² and Cochran’s Q. Results: Six studies were included, covering interventions such as bariatric surgery, community pharmacy programs, and dietary changes. The pooled mean cost was MYR7,517.91 (95% CI: MYR4,903.73, MYR10,132.10). Heterogeneity was substantial (I² = 99.6%; Cochran’s Q = 49,914.69; df = 5; p\<0.001) indicating significant variability in cost structures. Discussion/ Conclusion: The wide cost range of weight loss strategies reflects varying intensities and approaches. Standardised economic evaluations are essential for planning cost-effective obesity interventions in Malaysia. Obesity intervention costs among Malaysian women are highly variable, reflecting diverse intervention types and economic perspectives. Future health promotion strategies should integrate both cost considerations and culturally relevant motivators, such as the traditional kebaya, to enhance effectiveness and accessibility. Understanding the cost of obesity interventions and the cost implications of obesity is essential for influencing healthcare decisions, motivating healthier behaviours, and encouraging advocacy for improved access to affordable interventions by tailoring policies and interventions to inspire women's participation in weight loss while transpiring the inspiration of wearing the kebaya, which culturally enhances the elegance of Malaysian women.},

note = {Type: Poster Presentation; Organisation: ¹Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. ² Ministry of Health, WP Putrajaya, Malaysia.; Corresponding author: Nurul Ainie Anwar, dr_nurulainieanwar@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-573,

title = {Emerging Trend of Leprosy in an Urban District: A Retrospective Analysis in Cheras, Malaysia (2022 - 2025)},

author = {Salmiah binti Baharudin1 Balqis binti Zulkefli1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Leprosy, also known as Hansen’s disease, remains a public health concern in Malaysia. Leprosy’s incidence rate in Malaysia shows an increasing trend from 5.11 cases per 1,000,000 population in 2022 to 11.5 in 2025. The highest leprosy cases were recorded in Pahang, where the affected population is predominantly from the ‘Orang Asli’ community. However, leprosy also occurs in urban areas, including Cheras, Kuala Lumpur, where the incidence increased from 12.5 cases per 1,000,000 population in 2024 to 15.6 in 2025, following a period of zero incidence rate recorded between 2022 and 2023. This study aims to describe the sociodemographic characteristics and clinical profile of leprosy cases in Cheras. Materials and Methods: A retrospective cross-sectional study was conducted using secondary data from the Hansen database from 2022 to 2025. Universal sampling was applied, including all registered cases within the study period based on date of registration. Data on sociodemographic, type of leprosy, time to diagnosis and clinical presentation were retrieved. Data were analysed descriptively. Results: There were 9 cases reported from 2022-2025. Based on the data, the majority of cases were among adolescents and young adults (66.7%), males (88.9%), Malaysians (55.6%), lived in high-rise residential buildings (66.7%) and were employed (77.8%). However, only 22.2% of the cases had comorbidity. Additionally, 77.8% of cases were symptomatic, and all presented with skin lesions. Every case was diagnosed within 2 years from symptom onset. The multibacillary leprosy was the predominant type (88.9%). Conclusion: Leprosy remains present among Malaysians in urban areas. Misdiagnosis is possible due to the common perception that leprosy is a rural-only disease. Healthcare workers should consider leprosy in differential diagnoses to ensure timely detection and management. Strengthening awareness and urban-focused surveillance are essential to break the chain of transmission and reduce the disease burden.},

note = {Type: Oral Presentation; Organisation: 1TB and Leprosy Unit, Cheras Health Office, Wilayah Persekutuan Kuala Lumpur and Putrajaya State Health Office, WP Kuala Lumpur, Malaysia.; Corresponding author: Balqis binti Zulkefli, dr.balqis_9@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-635,

title = {Empowering the Nursing Workforce: Acceptability, Fidelity, and Preliminary Effectiveness Study of the Psychoeducation-Based Intervention Package (P-BIP) Intervention},

author = {Nor Haniza Zakaria1 Siti Zubaidah Ahmad Subki1 Nursyahda Zakaria1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Burnout among nurses in Malaysia is a critical concern that impacts both personal well-being and the quality of patient care. This study evaluated the acceptability, fidelity, and preliminary effectiveness of the Psychoeducation-Based Person-Directed Burnout Intervention Package (P-BIP), a 28-activity structured wellness module, designed specifically to mitigate burnout among the nursing workforce. Materials and Methods: A longitudinal study was conducted over one month involving 21 nurses, with assessments at three time-points: baseline (T0), post-intervention (T1), and one-month follow-up (T2). Intervention acceptability was measured using the Theoretical Framework of Acceptability (TFA) Questionnaire, an eight-construct framework, while fidelity was assessed using a questionnaire developed based on the National Institutes of Health Behaviour Change Consortium (NIH-BCC) domains. Questionnaire validation was performed using weighted Cohen’s Kappa. Burnout levels were evaluated through the Maslach Burnout Inventory \textendash Human Services Survey for Medical Personnel (MBI-HSS-MP) across three domains: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). Results: Overall, P-BIP achieved high delivery fidelity with an overall weighted Cohen’s Kappa of 0.724 (95% CI: 0.631\textendash0.817). Analysis showed that 27 out of 28 activities recorded high fidelity levels. Statistical analysis revealed significant improvements (p \< 0.05) in all eight acceptability constructs. Overall acceptability, affective attitude, perceived effectiveness, ethicality, self-efficacy, and intervention coherence increased from median scores of 4 (T1_T0) to 5 (T2_T1), while opportunity costs showed a reduction from 2 (T1_T0) to 1 (T2_T1). As for P-BIP effectiveness, nursing burnout scores showed positive trends by T1_T2. Mean EE scores decreased from 21.0 to 16.2, shifting into the low burnout category. In contrast, PA scores improved from 33.8 to 39.4, reaching the high personal accomplishment category. While the General Linear Model (Repeated Measures) showed notable mean differences, the 95% CI crossed zero, suggesting that while the module is highly acceptable among the participating nurses, a larger sample size of the nursing population is necessary to confirm long-term impact. Conclusion: From the feasibility study, P-BIP is a highly feasible, reliable, and acceptable module for nurses in the Malaysian clinical setting. The positive shifts in EE and PA indicate that the programme is a promising tool for nursing burnout management. Further implementation research study findings can be incorporated in the human resource development framework to safeguard mental wellbeing and ensure staff retention.},

note = {Type: Oral Presentation; Organisation: 1 Institute for Health Management, National Institutes of Health Malaysia, Selangor, Malaysia.; Corresponding author: Nursyahda Zakaria, nursyahda@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-660,

title = {eNCD: Digitalizing Non-Communicable Disease Data Collection and Defaulter Tracing in Primary Healthcare},

author = {Augustin G1 Hassim B2 Aaron WWL1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The prevalence of Non-Communicable Diseases (NCDs) is rising continuously in Malaysia, with the National Health and Morbidity Survey (NHMS) estimating that millions of adult Malaysians live with diabetes, hypertension, hypercholesterolemia, and obesity, resulting in immense economic and productivity losses. Given that traditional manual recording methods using individual workload books are inefficient, this study aims to evaluate the impact of a free, no-code digital application, eNCD, on data management efficiency and accuracy in primary healthcare settings. Materials and Methods: The eNCD application was developed using Google AppSheet and implemented continuously since 2022 at Samarindah Health Clinic, expanding to all clinics in the Samarahan Division in 2024. The system allows medical staff to input daily patient data via PCs or mobile phones and features an auto-calculator for monthly tabulation alongside an automatic tracking function to highlight defaulted patients. Results: The intervention led to a 99.9% reduction in monthly data extraction time, decreasing from an average of 5 days (10,800 minutes) to just 10 minutes. Data accuracy improved significantly, with hypertension reporting discrepancies falling from 54.22% to 0% at Samarindah Health Clinic, while diabetes reporting discrepancies dropped from 16.86% to 9.16% at Sebuyau Clinic and from 10.42% to 0.43% at Sebangan Clinic. Additionally, defaulter tracing was streamlined from a burdensome manual extraction to a real-time digital list, and the program demonstrated ease of use by integrating seamlessly with existing TPC-OHCIS workflows without causing data overlap or confusion. Discussion/ Conclusion. The eNCD application successfully modernised primary healthcare data management without incurring additional costs. By saving thousands of administrative hours and eliminating data discrepancies, the system enables healthcare providers to reallocate time to direct patient management, ultimately improving waiting times and the overall quality of public health monitoring.},

note = {Type: Poster Presentation; Organisation: 1Samarindah Health Clinic, Sarawak, Malaysia, 2Kota Samarahan Health Clinic, Sarawak, Malaysia, 3Samarahan Division Health Office, Sarawak, Malaysia.; Corresponding author: Aaron WWL, AaronWong1988@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-779,

title = {ENHANCING COMMUTING SAFETY: A CLUSTER RANDOMISED CONTROLLED TRIAL (CRCT) EVALUATION OF HEALTH BELIEF MODEL-BASED INTERVENTION ON COMMUTING SAFETY BEHAVIOUR AMONG HOSPITAL HEALTHCARE WORKERS},

author = {Rafee Baharudin2 Zawiah Mansor2 Nurulain Abu Bakar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Commuting accidents are increasing in Malaysia, particularly among healthcare workers (HCWs). These accidents occur while commuting between home and work, or work-related journey. They have significant consequences such as personal injuries, fatalities, missed workdays, higher compensation costs, and reduced healthcare service productivity. Commuting accidents contribute to the overall number of occupational accidents among HCWs. This study examines the effect of the Health Belief Model (HBM)-based intervention on commuting safety behaviours, knowledge and HBM constructs. Materials and Methods: A single-blind cluster randomized controlled trial was conducted among government hospital HCWs. The selected hospitals were randomly assigned to the intervention or control group. The intervention group received a one-full-day HBM-based intervention module. The validated Driver Behaviour Questionnaire (DBQ), knowledge and HBM constructs questionnaire were used to assess the effect of HBM-based intervention. The data was analysed using the SPSS 26.0 version. The response rate was 100%. The covariates at baseline were work routine, employment status, vehicle type, wearing a reflective jacket during riding, sleep quality and perceived benefit. Results: The generalised estimating equation (GEE) adjusted with covariates shows significant increases in commuting safety behaviour among the intervention group at 3 months post-intervention (p-value=0.003) and knowledge at immediate post-intervention (p-value\<0.001) and 3 months post-intervention (p-value\<0.001). There were increases in perceived benefit scores of the intervention group at 3 months post-intervention (p-value=0.009), perceived barrier scores at immediate post-intervention (p-value=0.01) and at 3 months post-intervention (p-value=0.02) compared to the control group at baseline. Conclusion: The study shows the HBM-based intervention module was effective in improving commuting safety behaviour, knowledge, perceived benefit and perceived barrier. However, the perceived benefit was not sustained at 3 months post-intervention.},

note = {Type: Poster Presentation; Organisation: 1Melaka Tengah District Health Office, Jalan Bukit Baru, Melaka, 75150, Malaysia. 2 Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia. 3Melaka State Health Department, Wisma Persekutuan, MITC, 75450, Melaka, Malaysia; Corresponding author: Zawiah Mansor, zawiah.mansor@upm.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-449,

title = {Enhancing Hospital Bed Management Efficiency Through a Strategic Data Dashboard: The Selangor BMU State Experience},

author = {Yeoh Chun Chiat1 Siti Nurliana Zulkefli1 Thivya mathi Sina rajoo1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Effective hospital bed management is vital for the provision of health services, which directly depends on patient access, quality, and system efficiency. Public hospitals face the potential for congestion, slow admissions, and suboptimal utilisation of beds when patient numbers grow, and hospital stays are longer. These challenges in Selangor highlighted the importance of a structured and data-oriented approach to facilitate time-sensitive decisions and coordinated management in Selangor. The objective of this study was to develop and implement an organisational strategic data dashboard to take routine hospital data and transform it into data visualisation for planning interventions and monitoring hospital bed utilisation. Materials and Methods: The strategic data dashboard was designed using the already commonly accessible hospital information on public health facilities in Selangor state in Malaysia. The dashboard was employed to track the counting of critical indicators for hospital bed management (hospital bed occupancy, patient admission, length of stay, and discharge efficiency). The data was aggregated and categorised by type of hospital and service type for comparison and trend detection. Visual features were designed to promote the hospital manager and decision-makers to receive information in as visually appealing and relevant a way as possible for them. The dashboard was designed to support the surveillance of regular events and to facilitate review meeting management and the early detection of capacity issues, which may lead to operational response. Results: A strategic data dashboard enhanced the visibility of hospital bed utilisation across facilities. Managers were able to track periods of high demand, fluctuations in bed occupancy, and services that felt ongoing capacity pressure. Timeliness and structure of information enabled earlier management actions to be taken such as coordination across services and prioritisation in admissions. Enhanced awareness of patient flow patterns enhanced more structured bed allocation efforts and less uncertain planning in operation. The dashboard also improved information sharing skills among clinical services and management, providing a common base from which to share information and make decisions. Conclusion: The results show that a strategic data dashboard can be used as an efficient clinical decision support system to manage hospital beds. It transforms difficult data into actionable information, which contributes to evidence-based decision making and maximises the use of limited health care resources. It leads to proactive management rather than reactive management of congestion and increases in demand. The dashboard is seen in Selangor to help with patient flow, coordination, and resilience of the system. Further fine-tuning and development of the dashboard could better support sustained improvements in hospital practice and health care delivery.},

note = {Type: Poster Presentation; Organisation: 1 Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia; Corresponding author: Thivya Mathi a/p Sina Rajoo, dr.thivya@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-702,

title = {Enhancing Safety Leadership in Emergency Department Triage: The Role of AI under Response Time KPI Pressure},

author = {Chuanwen Sun1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Emergency Department (ED) triage requires rapid clinical decision-making under response time Key Performance Indicator (KPI) pressure, often creating a critical tension between operational speed and patient safety. In high-demand and overcrowded settings, this pressure may lead to unsafe shortcuts and under-triage. Safety leadership is essential in maintaining safety prioritisation and guiding risk-aware clinical decisions in such environments. Materials and Methods: This study develops a structured conceptual framework through synthesis of literature on safety leadership, safety climate, and behavioural decision-making. ED-specific contextual factors, including KPI pressure and workload constraints, are incorporated. The framework proposes both direct and indirect pathways linking safety leadership to safety behaviour, with AI-assisted decision support introduced as a moderating mechanism to enhance decision quality under pressure. Results: The framework highlights that safety leadership influences safety behaviour directly and indirectly through safety climate. KPI pressure acts as a contextual stressor that may bias decision-making towards speed over safety. AI-assisted decision support is proposed to strengthen safety-oriented triage by improving risk recognition, supporting escalation decisions, and reducing cognitive bias in ambiguous clinical presentations. Conclusion: This framework offers a novel integration of safety leadership and AI in ED triage under KPI pressure. It provides a foundation for future empirical validation using vignette-based simulation and highlights the potential of AI as a decision-support tool to enhance patient safety and reduce unsafe triage practices in high-pressure clinical environments.},

note = {Type: Poster Presentation; Organisation: 1Yonsei University; Corresponding author: Chuanwen Sun, scw020115@163.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-448,

title = {Epidemiological Analysis of Risk Factors for Diabetic Nephropathy: A Cross-Sectional Study},

author = {Salwani Binti Kamaruddin1 Ainulbariah Binti Abd Wahid1 Loganathan Salvaraji1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Diabetic nephropathy is a leading cause of end-stage renal disease and represents a significant public health burden globally. Understanding the epidemiological risk factors for Diabetic nephropathy is essential for targeted prevention and early intervention strategies. To identify and quantify the risk factors associated with diabetic nephropathy in a large cohort of Type 2 Diabetes Mellitus patients. Materials and Methods: A cross-sectional analysis of 2,433 Type 2 Diabetes patients in Johor Bahru was conducted. Diabetic nephropathy was defined as the presence of albuminuria/proteinuria or reduced estimated glomerular filtration rate less than 60 mL/min/1.73m². Univariate logistic analysis was performed to calculate odds ratios with 95% confidence intervals for demographic, clinical, and laboratory variables. Results: The prevalence of diabetic nephropathy was 24.0% (n=584). Significant risk factors included male gender (OR: 1.36, 95% CI: 1.13-1.64), Malay ethnicity (OR: 1.39, 95% CI: 1.15-1.67), and prolonged diabetes duration. Comparing patients with diabetes duration less than 10 years, those with 11-20 years duration had 1.73 times higher odds (95% CI: 1.41-2.11), 21-30 years duration had 2.13 times higher odds (95% CI: 1.44-3.13), and those more than 30 years duration had 2.90 times higher odds (95% CI: 1.27-6.59) of developing Diabetic nephropathy. Protective factors included Chinese ethnicity (OR: 0.78, 95% CI: 0.64-0.95) and absence of diabetic retinopathy (OR: 0.66, 95% CI: 0.54-0.80). Conclusions: In this population, the risk of diabetic nephropathy is significantly predicted by the duration of diabetes, gender, and ethnicity. These findings suggest that enhanced renal surveillance and preventive interventions should be prioritised for high-risk subgroups, particularly those with prolonged diabetes duration and male gender.},

note = {Type: Poster Presentation; Organisation: 1Non-communicable Disease, Johor Bahru District Health Office, Ministry of Health Malaysia; Corresponding author: Loganathan Salvaraji, drloganathan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-621,

title = {Epidemiological Burden and Management of Animal Bite Cases in Rabies Prevention Services: A Record-Based Analytical Study},

author = {Deepak Karade¹ Divyeshkumar Pagare¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Rabies remains a fatal but preventable zoonosis, with animal bites contributing substantially to morbidity in India. Understanding species patterns, exposure severity, temporal variation, and biologic utilisation is essential for optimising program performance. This study aims to assess the epidemiological burden of animal bite cases and evaluate species-wise, category-wise, temporal, and operational determinants influencing rabies prevention services. Materials and Methods: A record-based analytical study was conducted from December 2024 to November 2025 at a public health facility. Data were collected on animal species, exposure categories, route of vaccine administration, serum use, and rabies mortality. Appropriate statistical methods were applied to assess associations, trends, and correlations. Results: Among 16,518 cases, dogs accounted for 69.6 per cent and cats 27.4 per cent of exposures. Severe exposures constituted the overwhelming majority of exposures, with Category III cases accounting for 14,424 cases (87.3 per cent). Marked variation in exposure severity was observed across animal species, along with a strong association between species and category of exposure. Bite severity also varied across months, with peaks during monsoon and post-monsoon periods. A clear upward trend in severe exposures was noted over time. Anti-rabies serum utilisation closely followed the burden of severe cases, indicating appropriate clinical management. Intradermal vaccination was the most commonly used regimen for post-exposure prophylaxis. One preventable rabies death occurred following incomplete post-exposure prophylaxis. Conclusion: Severe exposures form the major burden in rabies prevention services, with distinct temporal and species-related patterns. Clinical management was largely appropriate and aligned with disease severity. Strengthening treatment adherence and preparedness during high-incidence periods is essential to support rabies elimination efforts.},

note = {Type: Oral Presentation; Organisation: ¹Department of Community Medicine, Government Medical College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India; Corresponding author: Divyeshkumar Pagare, divyeshpagare007@yahoo.co.in},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-631,

title = {Epidemiological Characteristics and Temporal Trends of Hand, Foot, and Mouth Disease in Besut, Terengganu: A Ten-Year Retrospective Analysis (2016\textendash2025)},

author = {Ahmad Rizduan Azahari1 Hafizuddin Awang2 Mardhiyyah Azmi1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hand, Foot, and Mouth Disease (HFMD) remains a significant public health challenge in Malaysia, characterised by periodic outbreaks that place a considerable burden on the primary healthcare system and childcare facilities. Despite routine surveillance and control measures implemented by the District Health Office, periodic increases in cases suggest ongoing transmission within the community. This study aimed to analyse the descriptive epidemiology and temporal trends of the disease within the Besut district over a ten-year period from 2016 to 2025. Materials and Methods: A cross-sectional study was conducted using cleaned notification records from 2016 to 2025 extracted from the online notification system. The analysis includes descriptive analysis, calculation of incidence rate and seasonal decomposition for temporal trend. Results: A total of 982 cases were reported during the study period. The findings indicate that the disease disproportionately affects the paediatric population, with children aged zero to five years accounting for 87.3% of all recorded cases. The mean age of affected individuals was approximately three years, with a slight male preponderance observed (56.2% of the total case count). Geographically, the highest burden of disease was concentrated in the subdistricts of Kampung Raja, Pelagat, and Keluang based on the incidence rate. The analysis revealed that while the majority of cases presented with mild symptoms manageable in outpatient settings, approximately 12.3% of patients required hospital admission. Epidemiologically, the majority of transmissions were classified as sporadic or home-based, though approximately 18% of cases were linked to institutional settings such as nurseries, kindergartens, and primary schools. Temporal analysis identified significant annual fluctuations in disease incidence. The district experienced major surges in 2022 and 2025, recording incidence rates of 189.0 and 131.3 per 100,000 population, respectively. A sharp decline was observed during 2020 and 2021, a period coinciding with national movement restrictions and enhanced hygiene protocols during the COVID-19 pandemic. Seasonal decomposition using a multiplicative model demonstrated a consistent primary peak during the months of April and August, with a smaller secondary rise early of the year, suggesting a strong seasonal transmission pattern. Conclusion: Overall, HFMD in Besut predominantly affects children under five years old, with transmission mainly occurring within households and selected high-incidence subdistricts. This mid-year peak may suggest a correlation with school holiday periods and specific environmental conditions conducive to viral transmission. Targeted preventive measures should be implemented before peak periods, especially in childcare and school settings. Strengthening health education for parents and caregivers, early detection, and enhanced surveillance in high-risk areas are essential to reduce transmission and prevent outbreaks.},

note = {Type: Poster Presentation; Organisation: 1Disease Control Unit, Besut District Health Office, Besut, Terengganu, Malaysia. 2Besut District Health Office, Besut, Terengganu, Malaysia.; Corresponding author: Mardhiyyah Azmi, drmardhiyyahazmi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-588,

title = {Epidemiological Investigation of a Foodborne Disease Outbreak Among Healthcare Workers in a Private Medical Centre in Seremban, Malaysia},

author = {Suriyati Bt Abdul Aziz2 Noor Khalili Bin Mohd Ali1 Guganesan Krishnanmoorthy1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Foodborne disease outbreaks in healthcare settings imply a public health failure reflecting not only on the microbiological hazards but also on the systemic failures in food safety governance. Materials and Methods: This study investigates a point source foodborne outbreak among healthcare personnel following consumption of a catered festive meal at a private hospital in Seremban, Negeri Sembilan, Malaysia. A mixed-methods outbreak investigation integrating descriptive and analytical epidemiology, environmental health assessment, Hazard Analysis and Critical Control Point (HACCP) evaluation and microbiological analysis was conducted. Results: Among 318 exposed individuals, 72 cases were identified, leading to an attack rate of 22.6%. The epidemic curve showed a typical point-source pattern. Symptoms began 3 to 41 hours after exposure, which correlates with toxin-related illnesses. The case-control study identified nasi briyani ayam (OR = 10.14) and boiled eggs (OR = 3.22) as statistically significant contributing factors. Environmental assessments documented multiple food safety violations, such as temperature abuse, cross-contamination, poor sanitation, pest infestations, and inadequate food handler hygiene, as proven by a hygiene score of 48.28%. Laboratory analyses confirmed the presence of Staphylococcus aureus in food handler hand swabs, implicated food items, and environmental surfaces, pointing towards a staphylococcal food poisoning outbreak. Conclusion: In accordance with systems theory and risk governance frameworks, the outbreak was due to cumulative organisational and operational shortcomings, rather than a singular error. The convergence of descriptive and analytical epidemiological findings, environmental and HACCP assessments, and laboratory evidence identified nasi briyani ayam and boiled eggs as the most likely vehicles of infection, with Staphylococcus aureus as the probable etiological agent. These findings signify that HACCP certification, in isolation, is inadequate without rigorous implementation, verification, and accountability, particularly within outsourced catering arrangements in healthcare settings. Widespread hygiene deficiencies, temperature abuse, and ineffective HACCP implementation enabled contamination and toxin production. Subsequently, reinforcing food safety governance, continuous monitoring, and workforce competency is crucial to avert comparable outbreaks in high-risk institutional environments.},

note = {Type: Poster Presentation; Organisation: 1District Health Office Seremban, Seremban, Negeri Sembilan, Malaysia, 2Negeri Sembilan State Health Department, Seremban, Negeri Sembilan, Malaysia; Corresoponding author: Guganesan Krishnanmoorthy, kguganesan@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-772,

title = {Epidemiological Profile and Post-Pandemic Temporal Trends of Hand, Foot and Mouth Disease in Segamat, Johor, Malaysia: A Five-Year Surveillance Analysis (2021\textendash2025)},

author = {Mohammad Nafis bin Sahiran¹ Choo Teck Min¹ Nurul Arliya Shahidah binti Abd Kadir¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hand, foot, and mouth disease remains a significant public health concern in Malaysia, particularly among young children. Following the COVID-19 pandemic, a resurgence of cases has increased pressure on healthcare services, underscoring the need for updated local epidemiological data to guide prevention and control strategies. Objective: To describe the demographic characteristics, spatial distribution, and temporal trends of hand, foot, and mouth disease cases in Segamat district from 2021 to 2025, and to identify high-risk groups and seasonal patterns to inform public health action. Materials and Methods: A retrospective descriptive study was conducted using 3,457 cases notified to the Segamat District Health Office between January 2021 and December 2025. Data were obtained from the national communicable disease notification system and analyzed by age, sex, ethnicity, epidemiological week, and subdistrict distribution. Descriptive statistics and temporal trend analysis were used to assess epidemiological patterns over time and space. Results: A total of 3,457 cases were reported during the study period. Children aged below six years were disproportionately affected, with those aged 3\textendash5 years accounting for 35.3% of cases, followed by children aged 0\textendash2 years (29.0%). A male predominance was observed (56%). Temporal analysis demonstrated notable outbreak peaks in mid-2022 and mid-2025, with consistent seasonal increases during the second quarter (epidemiological weeks 19\textendash20), suggesting a cyclical seasonal transmission pattern. Spatial analysis identified Labis, Jementah, and Sungai Segamat as key hotspots. Notifications from private healthcare facilities (43.6%) and government clinics (43.3%) reflect a well-integrated dual-sector surveillance system. Conclusion: Hand, foot, and mouth disease in Segamat predominantly affects preschool-aged children and demonstrates cyclical seasonal patterns with predictable peaks in the second quarter of the year. Targeted public health interventions, including caregiver education and strengthened hygiene practices in childcare settings, should be implemented in identified hotspot areas before anticipated surge periods. Sustained collaboration between public and private healthcare sectors is essential for effective surveillance and control.},

note = {Type: Poster Presentation; Organisation: ¹Segamat District Health Office, Jalan Gudang Ubat, Segamat, Johor, Malaysia. ²University Malaya, 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Corresponding author: Nurul Arliya Shahidah binti Abd Kadir, nurul.arliya@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-591,

title = {Epidemiological Profile of Late Human-Immunodeficiency Virus (HIV) Diagnosis in Kedah from 2023 to 2025},

author = {Farah Izza Adenan1 Sharifah Saffinas Syed Soffian1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Late Human-Immunodeficiency Virus (HIV) diagnosis remains an important public health issue due to its association with delayed treatment, poorer health outcomes, greater healthcare burden, and ongoing transmission risk. Understanding the demographic and risk characteristics of individuals diagnosed late is essential to guide targeted screening and early detection strategies. This study aimed to describe the epidemiological profile of late HIV diagnosis cases in Kedah from 2023 to 2025. Materials and Methods: A cross-sectional study was conducted using secondary surveillance data on HIV cases reported in Kedah, retrieved from the National AIDS Registry. Data were analysed using descriptive statistics to summarise the distribution of cases by age group, sex, ethnicity, risk factor, educational level, occupation, and late HIV status. Mean age was also calculated. Results: The proportion of late HIV diagnosis in Kedah has been persistently ranging between 31 and 37% within the three-year period. The mean age of late HIV diagnosis was 39 years. The highest number of cases was observed among individuals aged 30\textendash39 years (34%). By ethnicity, most cases were Malay (67%), followed by Chinese (16%) and Indian (13%). The majority were male (85%), while female cases accounted for 15%. By risk factor, homosexual/bisexual exposure (44%) and heterosexual transmission (40%) were the predominant categories, followed by injecting drug use (9%) and undetermined risk (7%). In terms of educational attainment, the majority had secondary education. More than half were observed among the unemployed group (62%) followed by factory workers (23%). Conclusion: Late HIV diagnosis in Kedah predominantly affected adult men in the productive age group, particularly those aged 30\textendash39 years, with substantial contribution from sexual transmission. The findings suggest potential missed opportunities for earlier testing among socially and economically active adults. Strengthening targeted HIV screening, expanding provider-initiated and community-based testing, and improving risk-based outreach to key and vulnerable populations are essential to reduce delayed diagnosis and improve treatment outcomes.},

note = {Type: Oral Presentation; Organisation: 1Kedah State Health Department, Kedah, Malaysia; Corresponding author: Sharifah Saffinas Syed Soffian, drshsaffinas@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-644,

title = {Epidemiology And Attack Rate Pattern Of Influenza Outbreaks In Petaling District: A Post-Covid 19 Surveillance Analysis},

author = {Sharifah Fazlinda Syed Nor1 Fatin Adilah Abdullah1 Nur Suhada Ramli1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The epidemiology of influenza has undergone substantial shifts following the COVID-19 pandemic, with widespread resurgence observed after the relaxation of non-pharmaceutical interventions. However, granular evidence from tropical, rapidly urbanising settings remains scarce. This study aimed to characterise the epidemiology and attack rate (AR) patterns of influenza outbreaks in Petaling District during the post-pandemic period. Materials and Methods: A cross-sectional analysis of secondary surveillance data from the Petaling District Health Office was conducted. All notified and investigated influenza outbreaks between January 2023 and December 2025 were included. Temporal trends and geospatial distributions were described. Outbreaks were stratified by year, influenza virus type, locality, institutional setting, and AR (high ≥10%; low \<10%). Associations between outbreak characteristics and transmission intensity (AR) were assessed using chi-square tests. Results: A total of 73 outbreaks were identified, with a marked increase over time, rising from 16.4% in 2023 to 61.6% in 2025. Influenza A predominated (90.4%). Transmission occurred year-round with intermittent peaks; notably, 2025 demonstrated a pronounced seasonal surge during epidemiological weeks 40\textendash42, superimposed on persistent low-level endemic activity. Geospatial distribution across the three localities was relatively uniform. Early childhood institutions accounted for the largest proportion of outbreaks (41.1%) and were significantly associated with higher AR (𝞆²=20.41, p\<0.001). Discussion/ Conclusions: Post-pandemic influenza resurgence was substantial and disproportionately concentrated in early childhood institutional settings, consistent with immunity debt\textendashdriven amplification of transmission. The persistence of year-round transmission with episodic surges underscores the need for sustained surveillance. Targeted, risk-based prevention strategies in high-density congregate settings\textemdashparticularly childcare environments\textemdashare essential to mitigate future outbreak burden.},

note = {Type: Poster Presentation; Organisation: 1Petaling Health District Office, Shah Alam, Selangor, Malaysia. 2Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.; Corresponding author: Nur Suhada Ramli, nursuhadaramli@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-711,

title = {Estimating the Cost of Dengue Vector Control Activities in Putrajaya, Malaysia: A Provider-Perspective Cost Analysis},

author = {Maisarah Noor Anwar2 3 Noor Mohd Amin Moktar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue is still a significant public health issue in Malaysia, especially in high-population-density urban centres like Putrajaya, where the risk of transmission is high. Case investigation, premise inspection, larviciding, thermal fogging, and health education are all forms of vector control efforts that demand substantial financial allocations and manpower. Knowledge of the cost associated with these activities can support more efficient resource allocation and strengthen dengue prevention efforts. The objectives of this study were to estimate the cost of dengue case control operations of Vector Unit of the Putrajaya Health Office (PK Putrajaya) in controlling dengue cases between January and September 2025, cost per case of a sporadic dengue case, and cost per outbreak control cycle, the cost per capita of the population and the cost savings that may be achieved as a result of preventing and controlling dengue. Materials and Methods: A provider-perspective cost analysis was done with a micro-costing (bottom-up) approach with step-down costing to determine the actual costs of dengue control activities. Administrative spending records, asset and equipment inventories, completed reports on the operations of the vector units, records of pesticides and fuel used, and staff salary schedules were used to obtain data. The number of activity cycles of dengue control was analysed and it included 179 sporadic responses of cases and 160 outbreak control cycles. Ten cost elements were evaluated including building cost, asset and equipment, administrative cost, utilities and maintenance, labour, vehicle rental, pesticides, fuel, health education, and consumables. Annualisation of asset and building costs was done along with lifespan and rate of discount and labour costs were calculated in terms of actual working hours and salary rates. Per capita costs were estimated using population statistics published by the Department of Statistics Malaysia. Results: The approximate overall cost of dengue control operations in the period of the study was MYR316,361.02 of sporadic case control and MYR443,499.20 of outbreak control operations. The mean cost incurred in treating one case of sporadic dengue was MYR1,767.38, and the mean cost incurred in one cycle of outbreak control was MYR2,771.87. The greatest percentage of total expenditure was on labour costs, followed by vehicle rental, equipment costs and pesticides. The dengue control cost per capita for the Putrajaya population (120,300 individuals) was estimated at MYR2.63 for sporadic case management and MYR3.69 during outbreak control. Preventing a single case could result in cost savings of approximately MYR1,767.38. In contrast, averting an outbreak is estimated to yield substantially higher savings, ranging from MYR8,315.61 to MYR11,087.48. Conclusion: Dengue vector control operations are associated with high operational costs mainly due to labour-intensive fieldwork and logistical demands. The findings demonstrate the economic benefits of early screening, rapid response, and effective preventive measures in decreasing the need for recurring cycles of outbreak control. Enhanced preventive efforts and partnership with key stakeholders could help to increase cost-effectiveness and reduce the overall financial burden of dengue control programmes in urban areas like Putrajaya.},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Serdang, Selangor, Malaysia, 2Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia, 3Putrajaya District Health Office, Wilayah Persekutuan Putrajaya, Malaysia; Corresponding author: Mohd Fauzy Samsudin, dr.mohdfauzy@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-735,

title = {Evaluating Statutory Compliance in Digital Surveillance: A Retrospective Performance Analysis of HFMD Notification Timeliness in Cheras, Kuala Lumpur, 2025},

author = {Anis Nadirah Mohamad Zainudin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Timely notification of infectious diseases is the linchpin of effective public health response. For high-volume, highly transmissible diseases like Hand, Foot, and Mouth Disease (HFMD), delays can lead to rapid spread in childcare centres. This study evaluates the performance of the eNotifikasi system in meeting the 24-hour statutory notification requirement under Act 342. Materials and Methods: A retrospective analysis was conducted on all HFMD notifications (n = 3,804) recorded in the eNotifikasi system from January 1 to December 31, 2025. Notification Lead Time (NLT) was defined as the duration between the date of clinical diagnosis and the date of electronic notification. Descriptive statistics were used to determine the median NLT and the proportion of cases meeting the 24-hour benchmark. Results: Out of 3,804 HFMD cases, the median NLT was 0 days (IQR: 0\textendash0), indicating that more than 50% of cases were notified on the same day as diagnosis. An impressive 98.0% (n = 3,728) of notifications were completed within the 24-hour mandate. Only 2.0% (n = 76) of cases were classified as late. Even during peak months, the system maintained high efficiency, demonstrating robust resilience to high data volumes. Conclusion: The eNotifikasi system has achieved near-perfect compliance for HFMD surveillance in this region. This high level of timeliness provides a solid foundation for immediate public health interventions and school-level containment. These findings serve as a benchmark for other communicable diseases within the system that may still face notification bottlenecks.},

note = {Type: Poster Presentation; Organisation: 1Cheras Health District Office, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Corresponding author: Anis Nadirah Mohamad Zainudin, anisnadirah69@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-596,

title = {Evaluating Suspected Occupational Radiation Exposure in an Industrial Shipyard: A Case Series and Environmental Health Assessment},

author = {Ahmad Riadz Mazeli3 Afiqah Syamimi Masrani1; Noor Adillah Dawad2; Nurazimah Mohd Aris2; Haidar Rizal Toha2},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Industrial radiography using Iridium-192 (Ir-192) is widely employed in Malaysia’s heavy engineering and shipyard sectors. Although tightly regulated, incidents of suspected radiation exposure occasionally occur among non-radiography personnel, often driven by misinterpretation of symptoms or anxiety. In December 2025, two security personnel at a shipyard in Pasir Gudang reported symptoms they believed were caused by radiation exposure after inadvertently entering the outer perimeter of an active radiography zone. Objectives: To investigate potential ionising radiation exposure or contamination among the workers, evaluate workplace safety controls, and assess the adequacy of radiation-protection measures and communication practices. Materials and Methods: A mixed-methods public health investigation was conducted, integrating clinical assessment, exposure history, workplace inspection, dose reconstruction, and expert consultation. Clinical data were reviewed for signs consistent with acute radiation syndrome. Exposure timelines, distances, and symptom chronology were documented. A site visit assessed shielding, exclusion zones, and administrative controls. Dose estimation was performed using distance\textendashtime\textendashshielding principles and reference Ir-192 dose-rate data. Discussions with radiation protection officers and security supervisors explored operational procedures and psychosocial factors. Results: Both personnel were located approximately 200 meters from a shielded Ir-192 source for less than five minutes. Clinical evaluations and laboratory findings were normal, and reported symptoms were inconsistent with known radiation effects. Expert assessment confirmed that estimated doses were negligible and far below the 100 mSv threshold for biodosimetry. Workplace inspection demonstrated robust engineering and administrative controls, including shielded radiography buildings, ≥50-meter exclusion zones, and structured communication protocols. The incidents were attributed to lapses in worker alertness rather than system failure. Anxiety and risk amplification likely contributed to symptom perception. Conclusions: Neither case involved clinically significant radiation exposure or contamination. Strong engineering controls, substantial distance from the source, and short exposure duration resulted in negligible dose. The investigation highlights the importance of structured public health response, including dose assessment, symptom correlation, workplace evaluation, and effective risk communication, to manage suspected radiation incidents in industrial settings.},

note = {Type: Oral Presentation; Organisation: 1Johor State Health Department, Johor, Malaysia. 2Johor Bahru District Health Office, Johor, Malaysia.3Disease Control Division, Ministry of Health, Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Afiqah Syamimi Masrani, afiqahsyamimi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-597,

title = {Evaluation of Effectiveness of World AIDS Day Celebration 2025 Among Students in Tanah Merah District, Kelantan, Malaysia},

author = {Nik Aida Nik Adib1 Muhammad Fikri Idris1 Ahmad Zulfahmi Mohd Kamaruzaman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Human Immunodeficiency Virus (HIV) remains a significant public health challenge, particularly among adolescents who are vulnerable to misinformation, stigma, and high-risk behaviours. Educational interventions are essential to improve knowledge and promote preventive practices. This study aimed to evaluate the effectiveness of an HIV education program conducted during the World AIDS Day celebration at the Tanah Merah District level in 2025. Materials and Methods: A quantitative pre\textendashpost intervention study design was employed involving 78 students who participated in the program. A structured questionnaire was administered before (pre-test) and immediately after (post-test) the intervention to assess knowledge on HIV transmission, prevention, testing, and stigma. The intervention included health forums, interactive discussions, and educational materials delivered by trained health personnel. Data were analysed using SPSS version 25. Descriptive statistics and paired samples t-test were used, with statistical significance set at p \< 0.05. Results: The mean pre-test score was 6.97 (SD = 2.22), which increased to 9.63 (SD = 2.61) post-intervention. The mean difference of 2.65 (95% CI: 2.06, 3.25) was statistically significant (t(77) = 8.89, p\<0.001), indicating a substantial improvement in students’ knowledge following the program. Conclusion: The HIV education programme was effective in significantly enhancing students’ knowledge. These findings support the continued implementation of structured and interactive HIV education initiatives in school settings. Future research should assess long-term knowledge retention and behavioural outcomes.},

note = {Type: Poster Presentation; Organisation: 1 Tanah Merah Health District Health Office, Tanah Merah, Kelantan, Malaysia.; Corresponding author: Ahmad Zulfahmi Mohd Kamaruzaman, drzulfahmi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-638,

title = {Exhaustion At Heights: Unveiling The Link Between Fatigue And Occupational Incidents Among Construction Workers},

author = {Rozita Hod¹ Hanizah Mohd Yusoff¹ Nofi Yuliani Dahlan¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Fatigue is increasingly recognised as a critical human factor compromising safety in high-risk industries; however, its role in the construction sector remains underexplored. Construction workers are routinely exposed to physically demanding tasks, hazardous environments, and irregular work schedules, all of which predispose them to fatigue. These conditions elevate the risk of occupational accidents and near-miss incidents, which serve as early indicators of compromised safety performance. Evidence on the prevalence of fatigue and its association with occupational incidents among Malaysian construction workers remains limited. This study aimed to determine the prevalence of fatigue among construction workers and to examine its association with occupational accidents and near-miss incidents, guided by the Linear Accident Causation Model, Reason’s Human Error Theory, and the Demand-Induced Strain Compensation framework. Materials and Methods: A cross-sectional study was conducted among 600 construction workers employed at high-rise residential and commercial projects in the Klang Valley. Fatigue was assessed using a validated Malay version of the Fatigue Assessment Scale for Construction Workers. Data on occupational accidents and near-miss incidents over the preceding 12 months were collected using guided-administered questionnaires. Logistic regression analysis was performed to evaluate associations between fatigue and occupational incidents while adjusting for relevant sociodemographic and occupational factors. Results: Overall, 258 workers (43%) reported experiencing fatigue, and 180 workers (30%) reported at least one occupational accident or near-miss incident. Workers without fatigue had significantly lower odds of reporting occupational incidents compared with fatigued workers (adjusted OR = 0.253, 95% CI: 0.082, 0.287; p\<0.01). These findings support established accident causation theories, highlighting fatigue as a key precursor to unsafe behaviours and error pathways. Discussion/ Conclusion: Fatigue is highly prevalent among construction workers and is strongly associated with occupational accidents and near-miss incidents. Integrating fatigue management strategies into occupational safety and health interventions may substantially reduce accident risk and improve overall workplace safety in the construction sector},

note = {Type: Poster Presentation; Organisation: ¹Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. 2Department of Parasitology and Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.; Corresponding author: Nofi Yuliani Dahlan, p105678@siswa.ukm.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-500,

title = {Expanded Newborn Screening in Malaysia: Challenges, Progress, and Future Directions},

author = {Ngu Lock-Hock3 Hafizah Abdullah2 Anasufiza Habib1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Newborn screening (NBS) is a cornerstone of preventive healthcare, designed to identify serious and rare conditions before clinical symptoms emerge. In Malaysia, routine NBS currently includes screening for congenital hypothyroidism, glucose-6-phosphate dehydrogenase (G6PD) deficiency using cord blood, and congenital hearing loss. These conditions were prioritised due to their prevalence and the availability of effective interventions. However, the global expansion of NBS programs has highlighted the importance of detecting a broader spectrum of inborn errors of metabolism (IEMs), endocrine disorders, haemoglobinopathies, and rare genetic diseases using dried blood spot via a heel-prick approach. Malaysia has begun transitioning toward Expanded Newborn Screening (ENBS) to address unmet needs and improve health equity. Materials and Methods: The ENBS initiative has been implemented through a phased approach pilot programme. Key strategies include: Establishment of regional laboratories equipped with tandem mass spectrometry (MS/MS); Development of competency-based training modules for laboratory technologists; Pilot programme in five selected hospitals in the country involving 30,000 newborns to evaluate feasibility and outcomes; Collaboration with international partners, including SEA-DREAM and industry-led initiatives such as the SHINE program, to strengthen technical capacity and knowledge exchange. Results: Early outcomes from the 2008 pivotal pilot ENBS programme demonstrated improved detection rates of metabolic and genetic disorders that were previously undiagnosed. Enhanced laboratory capacity has increased throughput and accuracy, while training initiatives have strengthened workforce competency. Stakeholder engagement, including clinicians, laboratory professionals, policymakers, and patient advocacy groups, has facilitated policy discussions and raised public awareness. International cooperation has accelerated capacity building, enabling Malaysia to benchmark against regional best practices. Conclusion: Despite progress, challenges remain. Technical barriers include the need for standardised protocols, robust quality assurance systems, and expanded workforce expertise. Logistical issues such as sample transport, data management, and integration with electronic health records require systematic solutions. Policy development and sustainable ENBS funding are critical to ensure nationwide coverage and long-term viability. Importantly, stakeholder advocacy has underscored the ethical imperative of equitable access to ENBS, particularly in rural and underserved populations. Conclusion and Future Directions: Malaysia’s journey toward ENBS reflects significant achievements alongside persistent challenges. Current NBS programs provide a strong foundation, but expansion is essential to address the growing burden of rare diseases. Future plans include scaling pilot programs to national coverage, integrating ENBS into routine maternal and child health services, and establishing sustainable financing mechanisms. Continued investment, regional collaboration, and advocacy will be pivotal in realising the full potential of ENBS, ultimately safeguarding the health of future generations and advancing Malaysia’s commitment to health equity.},

note = {Type: Oral Presentation; Organisation: 1Institute for Medical Research, National Institutes of Health, Kuala Lumpur, Malaysia, 2Hospital Tunku Azizah, Kuala Lumpur, Malaysia, 3Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, 4Debra Malaysia, Cyberjaya, Selangor Darul Ehsan, Malaysia, 5Pejabat Timbalan Ketua Pengarah Kesihatan (Penyelidikan \& Sokongan Teknikal), Putrajaya, Malaysia; Corresponding author: Anasufiza Habib, anasufiza@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-476,

title = {Exploring Health Financing Pathways for an Integrated Healthcare Model in Malaysia},

author = {Justen Wong Han Wei3 Kurudeven2 Saguntala Selvamani1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia is advancing transformation toward an Integrated Healthcare Model to address fragmentation across care levels and ensure sustainable health financing amid rising service demands and fiscal pressures. Understanding workforce perspectives is critical for designing transformations that are both feasible and system-responsive. This study aimed to explore perceptions of readiness for an integrated healthcare implementation, urgency for financing reform, and preferred financing and governance arrangements among health personnel in Malaysia. Materials and Methods: A cross-sectional national survey involving 722 respondents was conducted among specialists, medical/dental doctors, pharmacists, nurses, allied health professionals, administrative cadres, and others within the public healthcare system. Respondents represented multiple states and service settings, with strong participation from high-density and policy-level locations. More than 80% of respondents had served for over 10 years, including 173 with more than 20 years of experience, indicating perspectives grounded in long-term familiarity with the system. The survey examined perceptions of expected outcomes of integrated healthcare, organisational readiness, urgency of financing reform, and preferred funding models and fund management structures. Descriptive and ranking analyses were performed to identify patterns of preference and thematic concerns. Results: The survey findings reflected a balanced cross-section of professional roles, with Allied Health Professionals forming the largest group, followed by Medical and Dental Officers and Pharmacists. Optimism toward integrated care was high, with 363 respondents rating it very likely to improve quality of care and 346 rating it very likely to strengthen collaboration among providers. In addition, 459 respondents rated the establishment of a national policy framework as extremely important, signalling a clear mandate for change. However, 63.6% perceived the Ministry of Health as only partially ready for implementation, while only 9.1% considered it fully ready, revealing a significant readiness gap and reinforcing preference for phased or pilot-based implementation rather than immediate nationwide rollout. Financing reform was widely viewed as urgent, with 418 respondents indicating reform should occur within two to three years and 60.4% broadly categorising it as urgent. The most preferred funding approach was a blended model combining taxation and contribution-based mechanisms (50.8%), reflecting recognition that reliance solely on general taxation may be insufficient and signalling increasing acceptance of shared financial responsibility. In governance ranking, a state-level integrated healthcare cluster managing pooled national health fund resources across hospitals and primary healthcare facilities emerged as the top option (mean rank 2.33; ranked top two by 66.8%). Qualitative findings emphasised financing alignment, clear governance frameworks, workforce capacity building, phased implementation, and equity considerations, particularly urban\textendashrural disparities. Conclusion: The findings demonstrate strong workforce support for integrated care and financing reform, coupled with pragmatic recognition of institutional readiness constraints. A phased implementation strategy, supported by pilot testing, protected primary healthcare funding, and strengthened governance and accountability mechanisms, will be critical to ensuring predictable financing pathways and enabling an equitable and sustainable transition toward an integrated healthcare model in Malaysia.},

note = {Type: Poster Presentation; Organisation: 1,2,4Health Transformation Office, Ministry of Health Malaysia, 3Family Health Development Division, Ministry of Health Malaysia; Corresponding author: Saguntala Selvamani, dr.saguntala@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-634,

title = {Factors Associated with Burnout Among Mothers Working in a Tertiary Clinical Setting},

author = {Jeevetha Gangesri1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Healthcare professionals face significant occupational stress, yet mothers in clinical roles experience a unique "double burden" of professional demands and domestic responsibilities. This study aimed to determine the prevalence of burnout and identify the individual, interpersonal, and institutional factors associated with burnout among working mothers in a tertiary hospital in Malaysia. Materials and Methods: A cross-sectional study was conducted among 300 full-time mothers (including nurses and doctors) at Hospital Tengku Ampuan Rahimah Klang using stratified random sampling. Burnout was measured using the Maslach Burnout Inventory\textendashHuman Services Survey (MBI-HSS), defined as high emotional exhaustion (EE ≥27) and/or high depersonalization (DP ≥13). Binary logistic regression was performed to estimate adjusted odds ratios (AORs). Results: The prevalence of burnout was 38.0%. Doctors experienced significantly higher burnout (House Officers: 52.6%; Specialists: 42.7%) compared to nurses (18.9%, p\<0.001). Key predictors included having an unemployed spouse (AOR = 41.31, 95% CI: 12.97, 131.55), workplace bullying (AOR = 28.76, 95% CI: 8.06, 102.62), and working \>60 hours/week (AOR = 26.47, 95% CI: 7.79, 89.93). Other factors included staying away from family (AOR = 11.78, 95% CI: 2.56, 54.30) and inadequate childcare (AOR = 3.04, 95% CI: 1.42, 6.49). Conclusion: A significant proportion of clinical mothers suffer from burnout, driven by a combination of extreme workloads, workplace culture issues like bullying, and a lack of domestic or social support. To ensure workforce sustainability and patient safety, institutional interventions must focus on regulation of working hours, enforcing zero-tolerance bullying policies, and providing targeted support systems for healthcare workers with care-giving responsibilities .},

note = {Type: Poster Presentation; Organisation: 1Hospital Tengku Ampuan Rahimah, Selangor, Malaysia; Corresponding author: Jeevetha Gangesri, jeevenesh13@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-607,

title = {Factors Associated with Dengue Outbreaks in Kota Setar and Pokok Sena, Kedah: A Retrospective Analysis},

author = {Mohd Zukri Ibrahim2 Fatin Aina Abu Bakar1 Nur Hazamii Abd Hamid¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: In 2024, World Health Organization recorded over 14 million dengue cases globally. Prior to this global surge, Malaysia experienced a significant spike in 2023, where Kedah reported an exponential increase from 1,461 to 5,207 cases in 2022 and 2023 respectively. Locally, cases in Kota Setar and Pokok Sena districts cumulatively tripled from 407 to 1,187, resulting in 80 outbreaks and 4 deaths in 2023. This study aimed to identify factors associated with dengue outbreaks in these districts. Materials and Methods: A retrospective cross-sectional analysis was conducted on confirmed dengue cases in Kota Setar and Pokok Sena districts from 2023 to 2025, based on data extracted from the national eDengue registry. This study included 468 samples which were equally categorised into 234 single and outbreak cases. Sociodemographic and entomological variables were initially screened using simple logistic regression, followed by multiple logistic regression to identify independent factors of dengue outbreak escalation. Results: The most statistically significant factors associated with dengue outbreaks were a Breteau Index ≥5 (aOR: 3.07, 95% CI: 1.97, 4.77, p\<0.001) and an Aedes Index ≥1% (aOR: 2.81, 95% CI: 1.56, 5.07, p\<0.001). Priority Locality 1 status (aOR: 1.88, 95% CI: 1.16, 3.03},

note = {Type: Poster Presentation; Organisation: ¹ Vector Borne Disease Control Unit, Kota Setar District Health Office, Kedah, Malaysia. 2 Kota Setar District Health Office, Kedah, Malaysia.; Corresponding author: Nur Hazamii Abd Hamid, hazamii@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-736,

title = {Factors Associated with Gestational Diabetes Mellitus: A Retrospective Tertiary Hospital Database Analysis (2018\textendash2024)},

author = {Rahana Abd. Rahman2 Rosnah Sutan1* Naqibah Afiqah Nadzri1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Gestational diabetes mellitus (GDM) is the most common medical condition among pregnant women, and it can cause both short-term and long-term health problems for both the pregnant mother and her unborn child (5). To reduce GDM-related problem, it is therefore essential to enhance GDM screening, preventive and control strategies by identifying the associated factors. Standard GDM screening protocols may fail to capture the distinct demographic and metabolic changes of the Malaysian population, leaving a gap in current risk identification strategies. Therefore, this study’s objective is to determine the prevalence of GDM and the associated factors. Materials and Methods: This cross-sectional study was conducted by retrieving at Hospital Canselor Tuanku Muhriz (HCTM) registered labour room records for the year between 2018 and 2024. Obstetric status, medical conditions, obstetric history, maternal demographics, and maternal anthropometrics were the independent variables, while GDM status was the dependent variable. 24,719 pregnant Malaysian individuals who met the inclusion requirements and were singleton pregnant were examined. Factors associated with GDM were identified using multiple logistic regression analysis. Ethical approval was obtained from the Universiti Kebangsaan Malaysia Research Ethics Committee (FF-2025-268) and the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID-25-01985-W60). Results: Between 2018 and 2024, the prevalence of GDM ranged from 17.8% to 26.1%, with 2024 seeing the highest frequency at 21.9%.Increased GDM risk was significantly associated with age (adjusted odds ratio [aOR]: 1.05, p \< 0.001), ethnicity (aOR: 1.40, p \< 0.001), pre-pregnancy body mass index (BMI) (aOR: 1.05, p \< 0.001), hypertension (aOR: 1.47},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health Medicine, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia. 2Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, Malaysia.; Corresponding author: Rosnah Sutan, rosnah.sutan@ukm.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-487,

title = {Factors Associated with Glycaemic Control Among Patients with T2DM In Perak: A Cross-Sectional Study},

author = {Norrina Esa2 Norazrul Nasri1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Glycaemic control is essential in the management of type 2 diabetes mellitus (T2DM) to prevent complications. However, poor glycaemic control remains prevalent across Malaysia. This study aimed to determine the prevalence of poor glycaemic control among diabetic patients in Perak and identify associated demographic and clinical factors. Materials and Methods: This was a cross-sectional study that used secondary data from T2DM patients recorded in the web-based NDR system. Adults aged 18 and above who were actively followed up at health clinics in Perak between May 2023 and April 2024 were randomly selected. A total of 9,141 records were collected, and after removing incomplete data, 7,121 patients were analysed. Poor blood sugar control was defined as HbA1c above 6.5%. Logistic regression was used to examine the relationship between poor control and factors such as age, ethnicity, BMI, diabetes duration, age at diagnosis, blood pressure, and insulin use. Results: The study's results indicate that most of the patients were aged 60 years or older (64.4%) and female (61.6%), with Malays comprising the largest ethnic group (63.5%). The prevalence of poor glycemic control was 60%, aligning with rates observed in other Malaysian states. Younger patients (\<60 years) had significantly higher odds of poor glycaemic control (adjusted odds ratio [AOR]: 1.574; 95% confidence interval [CI]: 1.369, 1.809; p\<0.001). Indian ethnicity was independently associated with poor control. Overweight and obesity were strongly linked to increased risk. Longer duration of diabetes and early onset (\<45 years) were also significantly associated with poorer outcomes. Patients using insulin had notably higher odds of poor glycaemic control (AOR: 6.070; 95% CI: 5.188, 7.101; p\<0.001), and elevated systolic and diastolic blood pressure were also significantly associated with poor control. Conclusions: Poor glycaemic control remains a significant public health challenge in Perak, particularly among younger individuals, Indian patients, those with obesity, longer disease duration, and insulin users. These findings underscore the need for targeted strategies in diabetes management, especially in these groups. The study's limitations include the absence of behavioural and psychosocial variables, and its focus on primary care settings, which may limit generalisability.},

note = {Type: Poster Presentation; Organisation: 1NCDC Medical Officer Jabatan Kesihatan Negeri Perak, 2Public Health Physician Jabatan Kesihatan Negeri Perak; Corresponding author: Norazrul bin Nasri, norazrulnasri@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-677,

title = {Factors Associated with Inadequate Toothbrushing Practice Among School Adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2022},

author = {Mohamad Fuad Mohamad Anuar2 Habibah Yaacob @ Ya’akub1 Nurulasmak Mohamed1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Brushing teeth at least twice daily is a fundamental preventive behaviour in caries control and is consistently promoted through Malaysia’s school-based incremental dental care programme. Despite structured service provision, suboptimal oral hygiene practices persist among adolescents. This study aimed to determine the prevalence of inadequate toothbrushing and to examine sociodemographic, behavioural, and psychosocial factors associated with inadequate toothbrushing practice among Malaysian school adolescents. Materials and Methods: Data were obtained from the National Health and Morbidity Survey 2022: Adolescent Health Survey, a nationally representative school-based survey employing multistage stratified cluster sampling. A total of 33,438 adolescents participated. Data were collected using validated self-administered questionnaires. Inadequate toothbrushing was defined as self-reported brushing less than twice per day. Complex sample logistic regression analyses were performed to estimate crude and adjusted odds ratios with 95% confidence intervals (CI). Results: Overall, 17.8% of adolescents reported brushing less than twice daily. The prevalence was higher among males (23.7%) compared with females (12.0%). In multivariable analysis, male adolescents had higher odds of inadequate toothbrushing (AoR 2.14; 95% CI: 1.93, 2.36). Inadequate brushing clustered with broader health risk behaviours, including inadequate fruit intake (AoR 1.72; 95% CI: 1.56, 1.91), ever drug use (AoR 1.59; 95% CI: 1.33, 1.89), physical inactivity (AoR 1.19; 95% CI: 1.06, 1.34), and poor hand hygiene (AoR 1.69; 95% CI: 1.55, 1.85). Adolescents who perceived their oral health as poor or very poor had substantially higher odds of inadequate brushing (AoR 2.77; 95% CI: 2.29, 3.35). Discussion/Conclusion: Although the majority of adolescents met recommended brushing frequency, a substantial minority continues to practice inadequate oral hygiene despite structured school dental services. The strong clustering of inadequate toothbrushing with other unhealthy behaviours suggests that brushing behaviour reflects broader lifestyle patterns rather than an isolated oral health issue. These findings indicate the need to strengthen oral health promotion within the incremental care framework, with greater emphasis on behavioural internalisation and integration with wider adolescent health strategies rather than solely increasing service activities.},

note = {Type: Poster Presentation; Organisation: 1 Oral Health Programme, Ministry of Health Malaysia, WP Putrajaya, Malaysia. 2 Biostatistics and Repository Data Sector, National Institute of Health, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Nurulasmak Mohamed, nurulasmak@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-699,

title = {Factors Influencing Late Diagnosis in People Living with Human Immunodeficiency Virus in Oman: An Ambidirectional Cohort Study, 1992-2024},

author = {Sanjay Jaju¹ Faryal Khamis³ Zainab M. Al-Zadjali¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Despite advancements in the management of human immunodeficiency virus, challenges remain in achieving early diagnosis, particularly in contexts with sociocultural and structural barriers. This study examined factors associated with late diagnosis among people living with human immunodeficiency virus in Oman from 1992 to 2024. Materials and Methods: An ambidirectional cohort study was conducted at the National Referral HIV Hospital in Muscat (Royal Hospital, Ministry of Health), including HIV-positive adults aged ≥18 years with complete baseline CD4 count, viral load, and haemoglobin data. Information was extracted from electronic medical records and analyzed using binary logistic regression, with significance set at p ≤ 0.05. Results: Of the 549 patients studied, 30.1% had a late diagnosis for treatment. Among late diagnoses, 72.1% were infected via sexual transmission, 64.8% were asymptomatic, and 52.5% had no comorbidities. Younger age groups had significantly higher adjusted relative risks (aRR) of late diagnosis: 5.66 (95% confidence interval (95% CI): 2.26, 14.21) for ages 18-27, 3.25 (95% CI: 1.33, 7.94) for ages 28\textendash37, and 3.51 (95% CI: 1.40, 8.77) for ages 38-47, compared to those aged 48 years and older. Notably, low haemoglobin levels less than 10 grams per deciliter were associated with an increased risk of late diagnosis (aRR = 3.03; 95% CI: 1.42, 6.67). Patients who were asymptomatic or classified as stage 1 (aRR = 7.34; 95% CI: 3.12, 14.29) and those with advanced symptoms or stage 3 disease (aRR = 2.93; 95% CI: 1.40, 5.68) were more likely to present late compared to individuals with severe symptoms or stage 4 disease, according to clinical staging. Additionally, patients with heart disease (aRR = 5.38; 95% CI: 1.36, 21.31) and hypertension (aRR = 3.34; 95% CI: 1.13, 9.91) demonstrated an increased likelihood of late diagnosis compared to those without comorbidities. Discussion/Conclusion: This study identifies key factors influencing the timing of diagnosis in Oman from 1992 to 2024, providing critical evidence to support data-driven decision-making. Late diagnosis was more prevalent among younger patients, those with disease stages 1 and 3, and those with cardiovascular comorbidities. However, those with low haemoglobin were diagnosed early. These findings emphasize the need for enhanced early testing strategies, tailored clinical care, stigma reduction, and timely psychosocial interventions to improve outcomes and support Oman’s 95-95-95 targets.},

note = {Type: Poster Presentation; Organisation: ¹ Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. ² Fundamentals and Nursing Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Oman. ³ Department of Infectious Diseases, Royal Hospital, Muscat, Oman.; Corresponding author: Zainab M. Al-Zadjali, zainab.alzadjali@yahoo.com,},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-489,

title = {Factors Influencing Vaccine Refusal for the Measles-Rubella Supplementary Immunisation Activity (MRSIA) In the Seremban District},

author = {Farah Nazneen Mohd Jais1 Noor Khalili Mohd Ali1 Yang Rashidi Abdullah1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The national Measles-Rubella Supplementary Immunisation Activity (MRSIA) vaccination campaign was conducted from 4th August 2025 to 12th October 2025 to curb the rise of measles cases in Malaysia. However, the vaccination rate in the Seremban district reached only 70% during this campaign, failing to meet the targeted 95% herd immunity threshold. This study was conducted to examine the level of vaccine refusal in the Seremban district and the factors contributing to the vaccination refusal. Materials and Methods: This cross-sectional study was conducted in the Seremban district. Data was collected by reviewing secondary data within the MyVAS system. The sampling method utilised was convenience and universal sampling, covering all 21,764 children aged 6 to 59 months in the Seremban district recorded in the MyVAS system who were eligible for the MRSIA vaccination. Results: There was a 10.2% vaccine refusal rate in the Seremban district. Refusal rates were significantly higher among children aged 24 months and above (p\<0.001), Malay ethnicity (p\<0.001), Malaysian citizens (p\<0.001), in-clinic vaccination locations (p\<0.001), and rural clinic areas (p\<0.001). Based on logistic regression analysis, the predictive factors for refusal were Malay ethnicity OR 1.48 (95% CI: 1.06, 2.07), Malaysian citizenship OR 3.72 (95% CI: 1.65\textendash6.39), in-clinic vaccination location OR 2.45 (95% CI: 2.09, 2.88) and clinics in rural areas OR 1.32 (95% CI: 1.19, 1.46). Conclusion: It is hoped that by identifying these refusal factors, better planning and more effective measures can be implemented in future vaccination campaigns to ensure vaccine refusal rates are reduced.},

note = {Type: Oral Presentation; Organisation: 1Seremban District Health Office, Negeri Sembilan, Malaysia; Corresponding author: Yang Rashidi Abdullah, dr.yrashidi@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-586,

title = {Fatal Neonatal Melioidosis: A Rare Case of Indirect Environmental Transmission via Household Contacts in South Seberang Perai, Penang, Malaysia},

author = {Mas Harithulfadhli Agus Ab Rahman1 Noor Farhana Mohd Fathil2 Mei Ching Lim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Melioidosis, a neglected tropical disease caused by the Gram-negative saprophytic bacterium Burkholderia pseudomallei, is endemic to Southeast Asia and associated with significant mortality. While typically manifesting in adults with comorbidities such as diabetes mellitus, neonatal melioidosis is an exceedingly rare clinical entity that often presents as a fulminant, rapid-onset infection. This report characterizes the clinical progression and environmental investigation of a fatal neonatal case to highlight the critical necessity for early diagnostic suspicion in paediatric populations. Materials and Methods: A retrospective clinical and environmental investigation was conducted following the mortality of a 15-day-old female neonate in South Seberang Perai, Penang. Data were synthesised from medical records, laboratory results (Blood C\&S), and a comprehensive field investigation. Environmental surveillance included the collection and analysis of soil and water samples from the patient’s residence and a proximal community playground. Results: The neonate, delivered via elective Caesarean section at 39 weeks and 1 day of gestation, presented on day 14 of life with a 48-hour history of pyrexia, followed by poor feeding, cough, and lethargy. Clinical examination revealed the signs of decompensated septic shock, including tachypnoea with subcostal recession, weak peripheral pulses, delayed capillary refill and a profound oxygen saturation (SpO2) of 68% on room air. Laboratory investigations demonstrated significant leukopenia (WBC 2.3 x 10^3/µL) and a markedly elevated C-reactive protein of 196 mg/L. Despite aggressive resuscitation with high-flow oxygen, inotropic support and broad-spectrum antimicrobial therapy (including Meropenem), the neonate succumbed to septicaemic shock and multiorgan failure within 24 hours of admission. Blood cultures confirmed the presence of Burkholderia pseudomallei. Conclusion: An extensive epidemiological investigation was conducted as the neonate had remained exclusively at home since birth, except for brief clinical appointments. Environmental sampling isolated Burkholderia pseudomallei from soil at the residence (kitchen perimeter) and the neighbourhood playground. Notably, the mother’s blood culture was negative, effectively ruling out vertical transmission. The investigation concluded that the most probable route of infection was horizontal transmission via direct physical contact with household members. The neonate’s father, who regularly performed lawn maintenance, and two older siblings who frequented the playground, likely introduced the pathogen into the home environment. This case underscores the extreme vulnerability of neonates to Burkholderia pseudomallei and demonstrates that direct environmental exposure is not a prerequisite for infection in neonates or infants. A key finding was the delay in notification to the district health office, which only occurred after the neonatal mortality meeting nearly a month later. Based on these findings, it is recommended that public health authorities in endemic regions implement targeted health education for families with newborns, emphasizing stringent hand hygiene for caregivers who engage in outdoor activities. Furthermore, clinicians must maintain a high index of suspicion for melioidosis in neonatal sepsis and ensure rapid notification to public health counterparts to facilitate timely environmental interventions and strengthen preventive strategies.},

note = {Type: Poster Presentation; Organisation: 1 South Seberang Perai District Health Office, Penang, MALAYSIA, 2 Communicable Disease Control Unit, Penang State Health Department, Penang, MALAYSIA; Correspondence email: Mei Ching Lim, jennmclim@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-581,

title = {Fatal Poisoning from Wild Rattan Shoot Consumption in a Remote Indigenous Community, Tatau, Sarawak, Malaysia},

author = {Imran Azwan Azizan1 Melvin Chung Hsien Liang1 Nurul Amirah Masani1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Toxic exposures from wild edible plants represent an important but under recognised public health risk in forest dependent communities. In Sarawak, young rattan shoots locally known as upa or umbut are commonly harvested and consumed as traditional foods. However, some morphologically similar rattan species contain toxic compounds that may cause severe poisoning, and accurate identification may be difficult after harvesting or cooking. On 10 November 2025, a food poisoning outbreak including two fatalities, was reported in Tatau, Sarawak following consumption of wild rattan shoots. This investigation aimed to describe the epidemiological and clinical characteristics of the outbreak and determine the source of exposure. Methods: A retrospective cohort study was conducted among seven individuals who participated in the forest food gathering activity. Data were collected through structured interviews and clinical record review. Variables included food exposure, symptom onset, clinical presentation, and outcomes. Food-specific attack rates were calculated, and relative risks (RR) were estimated to assess associations between exposures and illness. Fisher’s exact test was applied due to small sample size. Environmental assessment included photographic documentation of the suspected plant species, reviewed by experts from the Sarawak Forestry Department. Results: Six of seven individuals met the case definition, yielding an attack rate of 85.7% (95% CI: 42.1, 99.6). The incubation period ranged from 45 to 105 minutes (median: 75 minutes), consistent with acute toxic exposure. Predominant symptoms included headache (71.4%), vomiting (42.8%), dyspnoea (28.6%), dizziness (14.3%), and generalised weakness (14.3%). Two cases progressed rapidly to death, resulting in a case fatality proportion of 33.3% (95% CI: 4.3, 77.7). Consumption of upa goreng belacan showed complete exposure concordance with illness. All six individuals who consumed the dish became ill, while the only individual who did not consume it remained well (RR:10.82). Fisher’s exact test did not demonstrate statistical significance (p=0.143) likely reflecting limited statistical power due to the small sample size. A dose - response pattern was observed, with more severe outcomes among individuals who consumed larger quantities. Environmental assessment and expert review identified the likely plant species as Plectocomiopsis mira, a rattan species suspected to contain toxic compounds. Laboratory findings in fatal cases were consistent with severe systemic toxicity. Conclusion: This outbreak demonstrates the potential for severe and fatal poisoning resulting from the misidentification of wild edible plants in remote forest environments. Despite limited statistical power, the high attack rate, short incubation period, consistent clinical presentation and strong exposure disease association supports causal inference. In areas where communities rely on forest resources for subsistence, limited awareness of toxic plant species and difficulties in species recognition may increase the risk of accidental poisoning. A One Health approach, where collaboration between health authorities, forestry experts and local communities can facilitate early identification of environmental hazards and reduce the risk of toxic exposures in remote settings.},

note = {Type: Poster Presentation; Organisation: Bintulu Divisional Health Office; Corresponding author: NURUL AMIRAH BINTI MASAN, nurulamirah1401@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-562,

title = {Feasibility of Mobile-Based Vision Screening Among Underprivileged Paediatric population in the Klang Valley, Malaysia: A Community-Based Cross-Sectional Study},

author = {Arun Kumar Basavaraj2 Tehmina Nafees Sonia Khan1 Muhammad Nabil Bin Mohd Hasli1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Visual impairment is one of the major contributors to global eye-related health problems. Global estimates from the World Health Organisation indicate 285 million individuals suffer from vision impairment. Of these, 90% are blind or visually impaired reside in low-income countries. To minimise the increasing incidence of visual impairment, especially in remote areas, digital apps are revolutionising visual acuity (VA) screening by providing convenience, accessibility, and accuracy. This study aims to assess the feasibility and practical implementation of the Rapid Eye Screening Test (REST) mobile app for initial VA screening among the paediatric population from the underprivileged community in Klang Valley, Malaysia. Materials and Methods: A community-based cross-sectional VA screening was conducted in collaboration with community partners at different learning centres. Participants were screened using the REST App. VA was assessed for both eyes, and readings were recorded. Results: A total of 945 participants from the B40 population and 1405 from the refugee population in the Klang Valley were screened. Of these, 273 children (28.9%) were identified in the B40 population having visual findings suggestive of refractive errors and were assessed as requiring corrective spectacles. Conclusion: The REST mobile application demonstrates to be a feasible community-based vision screening tool in identifying previously unrecognised visual needs among underprivileged children and supporting accessible eye screening beyond conventional clinical settings.},

note = {Type: Oral Presentation; Organisation: 1IMU (International Medical University) University, Kuala Lumpur, Malaysia, 2Newcastle University Medicine, Johor, Malaysia; Corresponding author: Muhammad Nabil Bin Mohd Hasli, 00000033332@student.imu.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-572,

title = {Financial Burden of Medico-Legal Cases Resolution In Malaysian Public Tertiary Hospital: A Mixed-Methods Study},

author = {Milagros M. Spanoghe1 2 Izzaz Azman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Medicolegal cases in Malaysian public tertiary hospitals represent a growing financial burden that requires strategic management. Although both litigation and ex gratia settlements are used to resolve these cases, systematic comparisons of their financial costs and efficiency remain limited. This study was conducted to evaluate the financial burden of cost spending and cost efficiency of medicolegal case resolution within a selected Malaysian state to provide a data-driven foundation for sustainable policy reform. Materials and Methods: A convergent mixed-methods design was utilised. The quantitative component involved universal sampling of 50 settled medicolegal cases (Ex Gratia: n= 41, Litigation: n=9) from 2019 to 2021. Direct payouts, administrative costs and indirect costs were analysed using the Mann-Whitney U test. The qualitative components consisted of semi-structured interviews with seven medicolegal officers representing three levels of the healthcare system which are the Ministry of Health headquarters, state health departments, and hospitals, to explore professional perspectives on the financial and operational impact of these resolution processes. Results: Quantitative analysis revealed a significant financial disparity between the two resolution mechanisms (p\<0.001), with litigation payouts approximately 38 times higher, showing a median of MYR568,859.64 compared with MYR15,000.00 for ex gratia settlements. In addition, ex gratia cases were resolved significantly faster (p=0.015), with a median resolution time of 20 months compared with 46 months for litigation. Qualitative findings further indicated that although litigation costs are largely driven by external structural factors, there is substantial opportunity to strengthen institutional capacity through improved human resource utilisation. In particular, better alignment of medicolegal experts’ roles toward strategic advisory functions could enhance operational efficiency and strengthen governance at the system level. Conclusion: The findings indicate that ex gratia represents a more cost-efficient and timely pathway for resolving medicolegal cases within the Malaysian public healthcare system. However, periodic revisions to ex gratia compensation structures may be necessary to ensure their continued relevance and viability in light of increasing court awards. Strategic policy efforts should therefore prioritise predictive risk modelling and strengthened organisational governance structures, enabling medical professionals to focus on higher-value clinical governance and patient safety initiatives.},

note = {Type: Poster Presentation; Organisation: 1College of Public Health, University of the Philippines Manila, 2Medico Legal Section, Medical Practice Division, Ministry of Health Malaysia; Corresponding author: Izzaz Azman, izzaz@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-490,

title = {Forging Health Operational and Logistical Resilience in a Mandate-Strained Conflict Zone: A Mixed-Methods Strategic Evaluation of Malaysia’s Final Battalion Deployment in United Nation Interim Forces in Lebanon},

author = {Major (Dr) Ahmad Mustaqim Mohd Ghadzali¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Malaysia has been a proud member of the community of nations since 1960, resolutely advancing global peace through distinguished peacekeeping missions worldwide. Deployed to Lebanon since 2007, the final Malaysian Battalion 850-13 represents two decades of noble sacrifice, honour, and unwavering commitment to humanity. Maintaining essential health services during a peacekeeping mission drawdown requires integrating clinical delivery, logistical governance, and workforce adaptability. The final deployment phase of Malaysian Battalion 850-13 within the United Nations Interim Force in Lebanon peacekeeping mission provided a practical setting to evaluate operational resilience during progressive force reduction. This study aimed to assess the sustainability of medical workload, equipment governance performance, and workflow adaptability under constrained operational conditions. Materials and Methods: A convergent mixed-methods evaluation was conducted at Level 1 medical facilities located in Marakah Camp and Tibnin Camp within the Western Sector operational area. Quantitative analysis included 775 clinical encounters recorded between November 2025 and February 2026, referral and admission records, and governance assessment of contingent-owned equipment assets, specifically medical equipment, involving approximately 970 medical inventory items with an acquisition value of about MYR1.55 million. Descriptive statistical analysis was applied to workload distribution and asset disposition performance. Qualitative assessment utilised purposive semi-structured feedback from clinical, logistics, and command personnel, focusing on adaptive capacity, operational workflow stress, and governance coordination. Results: Clinical service continuity was maintained despite progressive manpower reduction. Outpatient services represented 39 per cent of encounters, community engagement medical activities represented 31.6 per cent, while combined referral and admission events were below one per cent. No sentinel adverse clinical outcome was reported during the observation period. Structured governance processes enabled preservation of more than sixty per cent of equipment value through phased inspection, verification, and controlled asset disposition involving repatriation, transfer, and regulated disposal pathways. Key operational stress factors included workload redistribution, triage processing delay risk, reduced redundancy in emergency response teams, and supply chain sensitivity. Conclusion: Operational medical resilience during mission contraction is achievable through coherent governance structures, protection of core clinical capability, and systematic logistical verification. The experience of Malaysian Battalion 850-13 demonstrates that controlled operational compression supported by centralised planning can sustain essential health service delivery in complex peacekeeping environments.},

note = {Type: Poster Presentation; Organisation: ¹Medical Officer, Malaysian Battalion 850-13 United Nation Interim Forces in Lebanon; Corresponding author: Ahmad Mustaqim bin Mohd Ghadzali, mustaqim941124@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-647,

title = {Framework analysis for youth empowerment on sexual health literacy.},

author = {Nor Azimah Mohammad2;Nur Ezdiani Mohamed3; Norliza Ahmad4; Zaleha Isa1 Nur Hazreen Mohd Hasni1 Rosnah Sutan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Youth represent a vulnerable population group requiring targeted empowerment through health literacy to enable the adoption of healthy behaviours aligned with their evolving health needs. Many non-communicable and reproductive health conditions originate during adolescence and early adulthood, highlighting the importance of early preventive interventions. Sexual and reproductive health constitutes a critical component of youth health; however, young individuals often remain asymptomatic and are less likely to seek preventive health services due to the absence of perceived risk or alarming symptoms. This underscores the need for customised health empowerment strategies that are tailored to youths’ preferences, particularly in terms of content design and delivery modalities, to enhance engagement and accessibility. Materials and Methods: A systematic review with meta-analysis was conducted to identify gaps in existing health education content and delivery approaches targeting youth populations. Three electronic databases, supplemented by document review, were systematically searched and analysed. Results: The findings indicate a strong preference for digital health approaches, particularly self-directed learning packages designed using youth-friendly language and visually engaging formats such as infographics. Ten key content domains were identified, with optimal suitability observed when materials are tailored to the needs of single middle-youth populations as the targeted group. Interactive and practical components, including step-by-step preventive techniques and self-testing strategies, were found to enhance user engagement and participation. Conclusion: Furthermore, collaboration with youth stakeholders at the community level emerged as an effective peer-led strategy for health promotion. The use of bite-sized videos, infographic-based e-books, and digital web applications significantly improves motivation, accessibility, and sustained engagement in health learning among youth.},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health Medicine, Medical Faculty UKM, Cheras, Kuala Lumpur, Malaysia. 2Department of Family Medicine, Medical Faculty UKM, Cheras, Kuala Lumpur, Malaysia. 3Centre for Healthcare Quality Research, Institute for Health System Research (IHSR), NIH Setia Alam, Selangor, Malaysia. 4Community Health Department, Faculty of Medicine and Health Science, UPM Serdang, Selangor, Malaysia.; Corresponding author: Rosnah Sutan, rosnah_sutan@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-757,

title = {From Bedside to Blocks: A Nosocomial-Triggered Community Rotavirus Outbreak in Temerloh, Pahang},

author = {Ammar Hussein Rosly1 Nordiana Rosli1 Shiz Yee Gan1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The 2025 Temerloh Rotavirus outbreak, officially declared on 30 May, highlights the risk of nosocomial-to-community transmission driven by systemic isolation failures. Centred in a high-density government housing community comprising 15 blocks and approximately 497 residents, this study aimed to identify the source of transmission, characterise the epidemiological profile, and evaluate environmental risk factors to inform future prevention strategies. Material and Methods: A multi-disciplinary investigation was conducted by the Temerloh District Health Office using Active Case Detection via door-to-door surveys and retrospective reviews of pediatric ward hospital registers. Environmental assessments included water quality analysis (turbidity and residual chlorine) at the source and end-user taps. Clinical confirmation was obtained via stool and rectal swab testing for Rotavirus. Results: A total of 28 cases were identified (14 laboratory-confirmed) among 587 exposed individuals, including ward occupants and healthcare staff, yielding an attack rate of 4.77%. The cohort was 57% male and 89% Malay, with onset dates ranging from 13 to 29 May 2025, peaking on 24 May. Clinical presentation was dominated by diarrhoea (100%), vomiting (75%), and fever (42.9%), with 57% of cases requiring hospitalisation. The Primary Case, a paediatric patient admitted for Kawasaki disease, was not isolated after developing gastroenteritis due to clinical instability and subsequently infected an adult caregiver in the same cubicle. This caregiver facilitated transmission into the community. The Index Case was a child from the affected community who was the first notified case, prompting outbreak investigation. Half of the cases were children aged ≤5 years. Environmental findings revealed systemic failures: intake water turbidity reached 6.69 NTU, while end-user taps showed 3.25\textendash5.01 NTU, shielding pathogens from disinfection. Critically, residual chlorine at user taps was as low as 0.03 mg/L, failing to reach the 0.2 mg/L required for viral inactivation. Social-behavioural analysis identified "neighbour-care" culture and "cross-cubicle" mingling by caregivers as primary vectors. Conclusion: This outbreak demonstrates "Isolation Protocol Inversion," where clinical stability was incorrectly prioritised over infection control. The "Caregiver Bridge" acted as a viral conduit from the hospital to the community. Water quality served as a significant indirect risk factor, as high turbidity and low chlorination compromised the environmental buffer against viral persistence. Immediate control measures included terminal cleaning of wards, home isolation, and collaboration with water authorities (PAIP) to increase chlorine dosages. The cluster was declared closed on 6 June 2025. We recommend a mandatory "Symptom-First" isolation policy for all pediatric AGE cases, regardless of clinical status, alongside strict enforcement of water quality standards (NTU \< 1, BCL \> 0.2 mg/L) in high-density housing to eliminate environmental persistence of enteric pathogens.},

note = {Type: Poster Presentation; Organisation: 1Temerloh District Health Office, 28000 Temerloh, Pahang, Malaysia.; Correspondence Email: Shiz Yee Gan, shizyee@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-559,

title = {From Cost-Effectiveness to Affordability: A Budget Impact Analysis of Increasing Contraceptive Implant Adoption in Malaysia},

author = {Zafar Ahmed² Mohamad Hafiz Harun¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Contraceptive implants have been identified as the most cost-effective method for preventing unintended pregnancies in Malaysia; however, their uptake in primary care remains low. While cost-effectiveness analysis (CEA) provides important evidence on value for money, policymakers require additional information on affordability to inform implementation and resource allocation decisions. This study aimed to estimate the budget impact of increasing contraceptive implant adoption in pre-pregnancy care services within Ministry of Health (MOH) primary healthcare facilities in Malaysia. Materials and Methods: A budget impact analysis was conducted from the MOH provider perspective over a 5-year time horizon (2025\textendash2030). The eligible population comprised women of reproductive age utilising contraceptive services in primary care, with a baseline of 1.29 million users and projected annual growth of new users. Four scenarios were developed and modelled: (1) status quo (implant use maintained at approximately 9%), (2) incremental growth (implant uptake increases by 2.5 percentage points annually), (3) moderate expansion (implant uptake reaching 25% by Year 5), and (4) large-scale adoption (implant uptake reaching 40% by Year 5). Annual method-specific costs were applied using Malaysia-specific cost data, and changes in method mix were modelled assuming proportional displacement of oral contraceptives and depot-medroxyprogesterone acetate (DMPA) injectable methods, while intrauterine contraceptive device utilisation was held constant. Deterministic sensitivity analysis was done to reduce the uncertainties by varying key parameters, including costs (±20%), implant uptake (±10%), and population size (±5%). Results: Total annual contraceptive expenditure increased across all scenarios, with cumulative 5-year costs estimated at MYR582.4 million under the status quo, MYR594.6 million under incremental growth, MYR598.1 million under moderate expansion, and MYR612.7 million under large-scale adoption. The incremental budget impact compared with the status quo ranged from MYR12.2 million to MYR30.3 million over the 5-year period. Cost increases were gradual and followed a predictable trajectory, with no evidence of abrupt budget escalation. Deterministic sensitivity analysis demonstrated that the results were robust to variations in key parameters, with wider uncertainty observed in higher adoption scenarios but without altering the relative ranking of scenarios. Conclusion: Increasing contraceptive implant adoption in Malaysia is associated with a moderate and manageable increase in healthcare expenditure. The gradual and predictable cost trajectory observed across scenarios indicates that scaling up implant use is unlikely to impose abrupt financial strain on the healthcare system. These findings are particularly relevant in the Malaysian context, where healthcare financing operates within constrained public budgets. In addition, the displacement of less cost-effective short-acting contraceptive methods, such as oral contraceptives and DMPA injectables, contributes to improved allocative efficiency within existing resources. The consistency of results under sensitivity analysis further strengthens confidence in the robustness of these projections for policy planning. When considered alongside prior CEA findings demonstrating implants as the most cost-effective option, these results suggest that expanding implant use is both economically efficient and financially feasible. A phased scale-up strategy is recommended to optimise affordability while improving reproductive health outcomes, aligning with national efforts to strengthen primary care services and close gaps in public health delivery.},

note = {Type: Oral Presentation; Organisation: ¹ Tumpat District Health Office, Ministry of Health Malaysia, Kelantan, Malaysia, ² Department of Social Work, Education and Community Wellbeing (SWECW), Northumbria University, United Kingdom; Corresponding author: Mohamad Hafiz Harun, hafizmd@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-652,

title = {From Directives to Dialogue: Developing a Culturally Adapted Brief Motivational Interviewing Module for Risky Drinking Among Indigenous Communities},

author = {Aimi Nadira Mat Ruzlin1 Mariam Mohamad1 Rifhan Rasuli1 and Engku Mardiah Engku Kamarudin2},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Indigenous communities are disproportionately affected by risky drinking, potentially leading to substantial health disparities. Unfortunately, current psychological interventions remain predominantly directive, information-centric, and lack cultural sensitivity, often demanding compliance rather than fostering autonomy. Addressing this gap, this study aimed to develop and evaluate the validity and acceptability of a culturally adapted brief motivational interviewing (MI) module for the local Indigenous community in Malaysia. Materials and Methods: Guided by the Medical Research Council framework for complex interventions, module development was commenced by anchoring the content on the Information-Motivation-Behavioural Skills model, while content delivery was structured using an MI approach. Initial drafts were appraised by a multidisciplinary panel composed of a psychologist with expertise in MI and two public health physicians specialising in health promotion and disease prevention, using the nominal group technique. Following extensive consultations with the local Indigenous Jakun community, cultural adaptations were incorporated using Bernal’s Ecological Validity Model across five dimensions: language, persons, contents, goals, and context. The revised module subsequently underwent content and face validation by a panel of raters comprising a medical officer of Jakun descent and two counsellors trained in MI and experienced in serving the Indigenous community. Finally, acceptability and appropriateness were assessed among participants (n=3) in a Jakun settlement in Rompin, Pahang, using the Malay version of the Acceptability, Appropriateness, and Feasibility Intervention Measures (AIM-IAM-FIM) questionnaire. Results: The finalised module consists of three sessions, from establishing rapport to exploring ambivalence to promoting coping strategies. The module shifts treatment goals from strict abstinence to harm reduction, and explicitly integrates family dynamics, the basics of local Indigenous dialect, essential non-verbal cues, and scripted socio-economic enquiries to enhance rapport and familiarity. Each session may last for approximately 30 minutes and can be conducted in appropriate, distraction-free settings to ensure confidentiality. Both the item-level content validity index (I-CVI) across relevance, clarity, simplicity, and ambiguity, and the item-level face validity index (I-FVI) across clarity and understanding demonstrated a perfect score of 1.00. The AIM-IAM-FIM scores ranged from 4.25 to 4.75, indicating a classification between ‘acceptable and appropriate’ and ‘highly acceptable and appropriate’. Discussion/Conclusion: Promoting a paradigm shift from rigid directives to collaborative dialogue, the module offers a structured, non-confrontational protocol designed to engage clients who may be resistant or in denial regarding their habits. By applying specific cultural competencies to bridge communication barriers and build trust, this approach encourages a partnership-based interaction that respects individual autonomy. At the same time, the I-CVI and I-FVI highlight the module’s relevance and clarity for the target population, while the AIM-IAM-FIM scores indicate that it is well-received by the participants. However, these findings should be interpreted with caution due to the small panel of raters and sample sizes. Ultimately, this intervention provides a practical, culturally informed approach to reduce risky drinking, contributing to ongoing efforts to improve health outcomes in partnership with the local Indigenous community.},

note = {Type: Poster Presentation; Organisation: 1 Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia. 2 Department of Counsellor Education and Counselling Psychology, Faculty of Educational Studies, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia.; Corresponding author: Rifhan Rasuli, drrifhan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-636,

title = {From Fragmentation to Coordination: A Patient-Led Approach to Strengthening Rare Disease Systems in Malaysia},

author = {Siti Saidatina Fatima Binti Abu Bakar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Rare diseases may be individually uncommon, but together they represent a real and growing public health concern. In Malaysia, there has been increasing attention at policy level, but implementation on the ground remains fragmented across different parts of the health system. This affects early diagnosis, continuity of care, and access to services. This is especially evident in conditions such as Epidermolysis Bullosa (EB), a rare genetic skin disorder where the skin is extremely fragile and can blister or tear with minimal friction, often requiring lifelong care. There is a need to look at rare diseases beyond individual conditions and consider how the system responds as a whole. Materials and Methods: This paper is based on a qualitative, practice-based approach from the perspective of a patient advocate actively engaged in the rare disease space. Insights are drawn from ongoing interactions with healthcare providers, policymakers, and patient groups, as well as direct observation of current initiatives and coordination efforts in Malaysia. Results: Several gaps are consistently observed. Roles and responsibilities across divisions are not always clear, there is still no integrated national rare disease registry, and patient groups are not yet systematically included in policy design and implementation. These gaps make coordination difficult and slow down progress. The formation of the Rare Diseases Coalition Malaysia (RDCM) shows how a patient-led platform can help bring different stakeholders together, improve communication, and support more coordinated efforts. Discussion/ Conclusion: Rare diseases should be seen as a system issue, not a niche area. Moving forward, a more coordinated and practical approach is needed, with stronger integration across sectors and meaningful involvement of patient groups. Patient advocates can play a useful role in connecting policy and real-world experience, especially in a system that is still evolving.},

note = {Type: Poster Presentation; Organisation: 1DEBRA Malaysia, 63000 Cyberjaya, Selangor Darul Ehsan, Malaysia.; Corresponding author: Siti Saidatina Fatima Binti Abu Bakar, saida@debramalaysia.org},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-464,

title = {From Fragments to Flow: Adaptive Frontline Integration in Langkawi, Malaysia},

author = {Devi Shantini A/P Rata Mohan² Nur Azmiah Zainuddin² Tg Mohamad Iskandar Tg Mohamad Rosman1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Integrated care models in Asia-Pacific typically follow top-down policy implementation. This study reveals a contrasting bottom-up phenomenon in Langkawi, a geographically isolated Malaysian island where healthcare workers spontaneously created integration mechanisms to overcome systemic barriers. With one hospital serving multiple dispersed primary clinics, patients with multi-morbidities face fragmented care across non-interoperable digital systems, while acute staff shortages and geographic isolation compound coordination challenges. We examine how frontline providers bridged these gaps through adaptive, informal collaboration. Materials and Methods: We conducted a qualitative study with 42 in-depth interviews and 7 focus group discussions involving 64 purposively sampled participants (healthcare providers, managers, local agency representatives) until thematic saturation. Data were analysed thematically using NVivo 14 through inductive coding, with triangulation across data sources. Results: Three interconnected adaptive strategies emerged locally from frontline workers: (1) Staff Mobilisation: Hospital specialists conduct two-weekly outreach clinics at primary care facilities, while radiographers cross-deploy between sites. For example, endocrinologists now see poorly controlled diabetes patients with complications directly at primary care clinic level, eliminating the previous 3-4 hospital visits annually per patient. (2) Asset Sharing: Clinics share medications, laboratory consumables, and departmental transport. Hospital-only medications are now shared with primary care facilities, eliminating patient trips to the hospital solely for medication collection. (3) Information Transfer: Providers created WhatsApp groups and shared cloud platforms to bridge the hospital-primary care data gap. Medication lists, discharge care plans, and urgent alerts now reach referring doctors and nurses within hours rather than weeks via formal channels. These initiatives improved care continuity and medication adherence, enabled more patient-centred care practices, reduced patient travel burden, and enhanced provider satisfaction despite resource constraints. Conclusion: Critically, these solutions emerged not from policy directives but from shared professional values, trust networks, and frontline leadership, reflecting what we term "adaptive integration under constraint." However, their informality creates vulnerability: sustainability depends on individual commitment and collapses when key personnel transfer.},

note = {Type: Oral Presentation; Organisation: 1Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, 2Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 3Hospital Sultanah Maliha, Langkawi, Kedah, Malaysia; Corresponding author: Tg Mohamad Iskandar Tg Mohamad Rosman, tgiskandar@moh.gov.my; This pattern mirrors the informal integration observed in remote Philippine and Indonesian island health systems, suggesting a broader Asia-Pacific phenomenon in which geographic isolation catalyses grassroots innovation. Policy Implications: Health systems must transition from overlooking to institutionalising such frontline innovations. We propose a "Remote Health Cluster Framework" where formal governance structures support resource pooling (staff, assets, data) while preserving the flexibility for providers to share resources informally and adapt practices based on local relationships and trust. This requires recognising that sustainable rural integration may require different policy architecture than urban models, one that legitimises and resources adaptive collaboration rather than imposing rigid standardisation. For Asia-Pacific's 10,000+ inhabited islands, understanding and scaling this bottom-up integration model is not peripheral, it's essential to achieving universal health coverage in geographically challenging contexts.},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-645,

title = {From Learning to Practice: Exploring Nurses’ Self-Efficacy After a Psychoeducation-Based Person-Directed Burnout Intervention Package in a Malaysian Public Hospital},

author = {Ili Abdullah Sharin1 Norehan Jinah1 Pangie Bakit1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Burnout among hospital nurses is a growing public health concern in Malaysia’s Ministry of Health, mainly due to high workload, emotional demands, and workforce constraints. A 2019 nationwide study reported high burnout prevalence, 24.4%, among public hospital nurses, indicating the need for targeted burnout management interventions. Existing interventions are generally categorised as person-directed and organisational-directed approaches. However, organisational interventions often require significant resources, time, and strong commitment from multiple stakeholders, making them challenging to implement in real-world settings. In contrast, person-directed interventions, particularly psychoeducational interventions, focus on strengthening individual resilience, self-care, and psychological well-being through approaches such as mindfulness and cognitive behavioural therapy. In response, the Psychoeducation-Based Person-Directed Burnout Intervention Package was developed in 2025 through a modified Delphi process to ensure it is evidence-based and suitable for the local context. This study aimed to explore participant self-efficacy following intervention implementation, focusing on the learning, application, and adaptability of activities in workplace and personal settings. Materials and Methods: As part of a feasibility study, this qualitative research was conducted following a two-day intervention programme in August 2025. 21 nurses were purposively sampled from Hospital Tengku Permaisuri Norashikin, Kajang, located in the central zone with documented high burnout prevalence based on predefined criteria. One month after the intervention, all participants were invited to focus group discussions, of whom ten consented. Three focus group discussions were conducted using a semi-structured interview guide. Audio recordings were transcribed verbatim and analysed using thematic analysis. Open and axial coding were conducted iteratively with regular team discussions to enhance analytical rigour, followed by deductive mapping into three predefined domains. A qualitative data analysis software was used to support data management and analysis. Results: Three main thematic domains, namely learning activities, application, and adaptability, were identified. First, participants reported learning a wide range of psychoeducational skills, including stress and coping strategies, emotional regulation, resilience, empathy, communication, and boundary-setting. These findings aligned with the 13 psychoeducational clusters in the intervention module, covering both self-management and relationship management components. Second, participants described the application of these skills in both work and personal settings, including managing emotions during heavy workload, reframing negative thoughts, supporting colleagues, and utilising support networks. Many participants combined multiple strategies, reflecting the practicality and flexibility of the interventions. Third, participants demonstrated adaptation of these skills across different situations, with improved emotional control, increased confidence in communication, and positive behavioural changes. Colleagues and superiors also recognised these improvements, indicating meaningful adaptation in daily practice. Conclusion: Upon completion of the programme, participants were able to apply what they learned in their daily work, with sustained use observed at least one month after the intervention. The findings suggest that the intervention is feasible and may support improvements in nurses’ self-efficacy in managing stress and interpersonal challenges, with potential to support burnout prevention. The intervention shows promise as a practical approach for the public healthcare setting, and further large-scale evaluation is recommended. This highlights the practical value of the intervention in supporting frontline nurses in resource-constrained settings.},

note = {Type: Poster Presentation; Organisation: 1Institute for Health Management, National Institutes of Health (NIH), Selangor, Malaysia.; Corresponding author: Pangie Bakit, pangiebakit@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-703,

title = {From Paper to Cloud: Impact of A Cloud-Based Clinical Management System (CCMS) On Patient Waiting Time in Klinik Kesihatan Telipok, Kota Kinabalu},

author = {Nirmal Kaur1 Mohd Shamril1 Shahkinna J1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Timely access to healthcare is an important component of quality primary care. Long waiting times remain a common challenge in busy public health clinics and may affect patient satisfaction and service delivery. The Malaysian Ministry of Health recommends that at least 90% of patients in primary care facilities should be attended to within 90 minutes. To improve clinic workflow and patient management, a cloud-based Clinical Management System (CCMS) was implemented at Klinik Kesihatan Telipok. This study aimed to evaluate the impact of CCMS implementation on patient waiting time. Materials and Methods: A retrospective before-and-after study was conducted at Klinik Kesihatan Telipok. Pre-implementation data were obtained from clinic records in 2023, while 1-year post-implementation data were extracted from the CCMS database in 2025. Waiting time was defined as the duration from patient registration until completion of consultation and medication dispensing. Maternal and Child Health services were excluded due to different patient flow processes. Descriptive analysis was used to determine the proportion of patients seen within 90 minutes. Results: A total of 4,311 patient visits were analysed before CCMS implementation and 3,328 visits after implementation. Prior to CCMS implementation, only 65.5% of patients were seen within 90 minutes, which was below the national target. Following implementation, the proportion increased to 91.9%, exceeding the recommended standard. The proportion of patients waiting more than 90 minutes decreased from 34.5% to 8.1%. Discussion/ Conclusion: The findings of this study demonstrate that the implementation of the cloud-based Clinical Case Management System (CCMS) was associated with a significant improvement in patient waiting time at Klinik Kesihatan Telipok. The proportion of patients seen within 90 minutes increased from 65.5% before implementation to 91.9% after implementation, exceeding the national waiting time target for primary care clinics. This improvement suggests that the digital system enhanced clinic workflow and patient flow management by integrating registration, consultation, and medication dispensing within a single platform, which may reduce delays and improve coordination among healthcare providers. These results highlight the role of digital transformation in strengthening primary healthcare service delivery. Digital systems can support better monitoring of patient flow and improve administrative efficiency, particularly in busy public clinics. This is consistent with global evidence that health information systems contribute to improved health system performance and quality of care. Although this study was conducted in a single clinic and other operational factors may have influenced the results, the findings suggest that cloud-based clinical management systems can enhance service efficiency and support timely access to primary healthcare, contributing to Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG 3). Implementation of the cloud-based Clinical Case Management System was associated with a significant improvement in patient waiting time performance. The findings highlight the potential role of digital health systems in improving clinic efficiency and supporting timely access to primary healthcare services.},

note = {Type: Poster Presentation; Organisation: 1Family Health Development Division, Kota Kinabalu Area Health Office, Kota Kinabalu, Sabah, Malaysia.; Corresponding author: Shahkinna J, nurshahkinna@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-750,

title = {From Policy to Practice: Evaluating Implementation and Timeliness of Public Health Policy Papers in Malaysia},

author = {Jamiatul Aida Md Sani1 Khairul Hafidz Alkhair Khairul Amin1 Normaslina Mustaza1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Public health policy papers serve as a critical bridge between strategic planning and programme implementation. While policies are often well-developed, their successful translation into practice remains a key challenge within health systems. Evaluating the extent of implementation and identifying barriers are essential to strengthen governance, improve accountability, and enhance overall system performance. This study examines the implementation status of public health policy papers and assesses their timeliness and underlying challenges. Materials and Methods: A cross-sectional descriptive analysis was conducted using documented public health policy papers from 2020 to 2023. A total of 24 policy papers were reviewed. Variables analysed included responsible division, implementation status, implementation within 12 months, and reasons for non-implementation. Data were extracted and analysed using descriptive statistics, including frequencies and percentages, to evaluate overall implementation trends and patterns. Results: Out of 24 policy papers, 19 (79.2%) were successfully implemented, while 5 (20.8%) were not implemented. In terms of timeliness, 17 policy papers (70.8%) were implemented within 12 months, whereas 7 (29.2%) exceeded the expected timeframe. The majority of policy papers were developed by the Disease Control Division (n=10), followed by the Nutrition Division (n=5) and the Family Health Development Division (n=4). Among the non-implemented policies, the primary reason identified was the need for further review and refinement (n=4), while one policy was affected by external organisational changes. These findings indicate that most implementation barriers are internally driven rather than externally constrained. Conclusion: The findings demonstrate a strong overall implementation rate of public health policy papers. However, delays in implementation and the need for policy revisions highlight gaps in policy readiness and planning processes. Strengthening pre-implementation assessment, stakeholder engagement, and monitoring mechanisms are essential to improve timeliness and ensure effective translation of policies into practice.},

note = {Type: Poster Presentation; Organisation: 1Public Health Development Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Normaslina Mustaza, masyi79@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-718,

title = {From Screening to Detection: Strengthening the Colorectal Cancer Screening Cascade in Selangor},

author = {Siti Diyana Ibrahim¹ Noor Rafizah Aminah Aziz¹ Mohd Faizal Kasnan¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Colorectal cancer remains a significant public health burden in Malaysia. Screening using the immunochemical faecal occult blood test (iFOBT) enables early detection of colorectal cancer and pre-cancerous lesions. This study evaluated the performance and outcomes of the colorectal cancer screening programme in Selangor from 2022 to 2025. Materials and Methods: A retrospective descriptive analysis was conducted using secondary programme data from 2022\textendash2025. Variables analysed included number screened, iFOBT positivity rate, colonoscopy referral acceptance, colonoscopy uptake, and colonoscopy findings. Results: A total of 23,161 individuals were screened over four years. The iFOBT positivity rate declined from 17.2% in 2022 to 8.2% in 2025. Acceptance of colonoscopy referral remained consistently high (88.5%\textendash95.8%). Colonoscopy uptake among those who consented improved from 51.3% to 72.3% during the study period. Among individuals who underwent colonoscopy, 42.4%\textendash50.2% had normal findings, while 19.2%\textendash30.0% were diagnosed with colonic polyps or adenomas. Confirmed colorectal cancer detection ranged from 1.5% to 6.1%. Discussion/ Conclusion: The Selangor colorectal cancer screening programme demonstrated progressive improvement in colonoscopy uptake and meaningful detection of pre-cancerous lesions. Strengthening follow-up mechanisms and addressing barriers to colonoscopy completion are essential to maximise programme impact and further reduce colorectal cancer burden.},

note = {Type: Poster Presentation; Organisation: ¹Non-Communicable Diseases Unit, Selangor State Health Department, Shah Alam, Selangor, Malaysia. 2Selangor State Health Department, Shah Alam, Selangor, Malaysia.; Corresponding author: Mohd Faizal Kasnan, faizalkasnan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-486,

title = {From Silos to Synergy: A Shared Digital Platform for Advancing Integrated School Health Services},

author = {Nur Iryani G2 Intan Melati AB1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: School-Based Integrated Care (SBIC) initiatives often struggle with the “Collaboration Trap,” characterised by organisational silos, misaligned goals, and interdepartmental rivalries. From the school’s perspective, fragmented engagement from multiple health programs can create administrative burden, scheduling conflicts, miscommunication, and occasionally overlooked or duplicated service requests. These inefficiencies undermine holistic student care and strain school\textendashhealth sector partnerships. This study examined whether a shared digital scheduling platform (Google Calendar) could strengthen coordination between public health units and school administrators while the School Health Unit took a role as the primary point of contact. Materials and Methods: A qualitative study utilised the Integrated People-Centred Health Services (IPCHS) framework focusing on service coordination across sectors. A digital calendar integrated schedules for mental health, dental, and nutrition services, with the School Health Unit acting as the central hub for information exchange and approvals between school administration and health programs. Feedback from practitioners and school leaders was analysed to assess enhancements in task distribution, service integration, and communication clarity. Results: From the school administration perspective, the shared calendar reduced scheduling overlaps, minimised forgotten or duplicated requests, and simplified approval processes. The School Health Unit’s role as a single referral gateway enhanced accountability and ensured continuity of communication. For health teams, real-time visibility of activities reduced perceived inequities and fostered collaborative planning. The system enabled coordinated “one-stop” service delivery, improving efficiency and responsiveness to student needs. Conclusion: A shared digital scheduling platform, anchored by a centralised School Health Unit referral structure, can mitigate silos and reduce administrative burden for schools. When supported by transparent leadership and shared accountability, digital coordination tools promote trust, streamline communication, and advance person-centred, integrated school health systems.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Pendang, Pendang, Kedah 2Unit Kesihatan Sekolah, Pejabat Kesihatan Daerah Pendang, Pendang, Kedah; Corresponding author: Nur Iryani Binti Ghazali, drnuriryani@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-480,

title = {Genomic Characterisation of Antimicrobial-Resistant Escherichia coli from Dairy Farm Environments in Selangor, Malaysia},

author = {Syahidiah Syed Abu Thahir1 Sakshaleni Rajendiran1 Yuvaneswary Veloo1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Antimicrobials are the keystone of modern medicine, revolutionising the management of infectious diseases in both humans and animals. Nonetheless, the extensive use of antimicrobials in animal production has accelerated the emergence and dissemination of antimicrobial resistance (AMR) worldwide. Agricultural settings, particularly dairy farms, act as critical hotspots where resistant bacteria and mobile genetic elements can accumulate, persist, and disseminate within soil, water, and effluent systems. These environmental components exploit as reservoirs, allowing AMR to spread between animals, humans, and the environment. Escherichia coli, a commensal bacterium commonly found in the intestinal microbiota of livestock, serves as an important indicator organism for assessing environmental AMR dynamics. Despite recognition of dairy farms as potential AMR and antimicrobial resistance gene hotspots, comprehensive genomic characterisation of E. coli in the environment remains limited. Therefore, this study aimed to investigate the genomic variety, plasmid contents, and ARGs profiles of E. coli isolated from dairy farm environments in Selangor using whole-genome sequencing (WGS). Materials and Methods: A total of 20 confirmed E. coli isolates were selected for WGS analysis. These isolates were obtained from environmental samples, including soil, farm effluent, and cow faeces, collected across eight dairy farms in Selangor. These isolates underwent genomic DNA extraction followed by PCR-free library preparation and sequencing on the Illumina MiSeq platform. High-quality sequence reads were assembled and analysed using established bioinformatic pipelines. Multilocus sequence typing was performed to determine the sequence types (STs), while the Galaxy platform was used to identify plasmids and detect acquired ARGs. Results: Whole-genome analysis revealed considerable genetic diversity among the isolates, with predominant STs including ST58, ST48, ST10, ST223, and ST162. Multiple plasmid replicons were identified, with some isolates carrying more than one plasmid type. The most frequent plasmid detected belonged to IncF family. This IncF plasmid contained ARGs conferring resistance to several antimicrobial classes, underscoring its importance in resistance gene dissemination. Genotypic analysis identified a wide-ranging spectrum of ARGs, including β-lactamase genes (blaCTX, blaTEM, blaOXA), tetracycline resistance genes (tet(A), tetX), aminoglycoside-modifying enzyme genes, trimethoprim resistance genes (dfrA), sulfonamide resistance genes (sul2, sul3), and other genes such as floR, fosA3, and mphA. Notably, four phenotypically confirmed ESBL-producing isolates harboured blaCTX genes, demonstrating concordance between phenotypic and genotypic findings. Conclusion: The findings demonstrate that dairy farm ecosystems in Selangor harbor genetically diverse E. coli populations carrying clinically and epidemiologically relevant resistance genes. The presence of multidrug resistance genes and transferable plasmids highlights the role of agricultural environments as reservoirs and expansion for AMR. Continuous genomic surveillance, together with improved antimicrobial stewardship and farm-level biosecurity measures, is essential to reduce the risk of resistance transmission across the animal\textendashenvironment\textendashhuman interface.},

note = {Type: Poster Presentation; Organisation: 1Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia 2Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia.; Corresponding author: Yuvaneswary Veloo, yuvanes@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-705,

title = {Hari Raya Celebration Sparks Food Poisoning Outbreak at Pre-Matriculation Institution, Kuala Langat, Selangor on 18-19 April 2025.},

author = {Siti Khadijah Sunarno2 Ardianah Mansor2 Muhammad Nazir Hassan1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {INTRODUCTION: On 19 April 2025, a food poisoning outbreak was reported among adolescent students at Kolej Matrikulasi Selangor, Banting, following the consumption of food prepared by an external caterer before the Hari Raya celebration. Although epidemiologically consistent with Bacillus cereus infection, the outbreak also provided insight into behavioural and psychosocial factors affecting adolescent mental wellbeing in institutional settings. This study aimed to investigate the food poisoning outbreak, identify the etiological agent, and associated risk factors, behavioural and psychosocial factors associated with the incident. MATERIALS \& METHODS: A case\textendashcontrol study involving 63 cases and 126 controls was conducted. A case was defined as any Block Mira student who consumed the catered food on 18 April 2025 and developed at least one acute gastrointestinal symptom between 18 to 25 April 2025. Epidemiological, environmental and laboratory investigations were performed alongside an assessment of food handling behaviours and practices. RESULTS: The overall attack rate was 13.88%, affecting female adolescents from Block Mira. Consumption of chicken rendang was significantly associated with illness (OR = 10.5; 95% CI: 3.11, 35.50; p\<0.001), identifying it as the most probable vehicle of infection. While clinical specimens were negative, B. cereus was isolated from a serving wok and a food handler hand swab. Hazard Analysis and Critical Control Point assessment identified multiple behavioural and system-level failures including poor personal hygiene compliance, inadequate temperature control and prolonged food holding beyond recommended limits. Beyond physical illness, the outbreak had potential mental health and behavioural implications for affected adolescents including increased anxiety, academic disruption and reduced concentration. Such experiences may have negatively influenced students perceived safety, emotional wellbeing and learning engagement. DISCUSSION/ CONCLUSION: The outbreak was consistent with a point-source event caused by B. cereus (diarrhoeal type) and was declared over after one incubation period. This incident highlighted the need to integrate behavioural science and mental health considerations into food safety management and outbreak preparedness in adolescent educational institutions during festive celebrations.},

note = {Type: Poster Presentation; Organisation: 1 Hulu Langat District Health Office, Selangor, Malaysia. 2 Kuala Langat District Health Office, Selangor, Malaysia; Corresponding author: Muhammad Nazir Hassan (nazirbhassan@gmail.com)},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-511,

title = {Healthy Shanghai (2019-2024): A Case Study of Multisectoral Health Promotion in a Megacity},

author = {Tong Wang2 Lin Zhu1 Mingfei Xu1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: This case report examines Shanghai’s comprehensive health promotion strategy under the Healthy Shanghai Action (2019-2030), presenting it as a model for urban health advancement in megacities. Materials and Methods: Through systematic analysis of policy implementation, monitoring data, and innovative practices up to 2024, we document how Shanghai has operationalised the “health in all policies” approach. Results: Key findings demonstrate substantial health gains attributable to Shanghai's integrated governance model. Life expectancy reached 85.35 years, while infant and maternal mortality rates remained at record lows (2.04‰ and 1.62%, respectively). Health literacy improved to 42.09%, and the adult smoking rate declined to 19.2%, the lowest among mainland Chinese cities. These outcomes stem from a coordinated framework involving 18 thematic action groups that embed health considerations across education, environment, urban planning, and other sectors. Innovative mechanisms include establishing China’s first provincial-level health promotion media centre, launching the nationally recognised Health Talk Show program, and incorporating health science popularisation into medical professionals' performance evaluations. Digital transformation through the Shanghai Health Cloud platform has enhanced data sharing, smart referrals, and telemedicine access. Environmental health indicators show 88.5% good air quality days and 97.5% of surface water meeting high standards. Conclusion: The COVID-19 pandemic response highlighted Shanghai’s strengthened public health infrastructure, with increased investments in surveillance systems, emergency preparedness, and community-level capacity. Persistent challenges include reducing youth consumption of sugar-sweetened beverages, expanding the nursing workforce, and stabilising health technology transfer revenues. Based on these findings, we recommend that other urban settings: (1) institutionalise cross-sectoral governance structures with clear accountability mechanisms; (2) integrate health promotion metrics into professional incentive systems; (3) leverage digital platforms to address health equity gaps; and (4) secure sustained political commitment through legislative frameworks. Shanghai’s experience demonstrates that a systems-based, data-driven approach can accelerate progress toward sustainable urban health development and universal health coverage.},

note = {Type: Poster Presentation; Organisation: 1Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai，China, 2Shanghai Patriotic Health Campaign Committee Office, Shanghai, China; Corresponding author: Mingfei Xu, xumingfei@shdrc.org},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-502,

title = {Heatwave and Healthcare System Burden in Developing Countries: A Systematic Review},

author = {Mohamad Ikhsan Selamat2 Rohaida Ismail1 Hadita Sapari1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Heatwaves are an increasingly prominent consequence of climate change and represent a major threat to population health globally. These events contribute to excess morbidity and premature mortality, disproportionately affecting vulnerable population groups and placing substantial pressure on healthcare systems. While the health system impacts of heatwaves have been widely studied in developed countries, evidence from developing countries remains fragmented, despite constrained healthcare resources and adaptive capacity. This evidence gap constrains progress towards Sustainable Development Goal (SDG) 3, which seeks to ensure healthy lives and promote well-being for all, and SDG 13, which emphasises urgent action to address climate-related risks. This systematic review aimed to synthesise existing evidence on the impact of heatwaves on healthcare services in developing countries to inform climate-resilient health system planning. Materials and Methods: The review protocol was prospectively registered with PROSPERO (CRD42022365471). A comprehensive search of peer-reviewed literature was conducted using Web of Science, PubMed, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies published between January 2002 and April 2023 that examined heatwave exposure and healthcare-related outcomes were included. Outcomes of interest comprised emergency ambulance dispatch, emergency department visits, hospital admissions, outpatient department visits, in-hospital mortality, and healthcare expenditure. Methodological quality and risk of bias were assessed using the Navigation Guide framework. Results: Nineteen studies met the inclusion criteria. Overall, heatwave exposure was consistently associated with increased healthcare service utilisation in developing countries. Hospital admissions were the most frequently reported outcome, with 12 of 19 studies (63%) demonstrating a positive association with heatwave exposure. These admissions commonly occurred within 0\textendash3 days following exposure and involved multiple conditions, including respiratory infection, cardiovascular, renal, metabolic, perinatal, mental health, and heat-related illnesses, with notable increases in mental health admissions, neonatal intensive care unit admissions, and renal conditions such as urolithiasis. Evidence also indicated heatwave increased utilisation of other healthcare services, including emergency ambulance dispatch (n = 3), emergency department visits (n = 4), outpatient department visits (n = 2), in-hospital mortality (n = 1), and healthcare expenditure (n = 1). Vulnerable groups, including older adults, children, outdoor workers, and socioeconomically disadvantaged populations, experienced disproportionately higher healthcare utilisation. Assessment Risk of Bias (RoB) indicated that approximately 67% of the studies yielded a ‘definitely low’ RoB, high quality of evidence (4+), and sufficient strength of evidence on the positive association between heatwave and their impacts on healthcare services. Conclusion: Heatwave exposure is strongly associated with increased healthcare system burden in developing countries. These findings highlight the need for climate-resilient health systems, including heat-health action plans, early warning systems, strengthened surveillance, and targeted intervention for vulnerable populations. Strengthening healthcare infrastructure, workforce preparedness, and intersectoral collaboration will be critical to mitigate the growing health impacts of extreme heat under climate change.},

note = {Type: Oral Presentation; Organisation: 1 Environmental Health Research Centre, Institute of Medical Research, National Institute of Health, Malaysia, 2 Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Malaysia; Corresponding author: Hadita Sapari, drhadita@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-730,

title = {Hidden in Plain Sight: A 10-Year Retrospective Study of Leprosy with Grade 2 Disability (G2D) in Selangor (2015\textendash2026)},

author = {Mardhiah Z. 1 Siti Hasmah I.1 Nurul Hidayu O.¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: In 1994, Malaysia successfully achieved leprosy elimination status. Nevertheless, the disease remains a relevant public health concern. In Selangor, new cases of leprosy are still being reported, with a proportion of patients presenting with Grade 2 Disability (G2D) at the time of diagnosis, indicating delayed detection and ongoing transmission within the community. This study aims to determine the prevalence of G2D and identify its associated risk factors among registered leprosy patients in Selangor. Materials and Methods: A retrospective cross-sectional study was conducted using secondary data from the national MyHansen leprosy registry between 2015 and 2025. A total of 311 confirmed cases of leprosy were analysed. Missing data for onset dates were addressed using median imputation. Data were analysed using descriptive statistics, alongside Chi-Square and Fisher’s Exact tests for bivariate associations. Multivariable binary logistic regression was performed to identify factors associated with G2D, and the Mann-Whitney U test was utilized to evaluate diagnostic delay durations. Results: The overall prevalence of G2D at diagnosis was 6.1% (n=19). The adjusted overall median diagnostic delay was 119 days. Following median imputation, patients with G2D experienced a significantly prolonged median delay of 277 days compared to 86.5 days for non-G2D patients (p = 0.031). Multivariate analysis revealed that patients residing in the Hulu Selangor district had significantly higher odds of presenting with G2D compared to those in other districts (AOR = 10.027, 95% CI: 2.23, 45.05},

note = {Type: Poster Presentation; Organisation: ¹Selangor State Health Department,40100 Shah Alam, Selangor, Malaysia.; Corresponding author: Nurul Hidayu O., hidayu.omar@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-748,

title = {Hidden Risks in Unregistered Care: Lessons from a Tuberculosis Outbreak in a Residential Facility in Taiping, Malaysia},

author = {‘Ammar Amsyar Abdul Haddi1 Mohd Zafrullan Zamberi2 Muhammad Naim Ibrahim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Tuberculosis (TB) outbreaks in institutional settings pose significant public health challenges, particularly among high-risk populations such as the elderly and individuals with mental illness. In December 2025, a TB outbreak was declared at an unregistered residential care facility in Kamunting, Taiping, Perak, following the detection of two smear-positive TB cases with associated mortality, involving vulnerable residents. The facility housed individuals with multiple comorbidities in a high-density environment, increasing susceptibility to disease transmission. This study aimed to confirm the outbreak, identify the source and mode of transmission, assess its magnitude, and implement appropriate control measures to prevent further spread. Materials and Methods: An outbreak response was initiated following the declaration on 4th December 2025. A comprehensive approach was implemented, including active case detection (ACD), environmental assessment, risk communication, and inter-agency collaboration. All residents and staff underwent screening using symptom assessment, sputum AFB examination, IGRA, and chest radiography. Environmental risk assessment was conducted to identify factors contributing to transmission. Data were collected using standardised line listing and assessment checklists. Control measures included closure of the facility under the Prevention and Control of Infectious Diseases Act 1988, implementation of infection control measures, and multi-agency coordination to reduce overcrowding, improve ventilation, and enhance hygiene. Continuous monitoring, health promotion, and workforce deployment were maintained throughout the outbreak period. Results: A total of 119 individuals were screened (100% contact coverage), comprising 99 residents and 20 non-residents (2 managers, 15 workers, and 3 workers’ family members). Three TB cases were identified among residents, including two smear-positive cases associated with mortality and one additional case detected through ACD. In addition, 11 individuals were diagnosed with LTBI, while the remaining were negative. The affected population had a mean (S.D) age of 51.7 (15.7) years, comprising individuals with multiple vulnerabilities, with psychiatric illness (59.6%) being the most common comorbidity. Environmental assessment identified key risk factors for transmission, including overcrowding, inadequate ventilation, shared living spaces, and poor infection control practices. The facility was unregistered with relevant authorities, including the Social Welfare Department (JKM) and Ministry of Health (MOH), and did not meet fire safety requirements. Several inter-agency engagements were conducted involving the JKM, local municipal council, state religious department, and Hospital Taiping to support outbreak management and ensure continuity of care. The outbreak remains under active surveillance, with no new cases detected up to April 2026, and is expected to be declared over by 29th June 2026. Conclusion: This outbreak highlights the need for greater caution regarding unregistered residential care facilities, where lack of regulation can increase the risk of tuberculosis transmission, particularly among vulnerable populations in high-density environments with inadequate infection control. A coordinated, multi-sectoral response enabled effective containment, demonstrating the importance of early detection, active surveillance, and inter-agency collaboration in outbreak management. These findings emphasise the need to strengthen regulation, registration, and routine health screening of such facilities to reduce transmission risk and improve preparedness for future outbreaks.},

note = {Type: Poster Presentation; Organisation: 1Larut, Matang and Selama District Health Office, Taiping, Perak, Malaysia. 2Department of Community Health, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia.; Corresponding author: Muhammad Naim Ibrahim, dr.naimibrahim@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-467,

title = {Hidden wounds, visible harm: trauma exposures and protective coping linked to self-harm in Malaysian youth mental health services},

author = {Nor Asiah Muhamad2 * Siti Sabrina Kamarudin1 and team},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Public mental health services frequently manage self-harm among adolescents and young people, yet routine assessments may not consistently capture upstream trauma exposures or protective coping resources that could guide early intervention. We examined which ACE domains and coping resources were independently associated with self-harm among young people referred to Psychiatry and Mental Health Services in Malaysia, to inform service-level screening and targeted support. Materials and Methods: This cross-sectional analysis used clinician-administered, interviewer-guided assessments from patients aged 10\textendash24 years referred to public Psychiatry and Mental Health Services. Of 1,244 eligible patients, 1,164 completed the questionnaire. Self-harm status was recorded as part of clinical care and examined against ACE domains and coping resources assessed through clinician-led interviews. We compared self-harm status across exposures using bivariate analyses and then fitted multivariable logistic regression models to identify independent associations, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Of 1,164 participants, 827 (71.0%) were identified as having self-harm. In bivariate analyses, all coping factors and 10 of 13 ACE domains were significantly associated with self-harm (p\<0.05). In the adjusted model, three coping resources remained protective: perceived ability to cope with stress (aOR 0.33, 95% CI: 0.24, 0.46; p\<0.001), perceived responsibility to loved ones or pets (aOR 0.71, 95% CI: 0.51, 0.97; p=0.035), and social support (aOR 0.64, 95% CI: 0.41, 0.99; p=0.048). ACE domains independently associated with higher odds of self-harm included history of emotional abuse (aOR 1.82; p\<0.001), sexual abuse (aOR 1.51; p=0.036), violence against household members (aOR 1.46; p=0.043), bullying (aOR 2.00; p\<0.001), and witnessing community violence (aOR 1.69; p=0.002). Conclusion: Self-harm was highly prevalent in this clinical-based sample and was independently associated with multiple ACE domains, particularly interpersonal and violence-related exposures. At the same time, modifiable coping resources and social connectedness showed protective associations. These findings support trauma-informed service approaches that combine systematic ACE screening with brief interventions aimed at strengthening coping skills and social support, alongside pathways for addressing violence exposure among young people presenting to mental health services.},

note = {Type: Poster Presentation; Organisation: 1Clinical Research Center Hospital Shah Alam, Institute for Clinical Research, National Institute for Health, Ministry of Health, Setia Alam, Malaysia., 2Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia., 3Department of Psychiatry and Mental Health, Hospital Raja Perempuan Zainab II, Kelantan, 4Department of Psychiatry and Mental Health, Hospital Tengku Permaisuri Norashikin, Selangor, 5School of Medical Sciences, University Sains Malaysia, Kelantan, 6Department of Psychiatry and Mental Health, Hospital Tengku Ampuan Rahimah, Selangor, 7National Centre of Excellence in Mental Health, Cyberjaya, Selangor; Corresponding author: Siti Sabrina Kamarudin, ssabrina@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-780,

title = {High Yield, Low Coverage: A Paradox in Thalassemia Screening Among Adolescents \textemdash A District-Level Study from Kluang District Health Office, Johor, Malaysia (2023\textendash2025)},

author = {Nor Hana Ahmad Bahuri1 Mohd Hafiidz bin Baharudin1 Nurus Soffina Abd Razak1 Nazmeen Adline Fawwazah bt A Fauzi1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Thalassemia is a major inherited hematological disorder and a significant public health concern in Malaysia. School-based screening programs targeting adolescents aim to identify carriers early and reduce future disease burden; however, incomplete screening coverage may limit program effectiveness. This study aimed to evaluate screening coverage, detection yield, and missed opportunities in thalassemia screening among Form 4 students in a high-risk district. Materials and Methods: A retrospective cross-sectional study was conducted using secondary data from the district-level school-based thalassemia screening program from 2023 to 2025. The study population included all enrolled Form 4 students. Data collected included annual enrolment, number screened, screening completion, and laboratory-confirmed carrier status. Screening coverage was calculated as the proportion screened out of total enrolment, while detection yield per 1,000 screened students was computed. Missed opportunity was defined as the number of unscreened students, and projected missed diagnoses were estimated by applying the observed detection rate to the unscreened population. Results: A total of 12,208 students were enrolled (2023-2025), of whom 5,481 were screened, yielding an overall coverage of 44.9%, which improved from 19.3% in 2023 to 62.9% in 2025. Screening completion rate was high at 96.5%. A total of 364 thalassemia carriers were detected, corresponding to an overall detection yield of 66.4 per 1,000 screened students. Annual detection yield remained consistently high (90.7/1,000 in 2023, 59.8/1,000 in 2024, and 64.3/1,000 in 2025), indicating a persistently high underlying carrier prevalence. Despite this, 6,727 students (55.1%) were not screened mainly due to financial constraint, representing a substantial missed opportunity; an estimated 447 additional carriers may have remained undetected over the study period. Hemoglobin E was the most common abnormality detected (168 cases), followed by alpha thalassemia (132 cases) and beta thalassemia (55 cases), with only two cases of thalassemia disease identified. Conclusion: These findings demonstrate a paradox of high detection yield despite suboptimal coverage, suggesting that while the program is effective in identifying carriers, a large proportion of the target population remains unscreened. Strengthening screening coverage, particularly in high-burden districts, is essential to maximize early detection and reduce future thalassemia burden, and targeted strategies should be implemented to address this critical gap.},

note = {Type: Poster Presentation; Organisation: 1 Maternal Child Health Unit, Kluang District Health Office, Johor, Malaysia. 2Public Health Division, Johor State Health Department, Johor, Malaysia.; Corresponding author: Nazmeen Adline Fawwazah bt A Fauzi, dr.nazmeen@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-667,

title = {Hypertension and Its Associated Factors in Coastal and Highland areas of Cirebon, West Java, Indonesia: A Cross-Sectional Study},

author = {2Catur Setiya Suistiyana 1Eni suhaeni 1Uswatun Khasanah},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hypertension remains a major public health challenge worldwide, especially in communities where social and environmental conditions may shape health risks differently. This study aimed to describe the epidemiological profile of hypertension and identify its associated factors in coastal and highland areas of Cirebon Regency, West Java, Indonesia. Materials and Methods: A cross-sectional analytic study was conducted in Cirebon Regency, West Java, Indonesia among adults aged 18\textendash65 years attending public health centers. A total of 281 respondents were included, consisting of 134 participants from coastal areas and 147 from highland areas. Data were collected using structured questionnaires and blood pressure measurements. Variables assessed included sex, age, education, occupation, socioeconomic status, family history of hypertension, obesity, physical activity, smoking, alcohol consumption, and sodium intake. Data were analysed using univariate analysis and chi-square tests. Results: Hypertension was more prevalent in coastal than in highland areas (75.4% vs. 51.0%). In coastal communities, age (p=0.004), occupation (p=0.028), and obesity (p=0.028) were significantly associated with hypertension. In highland communities, sex (p=0.018), age (p=0.015), education (p=0.015), occupation (p=0.010), and family history of hypertension (p\<0.001) were significantly associated with hypertension. No significant associations were found for socioeconomic status, physical activity, smoking, or sodium intake in either setting. Conclusion: Hypertension was highly prevalent in both areas, especially in coastal communities. The different patterns of associated factors across settings suggest that hypertension prevention and control strategies should be adapted to local contexts. Public health interventions should therefore be tailored to local conditions, with greater attention to obesity-related risk in coastal areas and to educational and familial risk factors in highland communities.},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health, Faculty of medicine, Universitas Swadaya Gunung Jati, Indonesia, 2Department of Medical education, Faculty of medicine, Universitas Swadaya Gunung Jati, Indonesia; Corresponding author: Uswatun Khasanah, Uswatun Khasanah},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-544,

title = {IDENTIFYING CHALLENGES IN HEALTH BEHAVIOUR ACQUISITION: INSIGHTS FROM THE TUNAS DOKTOR MUDA PROGRAMME (2023\textendash2025)},

author = {Mohd Razif Zakaria1 Nor Faizadatul Ain Abd Wahid1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The Tunas Doktor Muda (TDM) Programme is a health promotion initiative implemented across selected preschools and kindergartens in Malaysia to cultivate essential healthy behaviour among children aged five to six years. The programme monitors the acquisition of basic health practices through structured health education activities. This analysis examines the achievement patterns of specific health behaviours among preschool and kindergarten children based on programme monitoring data over a three-year period. Materials and Methods: Secondary data from programme monitoring records for the years 2023 to 2025 were analysed. Seven health behaviours were assessed, with the programme target requiring at least 80% of participating children to achieve "Mastered" (Telah Menguasai) status for at least five out of the seven assessed behaviours. Descriptive analysis was conducted to identify trends and variations in behaviour achievement across the three-year duration. Results: The analysis indicates that several behaviours consistently achieved high levels. Personal hygiene practices, including proper waste disposal (94%), handwashing (90%), and toothbrushing (86%), showed high levels of achievement throughout the observed period. However, certain behaviours demonstrated comparatively lower achievement levels and failed to reach the 80% target. These included consuming a variety of foods, particularly vegetables (73%) and the ability to distinguish between medicine and food (51%). Conclusion: The findings highlight significant variations in the achievement of different health behaviours among participating children. Identifying behaviours with lower achievement levels provides critical insights for programme enhancement and the development of targeted health education strategies. Further exploration of these behaviours is warranted to better understand the factors influencing the acquisition of specific health practices among preschool and kindergarten children.},

note = {Type: Poster Presentation; Organisation: 1Health Education Division, Ministry of Health; Corresponding author: Nor Faizadatul Ain Abd Wahid, faizadatul@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-497,

title = {Impact of an Artificial Intelligence\textendashBased Antibiotic Recommendation System (AI-Abx) for Acute Infection in Primary Health Clinic in Samarahan, Sarawak},

author = {Hii EHH3 Chua CL2 Chan LPY1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Antimicrobial resistance constitutes one of the ten most significant threats to public health, characterised by a rising incidence of antibiotic-resistant infections. The development of the Biojustice Webapp (AI-Abx), which incorporates Artificial Intelligence to provide antibiotic recommendations based on the National Antibiotics Guideline, Malaysia, serves a crucial function as a clinical decision support system (CDSS), particularly in the management of acute infections within primary healthcare settings. Therefore, this study was designed to ascertain the impact and usability of the AI-Abx system. Materials and Methods: Retrospective data were retrieved from the AI-Abx and categorised into pre- (January - June 2025) and post-AI-Abx implementation periods (July-December 2025). Comparisons were made regarding oral antibiotic consumption, quantified by the defined daily dose (DDD), the associated cost incurred, and the rate of acceptance of the AI-Abx recommendations. Results: The utilisation of AI-Abx demonstrated an increase of 51.88%, reaching 1411 entries, with a high recommendation acceptance rate of 92.37%. A notable reduction in the total DDD was observed following the implementation of AI-Abx (Pre-implementation: 87.26; Post-implementation: 57.35; a decrease of 29.91), accompanied by a reduction in antibiotic cost totalling MYR4,078.19 (a 13.99% decrease). The most substantial reductions in DDD were recorded for cloxacillin (-11.11), followed by amoxicillin (-9.85) and cephalexin (-5.43). The consumption of broad-spectrum antibiotics (Amoxicillin/Clavulanate tablets) decreased by -2.91 DDD, resulting in a cost reduction of MYR2,419.31, which accounts for 59.3% of the total cost reduction. The highest reductions in DDD were documented at KK Sebuyau (-6.53), followed by KK Samarindah (-5.06) and KK Asajaya (-5.42). Conversely, the reattendance rate showed a slight increase from 0.12% to 0.18%. Conclusion: The integration of AI has demonstrated a significant impact on antibiotic prescribing practices. The observed increase in AI-Abx usage and the high rate of recommendation acceptance suggest that prescribers place trust in the AI-driven suggestions. Furthermore, the reduction in total DDD, antibiotic costs, and the prescribing of broad-spectrum antibiotics are consistent with the core objectives of antimicrobial stewardship (AMS). However, the marginal increase in the reattendance rate of 0.06% post-implementation necessitates further investigation to determine whether this is attributable to undertreatment or to an improvement in the detection and recording of reattendance episodes following the AI-Abx deployment. A previous local qualitative study indicated a neutral perception regarding manpower reduction. This finding underscores the perceived burden on prescribers associated with parallel documentation within AI-Abx, a recognised barrier in CDSS where the time expenditure on data entry is extended. Nevertheless, other studies have indicated a decreasing trend in the time required for data entry over time. The evidence regarding the impact of AI-Abx clearly attests to its usability and its valuable role in optimizing antibiotic prescribing. Future initiatives should concentrate on user interface optimization and comprehensive user training to enhance operational efficiency.},

note = {Type: Poster Presentation; Organisation: 1Samarahan District Health Office, Sarawak, Malaysia 2Asajaya Health Clinic, Sarawak, Malaysia 3 Samarindah Health Clinic, Sarawak, Malaysia; Corresponding author: Laura Chan Pei Yian, laurachan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-623,

title = {Impact of the COVID-19 Pandemic on Outpatient Healthcare Utilization in Lithuania: Age, Gender, and Urban\textendashRural Differences},

author = {Skirmante Sauliune1 Aurimas Galkontas1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The COVID-19 pandemic highlighted important challenges in the functioning of healthcare systems, particularly in the provision and use of outpatient healthcare services. However, empirical evidence on how different levels of outpatient care and population groups were affected remains limited, especially in the context of urban\textendashrural differences. The aim of this study is to assess the impact of the COVID-19 pandemic on the use of outpatient healthcare services across different levels of care, focusing on variations by age, gender, and place of residence in Lithuania. Materials and Methods: National data on outpatient health care service utilization in Lithuania during 2017\textendash2023 were analysed. The dependent variable was the number of outpatient visits per 100 residents. Differences between population groups were assessed using the Mann\textendashWhitney U test, considering service level, age group (\<65 and ≥65 years), gender, and place of residence (urban vs. rural). Due to non-normal data distribution, results are presented using medians and interquartile ranges. Effect sizes (r) were calculated to assess the magnitude of differences. Results: A consistent decline in outpatient healthcare utilization was observed across all levels of care and population groups during the pandemic period. The reduction was particularly pronounced among older adults (≥65 years), who experienced the largest decreases in total healthcare visits in both urban and rural areas. In urban areas, declines among older populations reached around one-third of pre-pandemic levels, indicating substantial changes in service use. Younger populations (\<65 years) also showed reductions in service utilization, although the magnitude was generally smaller compared to older adults (≥65 years). Statistically significant decreases were observed in selected younger age groups, particularly among urban men (p = 0.029), while in most other groups the changes approached statistical significance (p = 0.057). Across both age groups, reductions were more pronounced in primary health care compared to secondary and tertiary services. Rural populations experienced similar trends, although decreases were generally less marked than in urban areas and often did not reach statistical significance (e.g.},

note = {Type: Poster Presentation; Organisation: 1Lithuanian University of Health Sciences, Kaunas, Lithuania; Corresponding author: Aurimas Galkontas, aurimas.galkontas@lsmu.lt},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-648,

title = {Implementation Readiness of a Mindfulness-Based Support Resource for Depression in Malaysian Primary Care: A Cross-Sectional Study},

author = {Chen Xin Wee1 Zahir Izuan Azhar1 Asma’ Khalil1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Depression continues to place a substantial burden on individuals and health systems worldwide. In primary care, mild to moderate depressive symptoms are commonly managed in settings where consultation time is limited and access to specialist mental health services may be restricted. To address this gap, a structured mindfulness-based resource was previously developed for primary care providers using a theory-driven process, refined through expert consensus, and supported by content and face validation. However, its suitability for routine implementation in practice has not yet been established. This study examined primary healthcare providers’ views on the acceptability, appropriateness, and feasibility of a structured mindfulness-based support resource intended for use in managing depression in Malaysian primary care clinics. Materials and Methods: A cross-sectional online survey was carried out among healthcare providers from selected primary care clinics in Selangor. Clinics were chosen through systematic random sampling. Eligible participants included providers involved in mental health screening activities or services within non-communicable disease units in each clinic. Participants were given an electronic version of the resource and approximately two weeks to review it before completing the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure questionnaire. Descriptive statistics summarised respondent characteristics and implementation outcome scores. Pearson correlation, independent-samples t-tests, and one-way ANOVA were used to explore differences across participant groups. Results: A total of 151 primary healthcare providers completed the survey. Participants had a mean age of 37.83 years (SD 5.67), and the majority were women (80.8%). Ratings across implementation outcomes were generally positive. Mean scores were 4.13 (SD 0.55) for acceptability, 4.07 (SD 0.59) for appropriateness, and 3.96 (SD 0.61) for feasibility. These findings indicate that respondents viewed the resource favourable overall, with feasibility rated slightly lower than the other domains. No statistically significant differences were found in implementation outcome scores according to age, sex, ethnicity, professional category, years of service, or clinic type (all p\>0.05). Overall satisfaction was also high, with a mean score of 4.21 (SD 0.78), and 84.8% of respondents gave ratings of 4 or 5. Conclusions: The findings suggest that this structured mindfulness-based resource was well received by primary care providers and was perceived as relevant and workable for routine practice. Although feasibility scores were slightly lower than acceptability and appropriateness scores, the overall pattern supports further testing in real service settings. These results provide early evidence that the resource may be suitable for pilot implementation in Malaysian primary care.},

note = {Type: Poster Presentation; Organisation: 1Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia. 2Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.; Corresponding author: Asma’ Khalil, drasma@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-724,

title = {Implementing Reflex Thalassaemia Testing in Kedah: Improving Carrier Detection and Genetic Findings through Population-Based Screening},

author = {Hafizah H¹. Siti Rohana A¹. Ngee Wen S¹.},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Thalassaemia is among the most common inherited blood disorders in Malaysia and remains a major public health concern. Early identification of carriers through population-based screening is essential for prevention. In Kedah, school-based thalassaemia screening among Form Four students is part of the national prevention strategy. However, the conventional screening approach often led to delays in confirmatory testing and substantial loss to follow-up among students requiring further investigation. To address these challenges, Kedah is the only state in Malaysia to introduce a reflex testing approach to streamline the screening and diagnostic pathway in 2025. Materials and Methods: In 2024, reflex thalassaemia testing was integrated into the existing school health screening programme for Form Four students throughout Kedah. Blood samples with abnormal screening indices (Hb ≥12.0 g/dL with MCH ≤27.0 pg) were automatically referred for confirmatory testing, including DNA analysis. The process was guided by the Malaysia Thalassaemia Diagnosis Code (MTDC), which was incorporated into the haemoglobin analysis report. This approach eliminated the need for repeat visits and additional sample collection. Programme data were analysed to determine screening coverage, carrier detection rates, genetic findings, laboratory turnaround time, and loss to follow-up. Results: A total of 17,585 Form Four students, representing 86.8% of enrolment, underwent thalassaemia screening. Initial full blood count results identified 29.4% of students as suspected carriers, and 14.5% were subsequently confirmed through diagnostic testing. The implementation of reflex testing, including automatic DNA analysis, eliminated loss to follow-up entirely (0% compared with 27.8% previously) and reduced the turnaround time for DNA results from 25 weeks to 16 weeks, enabling earlier diagnosis and more timely clinical decision-making. The combined prevalence of Hb E and beta-thalassaemia carriers was 64.2 per 1,000 students screened. Kedah also records the third-highest number of Hb E/beta-thalassaemia disease cases nationwide. In addition, alpha-thalassaemia carriers accounted for 30% of all thalassaemia carriers detected. As the diagnosis of alpha-thalassaemia carriers requires DNA analysis, the reflex testing model was particularly valuable. The most frequently identified mutations were the α3.7 kb deletion, the Southeast Asian (SEA) deletion, and the Hb Constant Spring mutation. The prevalence of alpha-thalassaemia carriers was estimated at 68.9 per 1,000 students screened. Conclusion: The implementation of reflex testing in Kedah represents an effective strategy for improving thalassaemia carrier detection and generating important population-level genetic data. This approach enhances programme efficiency, eliminates follow-up loss, and strengthens thalassaemia prevention efforts in Malaysia. Future efforts should focus on expanding genetic counselling services, particularly to reduce the burden of Hb E/beta-thalassaemia, HbH disease, and Hb Bart’s hydrops fetalis.},

note = {Type: Poster Presentation; Organisation: ¹ Family Health Unit, Kedah State Health Department, Simpang Kuala, Alor Setar, Kedah, Malaysia. ²Family Health Division, Ministry of Health Malaysia, Putrajaya, Malaysia; Corresponding author: Ngee Wen S., drngee.ws@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-537,

title = {Implementing the WHO Integrated Care for Older People (ICOPE) Framework for Nationwide Scale-Up: A function-centred primary care integration model in Kedah},

author = {Noraliza M². Nor Azilla¹ Siti Rohana A¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The World Health Organization (WHO) introduced the Integrated Care for Older People (ICOPE) framework in 2019 to advance healthy ageing through a four-step pathway: assessment of intrinsic capacity (IC) across five domains (cognition, locomotion, vitality, sensory, and psychological), in-depth assessment, development of a care plan, and follow-up. In Malaysia, the Ministry of Health is adopting the full WHO ICOPE framework, including replacing the existing Borang Saringan Status Kesihatan (BSSK) with the Malay translated and validated WHO ICOPE tool to support nationwide WHO ICOPE framework scale-up. A pilot study in Kedah was conducted to operationalise this model through integration of the ICOPE care pathway into primary care. Central to this framework is a function-centred model of care, which focuses on maintaining functional ability rather than managing diseases alone. This approach emphasises early detection of functional decline through integration with the National Health Screening Initiative (NHSI) at both clinic and community levels, followed by referral for in-depth assessment, intrinsic capacity\textendashbased risk stratification, and targeted multidisciplinary interventions based on functional status, with ongoing follow-up and community engagement. This Kedah pilot demonstrates a practical function-centred primary care integration model with holistic care to inform nationwide implementation of the full WHO ICOPE framework in Malaysia. Materials and Methods: A pilot implementation study was conducted in nine health clinics in Kubang Pasu, Kedah. Individuals aged ≥60 years attending primary care clinics from February to July 2025 were screened using the Malay-translated WHO ICOPE tool alongside National Health Screening Initiative components (blood glucose, blood pressure, cholesterol, Body Mass Index, and mental health screening) by trained healthcare workers. Individuals then were assessed across intrinsic capacity (IC) domains and categorised into two groups: high and stable capacity, or declining capacity. Those with stable IC received lifestyle advice, community engagement (Wellness Hubs/Elderly Clubs), annual screening recommendations, and national immunisation. Individuals identified with potential health or social decline were referred for in-depth assessment using standard reference tools (MMSE, SPPB, MNA-SF, GDS-14, WHO visual acuity chart, and Whisper Test) and managed through multidisciplinary care pathways, coordinated by clinic care managers with referral to community and social services. Patient information, IC domain outcomes, and social data were collected and monitored using standardised Excel-based reporting systems by the Family Health Unit, Kedah State Health Department. Results: A total of 565 older adults were screened, comprising 220 males and 345 females, with the majority aged 60\textendash69 years (n=339). Of these, 250 (44.2%) required in-depth assessment, while those with stable intrinsic capacity were provided with lifestyle advice, encouraged to participate in Wellness Hub and Elderly Club activities, advised on annual NHSI/ICOPE screening, and offered national immunisation. The prevalence of decline in intrinsic capacity (IC) domains was highest for vision (21.5%) and mobility (19.95%), followed by hearing (3.35%), cognitive (2.47%), depressive symptoms (1.77%), and vitality (nutrition) (1.76%). Referrals and follow-up included geriatric services (n=3), occupational therapy (n=14), physiotherapy (n=16), orthopaedics (n=2), cataract clinic (n=3), fundoscopy (n=2), ophthalmology (n=29), ENT (n=6), counselling (n=3), and psychiatry (n=4), with multidisciplinary care pathways initiated for individuals with confirmed decline. However, a notable proportion of clients declined in-depth assessments, particularly in the mobility domain (n=52 refusals), as well as in hearing and vision domains. Conclusion: This pilot demonstrates the feasibility of integrating the WHO ICOPE tool into routine primary care in Malaysia, particularly when aligned with NHSI workflows, with the Malay translation enabling standardised screening across settings.},

note = {Type: Poster Presentation; Organisation: ¹ Family Health Unit, Kedah State Health Department, Alor Setar, Kedah, Malaysia, ²Family Health Division, Ministry of Health Malaysia, Putrajaya, Malaysia, ³Kubang Pasu District Health Office, Jitra, Kedah, Malaysia, ⁴Kedah State Health Department, Alor Setar, Kedah, Malaysia; Corresponding author: Dr siti rohana Ahmad, drsitirohana@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-498,

title = {Imprisoned by Measles: Early Detection and Containment of Measles in a Correctional Facility in Selangor - A Case Report},

author = {Saidatul Fadzlyana binti Mohamad Isa2 Farah Asilah binti Mahmood2 Shirley Christina Santhanasamy1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measles remains one of the most highly contagious vaccine-preventable viral diseases and continues to pose a significant public health challenge, particularly in high-density institutional settings such as correctional facilities. Overcrowding, close contact among detainees, and restricted movement create conditions that facilitate rapid transmission once a case is introduced. Early detection and rapid public health response are therefore critical to preventing widespread outbreaks. This case study describes the detection, investigation, and containment of a measles outbreak in a correctional facility in Selangor, Malaysia. Materials and Methods: In December 2025, two detainees from Sungai Buloh Prison were identified as laboratory-confirmed measles cases following notification from Hospital Sungai Buloh. The first detainee developed prodromal symptoms of fever, cough, and coryza, followed by rash onset four days later, and was subsequently admitted for further evaluation. Three days after the first case’s symptom onset, a second detainee from a different housing block developed similar symptoms, with rash appearing two days later. Laboratory investigations confirmed measles infection in both individuals (Measles IgM Positive). Epidemiological assessment identified multiple close contacts among detainees and prison wardens. As both individuals had remained within the correctional facility prior to symptom onset, intra-institutional transmission was considered likely. Following laboratory confirmation, an immediate outbreak response was initiated. Control measures included formal outbreak declaration, enhanced surveillance for fever-rash illness, isolation of confirmed cases, and active monitoring of identified contacts. Health education sessions were conducted for prison wardens and clinic personnel to improve awareness of measles transmission, early symptoms, and infection prevention practices. Prison health staff were also advised to strengthen medical documentation and detainee movement tracking to facilitate contact tracing. Results: A targeted vaccination intervention was implemented through a supplementary immunisation activity conducted seven days after confirmation of the cases to rapidly increase population immunity. During this activity, 876 detainees from the affected housing blocks received measles-rubella vaccination. No additional cases were detected during the monitoring period, and the outbreak remained limited to two confirmed cases. Conclusion: This case highlights the importance of strong surveillance systems, rapid outbreak investigation, and coordinated collaboration between correctional institutions, healthcare providers, and public health authorities in preventing and controlling outbreaks in closed settings.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Gombak, Selangor, Malaysia, 2Jabatan Kesihatan Negeri Selangor, Selangor, Malaysia; Corresponding author: Dr. Shirley Christina Santhanasamy, dr.shirley@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-517,

title = {Improving Mental Health Service Utilisation Among Public Primary Healthcare Workers: Insights from a Qualitative Study in Malaysia},

author = {Ahmad Azuhairi Ariffin2 Halimatus Sakdiah Minhat2 Norhafizah Mohd Noor¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Mental health problems among healthcare workers are increasingly recognised as an important occupational and public health concern. Healthcare workers often experience demanding workloads and workplace pressures that may negatively affect psychological well-being and job performance. Although mental health services are available within the public healthcare system, utilisation remains low. Evidence on facilitators of mental health service utilisation among healthcare workers remains limited, particularly in Malaysia and other Asian settings where cultural stigma and workplace norms may influence help-seeking behaviour. Understanding these facilitators is important to inform workplace policies and interventions that support early help-seeking and improve workforce well-being. This study aimed to explore facilitators of mental health service utilisation among public primary healthcare workers in Malaysia. Materials and Methods: A qualitative study using in-depth semi-structured interviews was conducted among public primary healthcare workers in Negeri Sembilan, Malaysia. Participants were purposively selected from nurses, doctors, assistant medical officers, and assistant environmental health officers who had utilised mental health services within the past 12 months, including for screening, treatment, or counselling. Data were collected between May and June 2023 using a semi-structured interview protocol conducted by a trained interviewer. Interviews explored participants’ experiences and factors influencing mental health service utilisation. All interviews were audio recorded with consent and transcribed verbatim. Data were analysed using inductive thematic analysis involving familiarisation with transcripts, coding, development of categories, and identification of themes through an iterative process. Data collection continued until thematic saturation was achieved. Results: Seventeen healthcare workers participated in the study. Thematic analysis generated fourteen codes that were organised into five key facilitator themes influencing mental health service utilisation. The first theme, mental health training, improved knowledge of mental health conditions, reduced stigma, and increased familiarity with available services, thereby enhancing confidence to seek professional support. The second theme, co-worker support, highlighted the role of emotional, informational, and practical workplace support in encouraging help-seeking behaviour. The third theme, accessibility of services, including workplace-based services and convenient referral pathways, facilitated easier access to mental health care. The fourth theme, workplace mental health screening programmes, increased awareness of mental health status and promoted early engagement with services when conducted confidentially. The fifth theme, functional impairment, acted as a trigger for help seeking when declining work performance or difficulties in daily functioning became evident. Collectively, these themes demonstrate that mental health service utilisation is shaped by interacting predisposing, enabling, and need factors as described in the Anderson Behavioural Model of Health Service Use. Conclusion: Mental health service utilisation among public primary healthcare workers is influenced by predisposing, enabling, and need-related facilitators. Strengthening mental health training, fostering supportive workplace environments, improving service accessibility, and implementing confidential screening programmes may encourage earlier help-seeking and improve workforce well-being. These findings provide important insights for strengthening workplace mental health strategies in Malaysia.},

note = {Type: Poster Presentation; Organisation: 1Sector for Evidence Based Healthcare, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia, 2Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia, ³Department of Psychiatry, Sultan Idris Shah Hospital, Kajang, Selangor, Malaysia, ⁴Clinical Research Center Hospital Shah Alam, Institute for Clinical Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia; Corresponding author: Norhafizah Mohd Noor, hafizah5674@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-463,

title = {Improving Quality of Care in Joint Replacement Through Disease-Specific Certification: A Health Systems Approach in a Tertiary Healthcare Network},

author = {1Ming-Chou KU 1Yuan-Hsin Tsai 1Min-Fei Liao},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The rising prevalence of degenerative joint diseases in ageing populations presents significant challenges to health systems, particularly in ensuring safe, efficient, and high-quality surgical care. Disease-specific care certification has emerged as a strategy to standardise clinical pathways, strengthen multidisciplinary collaboration, and improve patient safety outcomes in complex surgical services such as joint replacement. This study describes the implementation and outcomes of a disease-specific quality certification program for joint replacement care within a tertiary healthcare system in Taiwan, highlighting its relevance to healthcare management and public health system strengthening. Materials and Methods: A descriptive quality improvement approach was applied to review the development and implementation of a joint replacement disease care certification program between 2023 and 2025. The program emphasised multidisciplinary team integration, standardised care pathways, continuous education and competency assessment, patient safety monitoring, and data-driven quality management. Key components included preoperative risk assessment, infection prevention strategies, perioperative safety protocols, rehabilitation integration, and ongoing performance monitoring through defined quality indicators. Results: The certification process facilitated the establishment of a structured joint replacement care model involving orthopaedic surgeons, anaesthesiologists, nurses, rehabilitation therapists, pharmacists, and case managers. Implementation outcomes included improved care coordination, enhanced adherence to safety protocols, standardised patient education, and strengthened monitoring of surgical outcomes and complications. Continuous review mechanisms and regular interdisciplinary meetings supported sustained quality improvement. The program also contributed to workforce capacity building and organisational readiness to address the increasing demand for joint replacement services in an ageing society. Conclusion: Disease-specific care certification for joint replacement can serve as an effective health systems strategy to enhance care quality, patient safety, and service sustainability. From a public health perspective, such certification frameworks support standardised, scalable, and transferable models of quality improvement that may be applied to other high-impact clinical conditions within integrated healthcare systems.},

note = {Type: Poster Presentation; Organisation: 1Show Chwan Memorial Hospital, Show Chwan Health Care System; Corresponding author: Min-Fei Liao, irene324@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-682,

title = {Improving Thalassemia Awareness and Premarital Screening Intentions Among Secondary School Students Using the THALEA (Thalassemia Education and Awareness) Kit: Findings from a Cluster Randomized Trial},

author = {Dalila Roslan1 Nik Nairan Abdullah1 Maisarah Noor Anwar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Thalassemia remains a significant public health concern in Malaysia, where early education and premarital carrier screening are essential strategies for prevention. However, awareness and knowledge of thalassemia among adolescents remain limited, particularly among students in private religious secondary schools who may not be routinely included in structured health promotion initiatives. Limited knowledge may contribute to less favorable preventive attitudes and reduced intention to undergo screening. This study aimed to describe changes in knowledge, preventive attitudes, and intention toward premarital thalassemia screening following exposure to the THALEA (Thalassemia Education and Awareness) kit, a theory-driven and validated intervention developed through expert consensus based on the Theory of Planned Behaviour. Materials and Methods: A cluster randomized controlled trial was conducted among 197 Form Four students from eight private religious secondary schools in the Klang Valley, Malaysia. Schools were randomized into intervention and comparison groups. Outcomes assessed included knowledge scores, preventive attitude scores, and intention toward premarital screening. Data were collected at baseline (T₀) and immediately post-intervention (T₁), and descriptive analyses were used to examine changes in mean scores and proportions across groups. Results: At baseline, knowledge regarding thalassemia was generally low, with correct responses ranging from 0% to 32.0% across items. Preventive attitudes were also limited, with only 61.4% recognizing the importance of premarital screening, while agreement with more complex preventive decisions was substantially lower. The most frequently reported reason for lack of intention to undergo screening was insufficient knowledge about the screening test (39.0%), followed by fear of test results (26.0%). Following the intervention, the intervention group demonstrated marked improvements in knowledge scores (mean increase from 2.38 to 18.96), compared with smaller increases in the comparison group (1.49 to 13.28). Preventive attitude scores increased from 1.37 to 3.16 in the intervention group, while only modest changes were observed in the comparison group. The proportion of participants expressing intention to undergo premarital screening increased from 19.8% at baseline to 92.1% post-intervention in the intervention group, compared with a smaller increase in the comparison group (24.0% to 33.3%). Conclusion: These descriptive findings indicate that adolescents initially had limited awareness and suboptimal preventive attitudes toward thalassemia. Exposure to a theory-based and validated educational intervention was associated with notable improvements in knowledge, attitudes, and screening intention. The THALEA kit may serve as a practical approach to enhance thalassemia awareness and support the efforts of the national thalassemia prevention and control program among adolescents, particularly in school settings with limited access to existing health promotion programs.},

note = {Type: Poster Presentation; Organisation: 1 Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia; Corresponding author: Maisarah Noor Anwar, drmaisarahanwar@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-566,

title = {In the Blink of an Eye: A Rare Presentation of Brucellosis},

author = {Fazilah Mydin1 Rax Innocent Vincent1 Su Peng Chua1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Brucellosis is a zoonotic infection of global importance, traditionally linked to livestock exposure and unpasteurised dairy consumption. It exemplifies the One Health paradigm, where human, animal, and environmental health intersect. While systemic manifestations are well recognised, ocular brucellosis is rare, and isolated eyelid involvement is exceptionally uncommon. This case highlights the need for integrated vigilance across sectors, even in urban, low-risk populations. Materials and Methods: An 86-year-old Chinese housewife from Penang presented with left upper eyelid swelling, pain, and discharge for a 10-day duration. She had two prior episodes of similar eyelid swelling in 2015 and 2018, both treated with incision and drainage (I\&D) and negative cultures. In March 2026, she underwent I\&D at a private hospital, and swab culture confirmed Brucella melitensis. Clinical evaluation, infectious disease consultation, and home risk assessment were conducted. Family members received health education, and systemic investigations were planned. Results: The patient was clinically stable, with no systemic brucellosis symptoms such as fever, malaise, or arthralgia. She reported no history of animal contact or consumption of unpasteurised dairy products. Environmental assessment of her home revealed no obvious risk factors. Microbiological confirmation of Brucella melitensis was obtained from eyelid swab culture. She was treated with oral antibiotics for two weeks, alongside topical ocular therapy. Blood cultures and serology were scheduled for further evaluation. Family members were counselled on symptom recognition and advised to seek care if unwell. Conclusion: This case underscores the One Health challenges of Brucellosis. First, it demonstrates that zoonotic infections can emerge outside classical epidemiological contexts, raising questions about hidden reservoirs and transmission pathways. Second, the recurrent nature of eyelid swelling culminating in Brucella isolation highlights the importance of microbiological investigation in atypical ocular infections. Third, the absence of systemic features suggests localised brucellosis, complicating diagnosis and delaying targeted therapy. The public health response, which includes active case detection, family education, and environmental assessment, illustrates the value of integrated surveillance linking clinical, community, and environmental domains. Isolated ocular brucellosis in a homebound elderly patient illustrates the unpredictable nature of zoonotic infections and the necessity of a One Health approach. Public health systems must remain alert to atypical presentations, strengthen laboratory capacity, and integrate human, animal, and environmental surveillance. Raising awareness among clinicians and communities is essential to prevent delayed recognition and safeguard against wider transmission.},

note = {Type: Poster Presentation; Organisation: 1Timur Laut District Health Office, Georgetown, Penang, Malaysia; Corresponding author: Su Peng Chua, chuasupeng@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-704,

title = {Incidence of Hepatitis C infection and its associated risk factors among PUSPEN inmates: An Observational Study},

author = {Jia Jun W1 Meerabaanu M1 Norlizah P1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Around 58 million people worldwide have chronic hepatitis C virus (HCV) infection, with 1.5 million new cases reported each year. Between 2003 and 2017, 23,112 cases of hepatitis C were documented in Malaysia. According to Malaysia Health Facts 2019, the incidence rate of HCV infection is 8.65 per 100,000 people. An Iranian meta-analysis from 2018 reports that intravenous drug users had the highest prevalence of HCV (53%) overall. But there is scarce data available in Malaysia about the prevalence of HCV infection and the risk factors that go along with it, especially for PUSPEN inmates. The objective of this study is to obtain the incidence of HCV infection, the demographic data, high-risk behaviours and their associated factors among the inmates in PUSPEN Kota Tinggi. Materials and Methods: This is a retrospective cross-sectional study. Medical data obtained from risk behaviour screening form and hepatitis C blood investigation, from July 2020 until June 2021, among inmates in PUSPEN Kota Tinggi. Results: The incidence of Hepatitis C is 12.9%, with a mean age of inmates is 35.58±7.134. The three main risk behaviours identified were inhalational drug use, history of incarceration, and multiple sexual partners with 94.2%, 48.9%, and 31.7%, respectively. There is a significant association between risk identified with HCV infection, namely history of incarceration, IVDU, and tattoos, with x2\<0.001. Whereas piercing, transgender, and HIV with x2\<0.006, 0.024, and 0.034, respectively. Conclusion: The incidence of HCV infection among inmates in PUSPEN Kota Tinggi is 12.9%. The significant associated factors identified include history of incarceration, IVDU, tattoo, piercings, transgender, and HIV.},

note = {Type: Poster Presentation; Organisation: 1Bandar Mas Healthcare Clinic, Kota Tinggi, Johor, Malaysia.; Corresponding author: Norlizah P1 drnorlizah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-585,

title = {Independent Predictors of Leptospirosis in a Rural Endemic District in Malaysia: Insights from Routine Surveillance Data},

author = {Mohd Safrin Mohamad Bashaabidin1 Noor Haslinda Ismail1 Muhammad Adzdzin Adlan Aszahari1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Leptospirosis is a neglected tropical zoonosis causing an estimated 1.03 million cases and nearly 58,900 deaths annually worldwide. Despite being preventable, it remains a persistent public health threat driven by interactions between environmental conditions and behavioural exposures. Jelebu District is predominantly rural, characterised by forested areas, hilly terrain, and scattered settlements. A substantial proportion of its population is engaged in agriculture and plantation-related activities, while numerous rivers, waterfalls, and eco-recreational sites increase environmental exposure risks. In 2025, Jelebu District reported the highest leptospirosis incidence in Negeri Sembilan despite declining trends in neighbouring districts. Cases occurred sporadically without clear clustering, suggesting ongoing environmental transmission rather than point-source outbreaks. To identify independent predictors of laboratory-confirmed leptospirosis among reported cases in Jelebu District, Negeri Sembilan using routine surveillance data. Materials and Methods: A cross-sectional study was conducted using national E-Notifikasi data and standardised case investigation records. Universal sampling of all probable cases reported between 2022 and 2025 was analysed. Cases were classified based on national case definition, with microscopic agglutination test (MAT) seropositivity as the outcome. Descriptive analyses were performed, followed by bivariate analysis using simple logistic regression. Multicollinearity was assessed, and multiple logistic regression using Enter, Forward, and Backward Likelihood Ratio methods was applied to identify the most parsimonious model, which was selected as the final model for analysis. Results: A total of 167 probable leptospirosis cases were included, of which 38.3% (n = 64) were laboratory confirmed by MAT. Most cases occurred among working-age adults aged 19\textendash59 years (62.9%), males (77.2%), and individuals of Malay ethnicity (65.3%). Cases were distributed across multiple mukim without a distinct hotspot. Environmental exposures were common, particularly outdoor activity (56.9%) and rodent exposure (55.1%), while recreational (24.0%) and untreated water exposure (21.0%) were also reported. Although more cases occurred during the non-rainy season (58.7%), MAT positivity was higher during the rainy season (50.7% vs. 29.6%). After adjustment, cases during the rainy season had 2.64 times higher odds of MAT-confirmed leptospirosis (aOR 2.64, 95% CI: 1.33, 5.23},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Jelebu, Kuala Klawang, Negeri Sembilan; Corresponding author: Muhammad Adzdzin Adlan Aszahari, dradzdzinaszahari@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-450,

title = {Insulinoma Initially Misdiagnosed as Migraine},

author = {Abed M. Zaitoun³⁴ Irbaz Ahmed² Javeria Hameed¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Insulinoma is a rare functional neuroendocrine tumour of the pancreatic islet cells, characterised by inappropriate endogenous insulin secretion leading to neuroglycopenic and autonomic symptoms that are relieved with glucose. Methods and Materials: We describe the case of a 39-year-old woman who experienced recurrent symptoms of hypoglycaemia for nearly five years, including headaches, visual disturbances, and episodes of collapse. These were initially misdiagnosed as migraine, resulting in significant diagnostic delay. Her presentation to the Emergency Department following a collapse with documented hypoglycaemia prompted further evaluation. Results: During a supervised 72-hour fast, she developed symptomatic hypoglycaemia with a plasma glucose level of 1.7 mmol/L, inappropriately elevated insulin levels of 83.5 mU/L, and C-peptide levels of 2,271 pmol/L, with a negative sulfonylurea screen, confirming endogenous hyperinsulinism. Contrast-enhanced CT imaging revealed a large hyper-enhancing mass in the body and tail of the pancreas, further confirmed on ⁶⁸Ga-DOTATATE PET as a solitary somatostatin-receptor\textendashpositive lesion without metastasis. She was commenced on medical therapy, including diazoxide and subsequently octreotide due to intolerance. She underwent a laparoscopic distal pancreatectomy with splenectomy. Histopathology demonstrated a well-differentiated Grade 1 neuroendocrine tumour measuring 90×65×40 mm, with clear margins and no lymphovascular invasion. Postoperative recovery was uneventful, and follow-up imaging showed no recurrence. Conclusion: This case highlights the importance of considering insulinoma in patients with recurrent unexplained neuroglycopenic symptoms, particularly when headaches mimic migraine but improve with glucose intake. Early recognition is essential to prevent complications and avoid inappropriate treatments.},

note = {Type: Poster Presentation; Organisation: 1Department of Acute Medicine, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 2Department of Accident and Emergency, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 3 Department of Cellular Pathology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 4Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK, 5Department of Cancer Care, Southampton General Hospital, University Hospital Southampton, Southampton, UK, 6Department of Diabetes and Endocrinology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Corresponding author: Ammar Salman Syed, ammarsalman.09@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-714,

title = {Integrating Political Leadership into Public Health: Short-Term Weight and Behavioural Outcomes of the Fit Ledang Obesity Intervention Program},

author = {Siti Farhana binti Nor1 Zaid bin Kassim1 Dina Nurfarahin binti Mashudi1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The prevalence of obesity is a critical public health issue in Malaysia, where over 50% of adults are classified as overweight or obese. In the Tangkak district specifically, 64.4% of screened individuals have an abnormal weight. To address this growing concern, the Fit Ledang Program, a community-based intervention integrating local parliamentary leaders as role models, was implemented to promote healthy lifestyles. The primary objective of this study was to evaluate the program’s short-term effects on participant weight, stage of behaviour change, and perceptions of exercise and healthy eating at a three-month follow-up. Materials and Methods: A quasi-experimental pre- and post-intervention study was conducted, targeting adults with a Body Mass Index (BMI) between 25 and 40 kg/m². The study initially recruited a final sample size of 50 participants (n=50). The multi-component intervention delivered structured fitness activities, dietary counselling, and educational modules. Baseline and three-month data were collected, encompassing anthropometrics, blood parameters, physical fitness tests, and the University of Rhode Island Change Assessment (URICA) scale to measure behavioural readiness. Generalized Linear Mixed Models (GLMM) were utilized to analyse longitudinal changes and adjust for covariates. Results: Descriptive analysis of the evaluated participants (n=41) revealed a predominantly Malay cohort with a mean age of 39 years (SD: 4.536), comprising 56.1% males (n=23) and 43.9% females (n=18). Baseline health statuses were notably poor: 70.7% were classified as obese, 82.9% had abnormal blood pressure, 58.5% were pre-diabetic, and 36.6% reported zero exercise per month. Following three months of intervention, there was a statistically significant weight reduction of 9 units compared to baseline (p=0.050). However, the program did not yield significant improvements in participants’ overall readiness to change their unhealthy behaviours, exercise habits, or dietary practices. Gender emerged as a significant predictor, with males scoring significantly lower in readiness to change compared to females. Additionally, the program faced a substantial functional attrition rate, despite promised incentives, more than half of the participants failed to attend the sessions regularly, severely impacting overall adherence. Discussion/Conclusion: The Fit Ledang program successfully facilitated significant short-term weight loss, validating the potential of utilizing community leaders to drive health initiatives. Nevertheless, the absence of significant behavioural shifts, compounded by a high attrition rate where over 50% of individuals exhibited poor attendance, emphasizes the complex nature of lifestyle modification. The small sample size also restricted the statistical power of the findings. Achieving long-lasting health improvements requires extended intervention durations, innovative strategies to mitigate participant drop-off, and continuous reinforcement to translate temporary physical outcomes into permanent behavioural habits.},

note = {Type: Poster Presentation; Organisation: 1Tangkak Health District Office, Tangkak, Johor Darul Ta'zim, Malaysia.; Corresponding author: Dina Nurfarahin binti Mashudi, dinanurfarahin@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-755,

title = {Inter-Facility Transfer in Primary Healthcare: Timeliness, Process Efficiency, and Temporal Patterns},

author = {Hiziani Hidzir 2 2 Nur Aisyah Abdul Rahim 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Efficient inter-facility transfer (IFT) systems are critical for ensuring timely access to higher-level care; however, operational evidence from primary healthcare settings remains limited. Understanding IFT performance is essential for strengthening health system responsiveness. This study aimed to evaluate the timeliness and process times of IFT by priority level and to examine temporal patterns of IFT cases. Materials and Methods: A cross-sectional analysis of routinely collected IFT data (n = 2,076) was conducted for transfers from five primary health clinics under the Titiwangsa District Health Office, Kuala Lumpur, to three receiving hospitals between 17 November 2025 and 31 March 2026. Referral characteristics and process times were compared by priority level (Priority 1 vs Priority 2). Temporal patterns were analysed by hour of the day and day type (weekday vs weekend). Results: Age and sex did not differ significantly between priority levels; however, patient category, referring clinic, and receiving hospital differed significantly (p\<0.05), indicating variation in case mix and referral pathways. Most IFT cases achieved ambulance response time (ART) within 90 minutes (93.6%), with no significant difference between priority levels. Despite similar ART achievement, Priority 1 cases had shorter ART (median = 26 vs. 33 minutes},

note = {Type: Poster Presentation; Organisation: 1Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Malaysia, 2Titiwangsa District Health Office, Kuala Lumpur, Malaysia, 3Kuala Lumpur Health Clinic, Kuala Lumpur, Malaysia.; Corresponding author: Nur Aisyah Abdul Rahim, dr.aisyahrahim@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-564,

title = {Internet Addiction and Suicidal Behaviour Among Pre-University Students In Malaysia: A Cross-Sectional Study},

author = {Nithiah Thangiah1 Maslinor Ismail1 Arini Dahlia Saadudin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Suicide remains a leading cause of mortality among youth globally. Pre-university students represent a particularly vulnerable population, as they experience distinctive psychological challenges during the transitional stage between adolescence and early adulthood. Concurrently, increasing internet addiction among adolescents represents a growing public health issue. However, empirical evidence on the association between internet addiction and suicidal behaviour in pre-university populations, particularly in Malaysia, remains limited. This study aimed to determine the prevalence of suicidal behaviour and internet addiction among Malaysian pre-university students and examine their association while accounting for sociodemographic characteristics, academic performance, high-risk behaviour and psychological distress. Materials and Methods: A cross-sectional study involving 1,305 students from five Malaysian matriculation colleges was conducted using systematic random sampling. Participants completed validated self-report questionnaires, including the Malay Version of the Internet Addiction Test, the Suicidal Behaviours Questionnaire-Revised, and the Depression Anxiety Stress Scales \textendash 21-item version for mental health assessment. Descriptive statistics and a Generalised Linear Model were used to identify predictors of suicidal behaviour. Results: Overall, 20.0% of students reported suicidal behaviour (11.4% ideation, 3.5% planning, and 5.1% attempts), and over 60% met the criteria for internet addiction. Multivariable analysis revealed that internet addiction was a significant predictor of suicidal behaviour (adjusted odds ratio = 1.62, 95% confidence interval: 1.10, 2.40},

note = {Type: Poster Presentation; Organisation: 1Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Corresponding author: Arini Dahlia Saadudin, arinidahlia@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-471,

title = {Intimate Partner Violence, Marital Control and Childhood under Nutrition: Evidence Highlighting importance of Parental Education in Pakistan},

author = {Mahbubur Rahman1 Zoofa Talha1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Women’s exposure to intimate partner violence and marital control behaviours during pregnancy can negatively affect maternal health by influencing health-related behaviours such as prenatal care utilisation and dietary intake, which may lead to adverse pregnancy outcomes. Postpartum exposure to abuse can further compromise mothers’ caregiving practices, resulting in inadequate child nutrition and healthcare. In addition, delayed healthcare seeking and increased psychosocial stress, associated with intimate partner violence, may contribute to poor child’s nutritional status. This study aimed to investigate the association between maternal exposure to intimate partner violence and marital control behaviours with childhood undernutrition among children under five years of age in Pakistan. Materials and Methods: Data were obtained from the most recent Pakistan Demographic and Health Survey. Chi-square tests were used in bivariate analyses to analyse associations between explanatory and outcome variables. Prevalence for stunting, wasting and underweight was calculated. Multivariable logistic regression models were performed to analyse the associations of maternal exposure to intimate partner violence and marital control behaviours with each of the outcome variables (stunting, wasting and underweight) separately. Unadjusted and adjusted odds ratios were computed. All models were adjusted for relevant socio-demographic confounders. Sampling weights were incorporated in all analyses to adjust for complex survey design. Results: A total of N=1679 mother-child pairs were analysed. Overall prevalence of stunting, wasting and underweight was 35.8% (95%CI: 0.32-0.39), 9.3% (95%CI: 0.08-0.11) and 21.2% (95%CI: 0.18-0.24) respectively. Neither exposure to intimate partner violence nor marital control behaviour was significantly associated with childhood undernutrition. However, higher household wealth was associated with lower odds of stunting, wasting and underweight, while higher parental education was associated with lower odds of underweight and stunting. Furthermore, rural residence was associated with lower odds of underweight. Conclusion: The findings highlight the importance of integrated, multi-sectoral public health strategies to address childhood undernutrition in low- and middle-income countries. While prevention of intimate partner violence remains critical for maternal and child well-being, policies targeting socio-economic inequalities, particularly those focused on improving parental education, reducing poverty, and expanding access to basic services, are essential to achieve meaningful improvements in child nutritional outcomes. Programs should specifically target urban slums, where children face compounded risks related to poverty, overcrowding, and limited access to health and nutritional services. Coordinated action across the health, education, and social welfare sectors is therefore necessary to develop comprehensive strategies that simultaneously address violence, poverty, and childhood undernutrition.},

note = {Type: Oral Presentation; Organisation: 1 Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan; Corresponding author: Zoofa Talha drzoofa@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-587,

title = {Intramuscular Anti-D Immunoglobulin for Dengue-Associated Thrombocytopenia: A Proof-Of-Concept Clinical Study},

author = {Dr. Jeetendra Singh³ Dr. Madhuri Kirloskar² Dr. Smita Avhad¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue is a common vector-borne disease associated with thrombocytopenia, which may increase the risk of bleeding and often leads to platelet transfusion. However, current management remains largely supportive, and no specific pharmacological therapy is available to improve platelet recovery. Anti-D immunoglobulin has been used in immune-mediated thrombocytopenia and in prevention of Rh isoimmunisation, suggesting a potential role in conditions involving immune-mediated platelet destruction. This study was undertaken to evaluate the feasibility and safety of intramuscular anti-D immunoglobulin in dengue-associated thrombocytopenia. Materials and Methods: This proof-of-concept clinical study included adult patients with laboratory-confirmed dengue infection and platelet counts between 50,000 and 90,000 per microlitre. Patients received a single intramuscular dose of anti-D immunoglobulin along with standard supportive care. Clinical monitoring and serial platelet counts were performed over a follow-up period of seven days. Outcomes assessed included platelet trends, bleeding manifestations, requirement of platelet transfusion, and adverse effects. Results: Seven patients were included in the study. Following administration of anti-D immunoglobulin, all patients demonstrated stabilisation or an increasing trend in platelet counts within seventy-two hours. None of the patients required platelet transfusion, and no bleeding manifestations or clinically significant adverse events were observed. Conclusion: Intramuscular anti-D immunoglobulin appears to be a safe and feasible adjunct in dengue-associated thrombocytopenia, showing a consistent trend toward platelet stabilisation. These findings support the need for larger controlled studies to further evaluate its effectiveness and potential role as a cost-effective therapeutic option in dengue-endemic and resource-limited settings.},

note = {Type: Oral Presentation; Organisation: ¹Assistant Professor, Department of Pharmacology, Government Medical College, Nashik, Maharashtra, India, ²Associate Professor and Head, Department of Medicine, MPGIMER, MUHS, Nashik, Maharashtra, India, ³Professor and Head, Department of Pharmacology, MPGIMER, MUHS, Nashik, Maharashtra, India, ⁴Professor and Head, Department of Pharmacology, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India, ⁵Professor and Head, Department of Anatomy, Government Medical College, Nashik, Maharashtra, India; Corresponding author: Dr. Smita Avhad, mbrsmita@yahoo.co.in},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-510,

title = {Introducing Dried Blood Spot Newborn Screening for Congenital Adrenal Hyperplasia in Malaysia: Birth-Weight\textendashStratified 17-Hydroxyprogesterone Cutoffs from a Pilot Study},

author = {Nor Daliza Mohd Razali1 Saraswathy Apparow1 Raja Hasyidah Raja Bongsu1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Newborn screening for Congenital Adrenal Hyperplasia (CAH) typically relies on the measurement of 17-Hydroxyprogesterone (17-OHP) in dried blood spots (DBS). Elevated 17-OHP concentrations in premature and low-birth-weight infants often increase false-positive rates in first-tier screening, necessitating birth-weight\textendashadjusted cutoff values. In Malaysia, CAH testing is currently performed mainly in symptomatic newborns using serum 17-OHP, and universal newborn screening has not yet been implemented. This pilot study represents the first Malaysian investigation utilizing dried blood spot samples to establish birth-weight\textendashstratified 17-OHP cutoff values to support the potential implementation of Malaysian universal newborn screening for CAH. Materials and Methods: A pilot observational study approved by the Ministry of Health Malaysia and the Medical Research and Ethics Committee (NMMR-21-1283-60298(IIR)) analysed 599 DBS samples from Malaysian newborns. First-tier 17-OHP quantification was performed using a time-resolved fluoroimmunoassay, verified against molecular testing. Newborns were stratified into two birth-weight groups: \<2500 g and ≥2500 g. Distributions of 17-OHP concentrations were examined, and percentile-based cutoff values were generated following Clinical and Laboratory Standards Institute recommendations. Results: The analysis showed significant differences in 17-OHP concentrations between the two birth-weight groups: ≥2500 g (n=481) and \<2500 g (n=117) - as demonstrated by the Mann\textendashWhitney U test, p \< 0.001). The 99th-percentile cutoff for infants ≥2500 g was 15.32 nmol/L, while infants \<2500 g demonstrated a substantially higher 99th-percentile value of 64.37 nmol/L. Applying these birth-weight\textendashspecific thresholds reduced the number of samples exceeding the screening cutoff compared with a universal value, indicating improved specificity and a potential reduction in false-positive results without compromising detection of suspected CAH cases. Conclusion: This pilot study provides the first Malaysian data supporting the feasibility of DBS-based CAH screening and demonstrates clear birth-weight\textendashrelated variation in 17-OHP concentrations. Implementing birth-weight\textendashspecific cutoffs may enhance screening specificity, particularly among low-birth-weight infants, and offers valuable evidence to support the development of a national newborn screening program for CAH. Further validation in larger multicentre cohorts is recommended.},

note = {Type: Oral Presentation; Organisation: 1Specialised Diagnostic Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia. 2Hospital Putrajaya, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia. 3Hospital Tunku Azizah, Kuala Lumpur, Malaysia. 4Hospital Selayang, Selangor, Malaysia. 5Center for Diagnostic, Therapeutic and Investigative Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.; Corresponding author: Raja Hasyidah Raja Bongsu, rajahasyidah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-788,

title = {Invisible Adolescents in National Wellbeing Frameworks: HPV Vaccine Inequity among Nomadic Communities in Bangladesh},

author = {Chameli Chakrabarty1 \& Susmita Rani Paul1 Anika Tahsin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Global inequalities in healthcare delivery are often reflected in disparities between high-income and low-income countries, largely shaped by where and to whom a child is born. Nomadic populations represent one such “hard-to-reach” group, as static health service delivery models are largely incompatible with their mobile lifestyles. This study examines the exclusion of nomadic adolescents\textemdashparticularly from Bede communities\textemdashfrom the National Strategy for Adolescent Health in Bangladesh, with a specific focus on barriers to HPV vaccination access. Materials and Methods: An exploratory qualitative research design was employed. Data were collected through 18 in-depth interviews (IDIs), 3 key informant interviews (KIIs), and 3 informal group sessions conducted in purposively selected areas of Cumilla and Feni districts. Thematic analysis was applied using the framework of structural violence to understand how systemic inequalities shape health access among marginalized populations. Results: The study reveals that nomadic adolescents are effectively “invisible” within health promotion interventions due to their mobility and lack of fixed residence. Bede families living in temporary settlements reported no awareness of the HPV vaccine or its availability, and no exposure to related campaigns. Although HPV vaccination is a critical strategy for preventing HPV-related malignancies, its implementation remains predominantly school-based, thereby unintentionally excluding adolescents who are outside formal education systems due to their socio-cultural and economic contexts. Parents lacked basic information, and adolescents\textemdashparticularly girls\textemdashwere entirely excluded from immunization efforts. This exclusion is especially concerning given the high prevalence of early marriage among Bede girls, which significantly increases the risk of high-risk HPV infection and, consequently, cervical cancer. Conclusion: The study argues that such exclusion is not merely a gap in service delivery but a manifestation of deeper socio-structural inequalities that deny marginalized adolescents their fundamental right to health. Addressing this issue requires rethinking adolescent wellbeing frameworks to incorporate flexible, community-based outreach strategies that ensure the inclusion of “hard-to-reach” populations.},

note = {Type: Poster Presentation; Organisation: 1Anthropology Department, Comilla University, Bangladesh; Corresponding author: Anika Tahsin, anikaellin200@stud.cou.ac.bd},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-504,

title = {Invisible Pollutants, Lasting Impacts: Volatile Organic Compounds Exposure and Child Neurodevelopment A Systematic Review and Meta-Analysis},

author = {² Nur Nabila Abd Rahim¹ Nurul Farehah Shahrir¹*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Volatile organic compounds (VOCs) are widespread environmental pollutants arising from traffic emissions, industrial activities, and household sources. Although epidemiological studies have demonstrated their neurotoxic effects, evidence linking early-life exposure to adverse neurodevelopmental outcomes remains inconsistent, and compound-specific risks are insufficiently quantified. Given the increasing global burden of neurodevelopmental disorders, elucidating early-life susceptibility to the VOCs is essential for preventive policy and environmental health regulation. This study synthesised and quantified associations between prenatal and childhood VOC exposure and neurodevelopmental outcomes in children. Materials and Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and registered in PROSPERO (CRD42023485433). PubMed, Scopus, and Embase were searched from inception to August 2025. Observational studies assessing VOC exposure and validated neurodevelopmental outcomes in children under 18 years were included. Random-effects meta-analyses generated pooled odds ratios (ORs), and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using ROBINS-E, study quality using the Newcastle\textendashOttawa Scale, and certainty of evidence using GRADE. Results: Twenty-eight studies met the inclusion criteria, of which 11 were included in the meta-analysis. Of the 18 VOCs analysed, five compounds demonstrated statistically significant adverse associations with neurodevelopment: propionaldehyde (pooled OR = 1.84; 95% CI: 1.19, 2.49), styrene (OR = 1.69; 95% CI: 1.30, 2.21), vinyl chloride (OR = 1.53; 95% CI: 1.24, 1.89), acrolein (OR = 1.48; 95% CI: 1.08, 2.04), and trichloroethylene (OR = 1.21; 95% CI: 1.04, 1.41). Benzene showed borderline significance (OR = 1.09; 95% CI: 0.98, 1.19). Heterogeneity ranged from low to moderate (I² = 0\textendash47%). Sensitivity analyses demonstrated stable effect estimates across studies. Conclusion: The observed associations could be explained by neurotoxic mechanisms, including lipid peroxidation and oxidative injury, disruption of myelination and neurotransmission, and the generation of reactive metabolites that impair mitochondrial function and activate neuroinflammatory cascades. Certainty of evidence was moderate for styrene and trichloroethylene, low for vinyl chloride, propionaldehyde, and acrolein, and very low for benzene. These findings identify specific VOCs with consistent evidence of neurodevelopmental risk, highlighting the vulnerability of the developing brain to early-life exposure, emphasising the need for strengthened exposure surveillance, improved indoor air regulation, and targeted prevention strategies.},

note = {Type: Oral Presentation; Organisation: ¹Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia, ²Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia, ³Lembah Pantai Health Office, Ministry of Health Malaysia, Kuala Lumpur, Malaysia, ⁴Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia, ⁵School of Medicine, Taylor’s University, Subang Jaya, Selangor, Malaysia, 6School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia; Corresponding author: Nurul Farehah Shahrir, farehah.shahrir@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-556,

title = {Issues and Challenges of Hospital Information System Implementation: A Scoping Review},

author = {Nazmeen Adline Fawwazah binti A Fauzi3 Faeiz Syezri Adzmin bin Jaaffar2 Su Peng Chua1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Hospital Information Systems (HIS) are integrated platforms designed to manage patient and hospital data across clinical and administrative domains. Malaysia initiated HIS adoption under the Sixth Malaysian Plan in 1993, with Selayang Hospital as the pioneer. Despite the potential to enhance efficiency, safety, and resource management, HIS implementation continues to encounter significant barriers. This scoping review aims to identify and classify the critical issues and challenges hindering HIS adoption globally, with implications for Malaysian healthcare institutions. Materials and Methods: Following the PRISMA-ScR guideline, a scoping review was conducted across Google Scholar, Scopus, and Web of Science. Search strings combined HIS-related terms with keywords on challenges and organisational contexts, focusing on publications between 2012 and 2021. Inclusion criteria required open-access, English-language, full-text original articles. Out of 804 records screened, nine studies met eligibility requirements. Data were extracted into a Table of Evidence and analysed thematically under technology, organisational, and human factors. Results: The nine studies originated from Malaysia, Switzerland, the USA, Sweden, Iran, France, and the Netherlands, employing cross-sectional, qualitative, and experimental designs. Technology-related challenges included limited compatibility, system complexity, and inadequate security measures such as lack of encryption and vulnerability to cyberattacks. Organisational barriers encompassed financial constraints, administrative inefficiencies, politicised healthcare structures, and absence of Chief Information Officers. Human factors highlighted resistance to change, inadequate training, documentation errors, and variations in perceived usefulness influenced by demographic and experiential variables. Collectively, these issues reduced user acceptance and hindered HIS optimisation. Conclusion: The findings demonstrate that HIS adoption is constrained by interdependent technological, organisational, and human dimensions. Compatibility gaps increase resistance, while lack of standardised strategies undermines reliability. Organisational limitations, particularly weak administrative support and financial shortages, exacerbate implementation difficulties. Human factors such as low adaptability and insufficient training contribute to errors and reduced confidence in HIS. Addressing these challenges requires integrated strategies that combine technical safeguards, organisational restructuring, and continuous workforce development. HIS implementation represents a systemic transformation rather than a mere technical upgrade. Hospitals must establish national information technology security frameworks, strengthen administrative leadership, and prioritise continuous training to enhance HIS acceptance. These insights provide guidance for healthcare administrators and policymakers in designing mitigation strategies, contingency plans, and sustainable adoption pathways. Future research should explore HIS innovation trends and system-specific challenges to deepen understanding and support effective implementation.},

note = {Type: Oral Presentation; Organisation: 1Timur Laut District Health Office, Georgetown, Penang, Malaysia, 2Batang Padang District Health Office, Tapah, Perak, Malaysia, 3Kluang District Health Office, Kluang, Johor, Malaysia, 4Perlis State Health Department, Kangar, Perlis, Malaysia,5Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-671,

title = {Kelantan Spatial Kit (KSK): A Modular, Open-Source Platform for District-Level Spatial Intelligence on Communicable Diseases},

author = {Che Muhammad Nur Hidayat Che Nawi 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Rapid, locality-specific insight is essential for communicable disease control, yet spatial analysis in district health services is often fragmented, time-consuming, and difficult to reproduce. This study aimed to develop and demonstrate the Kelantan Spatial Kit, a generalisable open-source web-based platform for district-level spatial analysis of communicable diseases in Kelantan. Materials and Methods: The platform was designed to integrate a standardised case line list, subdistrict boundary files, and annual population data. It automatically harmonises place names and map projections, generates interactive point maps and choropleth incidence maps, produces year-by-year spatial visualisations, and includes data quality checks to identify mismatches between surveillance, population, and boundary datasets. Demographic summaries and searchable case records were also incorporated to support epidemiological review and follow-up. Hand, foot and mouth disease data were used as an exemplar to assess the functionality of the platform. Results: The platform successfully transformed routine surveillance data into interactive spatial outputs that enabled visualisation of case distribution and subdistrict-specific incidence across multiple years. The exemplar analysis demonstrated marked within-district variation and identified subdistricts with persistently higher incidence, thereby supporting more focused prioritisation of hygiene promotion, school- and childcare-based interventions, and environmental control activities. Conclusion: By integrating data preparation, analysis, and visualisation within a single interface, the Kelantan Spatial Kit improves reproducibility, reduces analytic burden, and strengthens decision support for district public health teams. The platform has strong potential for wider adoption across Kelantan and may serve as a scalable model for communicable disease spatial intelligence in similar settings.},

note = {Type: Oral Presentation; Organisation: 1 Machang District Health Office, Machang, Kelantan, Malaysia.; Corresponding author: Che Muhammad Nur Hidayat Che Nawi , drchehidayat@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-567,

title = {Knowledge, Attitude and Practice Among Parents Regarding Severe Neonatal Jaundice In Batu Pahat District},

author = {Farha Ibrahim2 Marina Mohd Said1 Khalsom Samsudin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Neonatal jaundice is a common condition in newborns that can quickly become severe (SNNJ) if not carefully monitored. If left untreated, severe neonatal jaundice can lead to permanent brain damage, such as kernicterus. Because of this, parents play a vital role in early detection and in seeking timely medical care for their babies. To assess the level of knowledge, attitude, and practice regarding severe neonatal jaundice among parents and to identify the factors contributing to poor KAP. Materials and Methods: A cross-sectional study was conducted among 280 parents attending health clinics in Batu Pahat District. Data was collected using validated questionnaires. Descriptive statistics were used to determine KAP levels, and multiple logistic regression was applied to identify factors associated with poor KAP. Results: The mean scores for knowledge, attitude, and practice were 57.1%, 84.8%, and 88.0%, respectively. In terms of knowledge, more than half of the parents (57.9%) had a poor level, 35.0% had a moderate level, and only 7.1% showed good knowledge. However, parents demonstrated highly positive attitudes (61.4% good, 33.9% moderate, 4.6% poor) and safe practices (82.9% good, 16.1% moderate, 1.1% poor). Regression analysis showed that parents aged 20\textendash35 years were 50% less likely to have poor knowledge compared to those over 35 years old (p=0.032},

note = {Type: Poster Presentation; Organisation: 1Batu Pahat District Health Office, Batu Pahat, Malaysia, 2Kluang District Health Office, Kluang, Malaysia; Corresponding author: Khalsom Samsudin, drkalsom.samsudin@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-661,

title = {Knowledge, Attitude, and Practice (KAP) Towards Leptospirosis Prevention Among Healthy Malaysian and Non-Malaysian Pioneer Dairy Farm Workers in Mersing, Johor},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Aiman Syakirin bin Zaidun1, Siti Sabrina binti Mohamed Hanafi2, Amirul Akmal bin Sohor2 Introduction: The rapid development of the Jemaluang Dairy Valley (JDV) may increase occupational exposure to zoonotic infections such as leptospirosis, an endemic disease in Malaysian agricultural settings. Assessing the baseline health literacy of the pioneer workforce is important for preventing workplace transmission and guiding targeted occupational health interventions. This study aims to evaluate the baseline Knowledge, Attitude, and Practice (KAP) towards leptospirosis prevention among healthy Malaysian and non-Malaysian pioneer dairy farm workers in Mersing working in Malaysia’s emerging large-scale dairy industry. Materials and Methods: A cross-sectional descriptive study will be conducted among agricultural workers at the JDV facility. Universal sampling (census) is applied to recruit all 57 eligible workers present during the study period. Data collection is integrated into a proactive occupational health programme conducted by the Mersing District Health Office. A comprehensive 47-item bilingual KAP questionnaire, adapted from a validated Malaysian instrument, is utilised. Following expert content validation, the questionnaire assesses demographic characteristics, knowledge of transmission, attitudes toward workplace hygiene, and self-reported preventive practices including Personal Protective Equipment (PPE) utilization. Ethical approval has been registered via the National Medical Research Register (Research ID: RSCH ID-26-01833-HXT), and informed consent is obtained prior to the anonymous guided survey. Expected Results: Data collection involving the total census of 57 pioneer agricultural and dairy workers is currently underway. It is anticipated that the findings will reveal a unique epidemiological dynamic: high levels of reported preventive practices (e.g., strict PPE compliance and sanitation) driven primarily by stringent farm SOPs and management enforcement, contrasting with disproportionately low baseline knowledge regarding actual leptospirosis transmission. This knowledge deficit is expected to be particularly pronounced among the predominantly migrant (Pakistani) workforce, where language and educational barriers limit the comprehension of occupational zoonotic risks. Discussion/ Conclusion: This baseline assessment is expected to highlight a critical vulnerability: while physical biosecurity practices are administratively maintained, the underlying health literacy of the workforce remains fragile. Effective leptospirosis prevention requires inclusive communication strategies. Addressing language barriers among non-Malaysian workers and tailoring information for individuals with lower educational backgrounds is essential to fostering positive attitudes and sustainable preventive behaviours. Future studies should expand this KAP assessment to include Muadzam Shah Dairy Valley, providing a comprehensive, comparative overview of leptospirosis perceptions across Malaysia's major dairy hubs.},

note = {Type: Poster Presentation; Organisation: 1 Jemaluang Health Clinic, Mersing, Johor, Malaysia. 2 Mersing District Health Clinic, Johor, Malaysia.; Corresponding author: Aiman Syakirin bin Zaidun, aiman.zaidun@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-674,

title = {Knowledge, Attitude, and Practice Questionnaire on Measles and Immunisation Among Parents in an East Coast Peninsular State 2025},

author = {Siti Nor Shuhada Mustfar1 Nurnajayati Omar1 Nur Akmal Ismail1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measles remains a significant public health concern despite the availability of effective vaccines, with vaccine hesitancy contributing to suboptimal immunisation coverage. Understanding the knowledge, attitudes, and practices (KAP) of community especially among parents is essential to inform targeted interventions and improve vaccine uptake. This survey aimed to assess the KAP regarding measles and immunisation among parents in the community. Materials and methods: A cross-sectional survey was conducted among parents using a structured and validated KAP questionnaire on measles and immunisation. The instrument comprised items assessing knowledge, attitudes, and practices, along with sociodemographic characteristics. Descriptive statistics were used to summarise KAP levels. Results: A total of 166 parents participated in the survey (mean age 34.40 ± 6.727 years; 94.6% female). The overall knowledge score indicated good knowledge with 128 respondents (77.11%), with notable gaps in understanding measles complications and the importance of timely vaccination. Attitude scores significantly reflected positive attitude towards immunisation with 126 respondents (75.9%), although concerns regarding vaccine safety were evident. Overall, respondents’ vaccination practices were poor, with 97 participants (58.4%) demonstrating suboptimal behaviours, the most notable gap being the low rate of encouraging relatives and peers to complete childhood immunisations. Conclusion: Parents demonstrated good levels of knowledge and positive attitudes towards measles and immunisation, with persistent misconceptions and safety concerns influencing vaccination practices. Targeted health education and community-based interventions are needed to address these gaps, enhance confidence in vaccine safety, and promote timely immunisation among children.},

note = {Type: Poster Presentation; Organisation: 1Public Health Division, Terengganu State Health Department, Terengganu, Malaysia.; Corresponding author: Nur Akmal Ismail, dr.nurakmalismail@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-765,

title = {Knowlesi Malaria in Sabah, North Borneo: Spatial, Temporal, and Sociodemographic Trends},

author = {Mohd Hanif Zailani3 Abdul Marsudi Manah2 Abraham Zefong Chin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Plasmodium knowlesi malaria has become the predominant malaria species in Malaysia following the successful reduction of indigenous human malaria transmission. Sabah continues to experience a considerable burden of zoonotic malaria due to ecological exposure, forest proximity, and occupational activities. Understanding temporal trends and sociodemographic distribution is essential to support targeted surveillance and prevention strategies. Materials and Methods: A cross-sectional study was conducted in Sabah State using secondary surveillance data. Quantitative analysis included all confirmed Plasmodium knowlesi malaria cases recorded in the Vekpro surveillance system from epidemiological week 1 of 2019 to epidemiological week 52 of 2024. Descriptive analysis was performed to examine temporal trends, incidence patterns, geographic distribution, and sociodemographic characteristics, including age, gender, ethnicity, citizenship, and district-level burden. Results: A total of approximately 9,897 confirmed Plasmodium knowlesi malaria cases were reported in Sabah during the six years. Overall case numbers demonstrated a fluctuating trend, with increasing incidence observed from 2019 to a peak in 2021, followed by a gradual decline through 2024. Seasonal variation was evident, with higher case occurrence during the middle epidemiological weeks of the year (EW 20\textendash28). Geographic clustering consistently identified Ranau, Keningau, Lahad Datu, Kudat, and Kota Marudu as the highest-burden districts across multiple years. Sociodemographic analysis demonstrated that infections predominantly affected adult populations, particularly individuals aged 25\textendash64 years, with incidence rates increasing until 2021 before declining thereafter. Children and adolescents consistently recorded lower incidence rates. Males had persistently higher incidence rates compared with females throughout the study period. Native Sabahans represented the largest proportion of reported cases, although ethnicity-specific incidence trends suggested increasing rates among other ethnic groups over time. Occupational distribution demonstrated higher case burden among individuals involved in agriculture, plantation work, forestry, and other outdoor labor-intensive sectors. Reported risk activities commonly included forest entry, farming, hunting, logging, overnight stays in forested areas, and occupational exposure near forest fringes. Spatial distribution mapping showed repeated clustering of cases within similar localities across consecutive years, indicating persistent transmission hotspots. Conclusion: Plasmodium knowlesi malaria remains an important public health concern in Sabah, characterized by fluctuating temporal trends, geographic concentration in selected districts, and disproportionate burden among working-age adults and males. Persistent clustering in endemic localities suggests ongoing environmental and occupational exposure risks. These findings support the need for geographically targeted interventions, strengthened surveillance, and tailored prevention strategies focusing on high-risk populations and transmission hotspots.},

note = {Type: Poster Presentation; Organisation: ¹ Preparedness, Surveillance and Response Section, Public Health Division, Sabah State Health Department, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia. 2 Vector Borne Diseases Section, Public Health Division, Sabah State Health Department, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia. 3 Zoonosis Control Sector, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia. 4 Dept. of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.; Corresponding author: Abraham Zefong Chin, abraham.chin@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-713,

title = {Leading Through the Storm: Determinants of Crisis Leadership Competencies Among Government Healthcare Middle Managers During the COVID-19 Pandemic},

author = {Lim Ming Yao3 Fredie Robinson2 Nachia Banu Abdul Rahim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The COVID-19 pandemic exposed critical gaps in crisis leadership within healthcare systems, particularly among healthcare middle managers (HMMs), who play a pivotal role in translating policy into operational practice. Despite their importance, empirical evidence on factors influencing crisis leadership competencies remains limited. This study aimed to determine the sociodemographic, organizational, structural, political, and cultural challenge predictors of crisis leadership competencies among HMMs during the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted from June to December 2023 among 342 healthcare middle managers in public healthcare facilities in Kota Kinabalu, Malaysia. Data were collected using a validated self-administered Crisis Leadership Questionnaire (CLQ), assessing five key competencies: team leadership, credibility, integrative thinking, emotional effectiveness, and courage and perseverance. Multiple linear regression analysis was performed to identify significant predictors, with p \< 0.05 considered statistically significant. Results: The majority of respondents were female (60.5%), worked in hospital settings (87.5%), and were married (70.2%). Most held diploma-level education (41%), had no comorbidities (80.1%), and supervised more than 10 subordinates (58.5%). Further analysis identified nine significant predictors of crisis leadership competencies (p\<0.05). Age and level of education were significant sociodemographic predictors, while organizational position and number of subordinates were significant organizational predictors. Additionally, bureaucracy, organizational infrastructure, employee growth, environmental orientation, and emphasising responsibility emerged as significant challenge-related predictors. All identified variables demonstrated significant positive associations with crisis leadership competencies, indicating that both individual characteristics and organizational conditions independently predict leadership competencies during crises. Discussion/ Conclusion: The findings suggest that crisis leadership competencies are influenced by both individual capacity and organizational context. Greater experience and higher educational attainment may enhance decision-making and adaptability, while increased managerial responsibility strengthens leadership exposure. Furthermore, supportive organizational environments characterized by efficient bureaucracy, adequate infrastructure, and a culture that promotes growth and responsibility are critical predictors of effective crisis leadership. Crisis leadership is multifaceted, shaped by a combination of individual experience and supportive organizational frameworks. Strengthening these predictors through targeted leadership development and organizational improvements is essential to enhance healthcare system resilience and preparedness for future crises.},

note = {Type: Poster Presentation; Organisation: 1Pejabat Kesihatan Daerah Timur Laut, George Town, Pulau Pinang, Malaysia. 2Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia. 4Hospital Queen Elizabeth II, Kota Kinabalu, Sabah, Malaysia. 5Hospital Wanita dan Kanak-Kanak Sabah, Kota Kinabalu, Sabah, Malaysia.6Pejabat Kesihatan Kawasan Kota Kinabalu, Kota Kinabalu, Sabah, Malaysia.; Corresponding author: Nachia Banu Abdul Rahim, nachiarahim@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-553,

title = {Life expectancy inequalities by sex in Lithuania: changes before and after the implementation of national health policy measures},

author = {Snieguole Kaseliene2 Daumantas Stumbrys1 Olga Mesceriakova1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Lithuania stands out globally for its exceptionally large gender disparities in life expectancy, ranking fifth worldwide and first among European Union member states. The ten-year gap in life expectancy between men and women reflects deep-rooted social, behavioural, and health care-related challenges that pose challenges for the country’s demographic development. In 2014, important policy documents were adopted outlining the implementation of targeted measures aimed at reducing this disparity. For instance, the Lithuanian Health Strategy set a goal to reduce the difference in average life expectancy between men and women to 8 years by 2025. The aim of this study is to assess life expectancy and its inequalities by sex in Lithuania before the implementation of national health policy measures aimed at increasing life expectancy and reducing health inequalities (1990\textendash2013) and after their implementation (2014\textendash2024). Materials and Methods: Data on deaths and population size for the period 1990\textendash2024 were obtained from the National Mortality Register. Life expectancy for males and females was calculated using life tables for the total population of Lithuania and separately for urban and rural populations. Changes in the magnitude of life expectancy inequalities by sex were assessed using rate differences (females minus males). Trends in life expectancy inequalities (average annual per cent change (AAPC) with 95% confidence intervals (95% CI) were estimated using Joinpoint regression analysis. Results: During 1990\textendash2013, an increasing trend in the gap in life expectancy between females and males was observed in Lithuania, rising from 9.83 to 10.83 years (p\>0.05). In contrast, during 2014\textendash2024 the gap decreased significantly, from 10.7 to 8.62 years (AAPC −2.04% [95% CI: −2.59, −1.50]; p\<0.001). In urban areas of Lithuania, life expectancy differences between females and males increased from 9.25 to 10.55 years during 1990\textendash2013 (AAPC 0.38% [95% CI: 0.01, 0.74]; p\<0.05), whereas in 2014\textendash2024 the gap declined from 10.34 to 8.09 years (AAPC −2.41% [95% CI: −3.03, −1.79]; p\<0.001). In rural areas, the difference in life expectancy between males and females did not change significantly during 1990\textendash2013 and fluctuated between 11.21 and 13.56 years (P\>0.05). However, in 2014\textendash2024 the gap decreased from 11.27 to 9.28 years (AAPC −1.69% [95% CI: −2.22, −1.14]; p\<0.001). Conclusions: Gender inequalities in life expectancy in Lithuania remained large throughout the study period; however, a significant decline in the gap between women and men has been observed since 2014. The reduction in disparities was evident both in urban and rural populations, although inequalities remain greater in rural areas. These findings suggest that the implementation of national health policy measures may have contributed to the recent narrowing of life expectancy differences by sex. Nevertheless, the persistence of substantial inequalities indicates the need for continued and targeted public health interventions aimed at improving male health and further reducing gender disparities in life expectancy. Keywords: Life expectancy, health inequalities by sex, health policy, Lithuania.},

note = {Type: Poster Presentation; Organisation: 1Vilnius University, Vilnius, Lithuania,2Lithuania University of Health Sciences, Kaunas, Lithuania; Corresponding author: olga.mesceriakova@fsf.vu.lt},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-710,

title = {Limited Diagnostic Value of Full Blood Count in Early Dengue Diagnosis in Bagan Datuk, Perak},

author = {Ahmad Fahim Ngimron1 Mohamad Zarudin Mat Said1 Muhammad Ikhwan Mud Shukri1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Full blood count (FBC) is routinely used in dengue management for diagnosis, disease monitoring, complications detection, and fluid therapy guidance. In practice, it is often performed before confirmatory tests such as PCR or serology. Early dengue diagnosis is crucial to reduce severity and mortality. However, most existing studies focus on the prognostic value of FBC among confirmed dengue cases, with limited evidence on its role in differentiating dengue from non-dengue cases. This study is among the first to evaluate the diagnostic value of FBC parameters and to compare their patterns between early and late phases of dengue in Bagan Datuk, Perak. Materials and Methods: A retrospective cross-sectional study was conducted among patients notified as suspected dengue cases to PKD Bagan Datuk via the CDCIS system from January 2023 to December 2025. Inclusion criteria were residents of Bagan Datuk with complete FBC results on the day of diagnosis. Patients with missing data, duplicate records, or comorbidities affecting haematological parameters (e.g., anaemia, haematological disorders, chronic kidney disease) were excluded. Of 1,332 notified cases, 1,077 met the selection criteria. Data were collected using a validated proforma. Statistical analyses included multiple logistic regression, independent t-test, chi-square test and Mann\textendashWhitney U test. Results: Age group and platelet count were significant predictors of dengue diagnosis. Adults (AOR = 3.84; 95% CI: 2.35, 6.29), elderly patients (AOR = 2.94; 95% CI: 1.56, 5.55) and thrombocytopenia (AOR = 1.93; 95% CI: 1.33, 2.80) were significantly associated with dengue. Other variables, including gender, ethnicity, occupation, white cell count (WCC), and haematocrit (HCT), were not significant. In the early phase of dengue (\<48 hours), WCC, HCT, and platelet levels were within normal ranges in both dengue and non-dengue groups. In contrast, during the late phase, platelet counts were significantly lower in dengue cases compared to non-dengue cases (p\<0.001). Among dengue patients, platelet levels declined significantly from the early to late phase (p=0.004). The diagnostic performance of thrombocytopenia was poor, with a sensitivity of 35.3% (early phase); 58.4% (late phase), and a specificity of 65.9% (early phase) and 67.4% (late phase). Discussion/ Conclusion: Although thrombocytopenia is associated with dengue, its diagnostic value is limited, particularly in the early phase when FBC parameters often remain within normal ranges and demonstrate low sensitivity and specificity. Normal FBC results do not exclude dengue infection, and reliance on these parameters to guide testing decisions may lead to missed or delayed diagnoses. Current evidence indicates that leukopenia and thrombocytopenia are time-dependent and non-specific, with most studies emphasising their prognostic rather than diagnostic value. These findings challenge the common practice of using FBC as a gatekeeper for confirmatory testing. Therefore, decisions to perform confirmatory testing should be guided by clinical suspicion and epidemiological context rather than FBC findings. FBC parameters have limited roles in the early diagnosis of dengue and should not be used to determine the need for confirmatory testing. Strengthening early testing strategies is essential to improve timely dengue detection. Future research should explore the diagnostic role of FBC in outbreak-prone and urban populations.},

note = {Type: Poster Presentation; Organisation: 1Bagan Datuk District Health Office, 36300 Sungai Sumun, Perak, Malaysia. 2Perak State Health Department, 30000 Ipoh, Perak, Malaysia.; Corresponding author: Muhammad Ikhwan Mud Shukri, drm.ikhwan@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-663,

title = {Linking Intervention Design and Implementation Fidelity: A Conceptual Framework for Evaluating the Psychoeducation-Based Person-Directed Burnout Intervention Package for Ministry of Health Hospital Nurses},

author = {Nor Haniza Zakaria1 Nursyahda Zakaria1 Siti Zubaidah Ahmad Subki1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Burnout among hospital nurses is a major workforce and public health concern, yet the implementation of burnout interventions often varies across settings. Variability in implementation may obscure the relationship between intervention components and their effects. Therefore, conceptualising the implementation of interventions is critical to understanding the mechanisms through which they achieve intended outcomes, particularly in complex healthcare settings. In 2025, we developed the Psychoeducation-Based Person-Directed Burnout Intervention Package (P-BIP) in response to the need for structured burnout management among Ministry of Health hospital nurses. Existing implementation fidelity frameworks primarily emphasise adherence and moderating factors but provide limited explanation of how intervention structure, psychological mechanisms, and fidelity processes interact. This study aimed to develop a conceptual framework to assess the implementation fidelity of the P-BIP among hospital nurses. Materials and Methods: This study employed a narrative conceptual review to synthesise literature findings on implementation fidelity and psychoeducational interventions. Relevant studies were identified through targeted database searches, including PubMed, Scopus, the Cochrane Library, and ProQuest, as well as reference tracking of seminal studies. Search terms focused on the concept of implementation fidelity, including “implementation fidelity”, “intervention fidelity”, “treatment fidelity”, and “program fidelity”. A comparative synthesis was undertaken to identify key fidelity constructs, psychological mechanisms, and moderating factors, and to integrate these into a framework tailored to the P-BIP. Results: Based on the review synthesis, the proposed framework presents an integrated model linking P-BIP with three fidelity processes: delivery, receipt, and enactment. The intervention comprises 28 activities delivered over a two-day programme. The activities were organised into four psychological domains: resilience, insight, self-compassion, and empowerment. These domains address both self and relationship management, encompassing coping and stress management, emotional regulation, empathy, and interpersonal skills. The framework also incorporates moderators that may influence implementation, including intervention complexity, quality of delivery, participant responsiveness, contextual influences, and facilitation strategies. By linking intervention design, psychological mechanisms, and fidelity processes, the framework provides a structured basis for identifying where implementation variability may occur. Discussion/ Conclusion: This study advances a theoretically grounded framework for assessing implementation fidelity of psychoeducational interventions targeting nurse burnout. By explicitly linking intervention components with fidelity processes and contextual moderators, the framework offers practical value for guiding fidelity assessment and strengthening the implementation quality of P-BIP. Furthermore, it provides a foundation for future empirical validation and offers practical utility for improving the implementation quality and scalability of psychologically-based interventions in healthcare settings.},

note = {Type: Poster Presentation; Organisation: 1 Institute for Health Management, National Institutes of Health (NIH), Shah Alam, Selangor, Malaysia.; Corresponding author: Siti Zubaidah Ahmad Subki, siti.zubaidah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-691,

title = {Linking Screening to Care: Evaluating Outcomes of the National Health Screening Initiative for Hypertension and Type 2 Diabetes Mellitus in Petaling District},

author = {4 Muhammad Fikri bin Azmi2 Nor Fauziah Salaton1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Noncommunicable diseases (NCDs), particularly hypertension (HPT) and type 2 diabetes mellitus (T2DM), impose a growing burden globally and in Malaysia. Early detection through systematic screening is essential to early treatment, reducing preventable complications, and improving population health outcomes. The National Health Screening Initiative (NHSI) was implemented to identify adults at risk and link them to care. This study evaluated and assessed follow-up attendance for confirmatory testing and identified determinants associated with newly diagnosed cases in the Petaling district, Selangor. Materials and Methods: A cross-sectional analysis was conducted using NHSI screening data (N=80,285) and Petaling Outpatient Registry records (N=55,723) for 2024. Records were deduplicated and linked to capture confirmatory clinic attendance. Multivariate logistic regression was used to identify predictors of confirmed T2DM and HPT. Results: NHSI screening identified 10,684 adults with elevated blood pressure or glucose. Only 7% (N=738) were identified as having visited health clinics post-screening, among whom 60% (N=441) were confirmed to have T2DM, HPT, or both. Older age, obesity, and Malay or Indian ethnicity were independently associated with higher odds of T2DM, while age and obesity predicted HPT. Conclusion: NHSI effectively detects adults at risk for HPT and T2DM and is acceptable to the public. Although follow-up and treatment initiation remain low, the initiative provides opportunities for targeted interventions, improved linkage to care, and integration of digital and community-based strategies to optimize population health outcomes in Malaysia.},

note = {Type: Oral Presentation; Organisation: 1National Institute for Health Malaysia, Selangor, Malaysia. 2Petaling District Health Office, Selangor Health Department, Selangor, Malaysia. 3Social and Preventive Medicine, University of Malaya, WP Kuala Lumpur, Malaysia. 4Family Health Development Division, Ministry of Health Malaysia, WP Putrajaya, Malaysia.; Corresponding author: Nor Fauziah Salaton, norfauziah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-646,

title = {Living with Fragile Skin: Understanding the Public Health Challenges of Epidermolysis Bullosa in Malaysia},

author = {Siti Saidatina Fatima Binti Abu Bakar1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Epidermolysis Bullosa (EB) is a rare genetic skin condition where the skin is extremely fragile, and even simple contact can cause painful wounds. Although rare, EB reflects broader gaps in how health systems respond to people who need long-term, complex care. In Malaysia, awareness is still limited, and care is often not well coordinated. As a result, EB becomes not just a clinical issue, but a public health concern involving access, equity, and long-term support for patients and families. Materials and Methods: This paper is based on a qualitative, practice-based approach from the perspective of a patient advocate and caregiver. The insights come from lived experience, as well as ongoing engagement with healthcare providers, patient groups, and families affected by EB in Malaysia. Results: Many patients face delays in diagnosis and referral, limited access to specialised care, and ongoing costs for basic wound care. Care often depends on individual providers rather than a clear pathway. Beyond the medical challenges, families also carry emotional, social, and financial stress. Limited awareness among healthcare providers and the public further contributes to misunderstanding and stigma. Conclusion: EB highlights the need for a more coordinated and inclusive approach to care. Strengthening early recognition, improving access to appropriate services, and supporting families are important steps forward. More importantly, EB shows how rare conditions can reveal gaps in the system that also affect other groups. Looking at EB through a public health lens can help guide more practical and equitable responses to rare diseases in Malaysia.},

note = {Type: Poster Presentation; Organisation: 1DEBRA Malaysia, Cyberjaya, Selangor Darul Ehsan, Malaysia.; Corresponding author: Siti Saidatina Fatima Binti Abu Bakar, saida@debramalaysia.org},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-509,

title = {Malaysia’s Progress on Rapid Antiretroviral Therapy Initiation: A National Analysis},

author = {Ku Anis Shazura Indera Putera1 Natasya Nur Mohd Nasir1 Nor Fauziah Salaton1 Mazliza Ramly2 Nur Jihan Noris1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The WHO recommends Rapid Antiretroviral Therapy Initiation (RAI), whereby treatment is commenced immediately following an HIV diagnosis, ideally on the same day or within seven days, irrespective of the patient’s CD4 count to improve long-term clinical outcomes. Malaysia’s 2022 national HIV treatment guideline adopted RAI to standardise early treatment across health facilities. Despite this, ART initiation timing varies by state, and adherence to WHO recommendations has not been systematically assessed. This study therefore examines ART initiation timing across Malaysian health facilities relative to WHO recommendations. Materials and Methods: This study is a retrospective, cross-sectional analysis of the MyHIVCare Cascade (MyHCC) database, a national registry monitoring the HIV care journey in Malaysia from diagnosis to ART, treatment initiation, and follow-up. The analysis included all eligible HIV cases from 2016 to 2025, focusing specifically on public primary health clinics across Malaysia. The primary outcome was time to ART initiation, measured in days from HIV diagnosis to treatment commencement, and classified as timely initiation (≤ 7 days) or delayed initiation (\> 8 days). State-wise analyses were conducted to identify geographic disparities and patterns in ART initiation across Malaysia. Ethical approval and data access were obtained from the Ministry of Health Malaysia, ensuring compliance with national regulations and patient confidentiality. Results: Analysis of 10,039 patients over a 10-year period (2016\textendash2025) reveals a predominant trend of delayed ART initiation; 71.6% (n=7,189) started treatment after 8 days, compared to only 28.4% (n=2,850) receiving timely treatment. Significant geographical disparities were evident across all 16 states and territories. Selangor accounted for the highest share of both timely and delayed ART initiation, representing 36.0% of individuals with timely initiation and 28.7% of those with delayed initiation. WP Kuala Lumpur (14.7%) and Johor (11.3%) followed in the timely initiation group, while Sarawak (9.5%) and Johor (9.4%) were the next highest in the delayed initiation group. Among individuals with delayed ART initiation, the majority were aged 30\textendash39 years (39.8%). Most were male (91.5%), and the Malay ethnic group comprised the largest proportion (64.5%). The vast majority were Malaysian nationals (97.3%). In terms of risk group, Men who have Sex with Men (MSM) represented the largest proportion (59.8%). Conclusion: Despite improvements in some states, delayed ART initiation remains common, with notable variability across states. These delays may be influenced by healthcare provider factors, such as the need to complete baseline investigations or address clinical concerns, as well as patient-related factors including late presentation, psychosocial barriers, and readiness to start treatment. These findings underscore the need for targeted programmatic support and enhanced monitoring to ensure consistent implementation of RAI, while future studies should investigate determinants of ART initiation timing to guide evidence-based strategies for its standardised nationwide implementation. Malaysia has implemented comprehensive policies and programmatic initiatives to strengthen HIV care, achieving progress in timely ART initiation in several states. Nevertheless, delayed treatment remains widespread, and inter-state disparities persist. These findings emphasise the imperative to accelerate nationwide implementation of Rapid ART Initiation to improve treatment timeliness and ensure alignment with WHO recommendations.},

note = {Type: Poster Presentation; Organisation: 1Institute for Health Management, National Institutes of Health Malaysia, 2HIV, Hep C and STI Sector, Ministry of Health Malaysia; Corresponding author: Nor Fauziah Salaton, norfauziah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-477,

title = {Mapping Dental Facility Density and Clustering in Malaysia: Public vs. Private Sector},

author = {Iqbal Ab Rahim1 Devi Shantini Rata Mohan1 Nur Elina Abdul Mutalib1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: In Malaysia, the dental care system comprises both public and private sectors; however, the geographical distribution of these facilities and their alignment with population needs remain inadequately understood. Disparities in access can exacerbate public health gaps, particularly for underserved communities. This study employs spatial analysis to visualise the spatial distribution of public and private dental facilities across Malaysian electoral constituencies; and to identify spatial clustering or dispersing patterns of the facility-to-population ratio per 100,000 people for both sectors. Materials and Methods: This national-level ecological study utilised 2020 data from the Ministry of Health’s Health Informatics Centre (PIK) for non-hospital, non-school-based program and non-mobile outreach program public dental facilities (n=862) and Cawangan Kawalan Amalan Perubatan Swasta (CKAPS) for private facility (n=2491) locations. Population data for the corresponding spatial units were sourced from the Department of Statistics Malaysia. All geospatial analyses were conducted using QGIS 3.40 for data integration, mapping, and calculation of each electoral constituency’s facility-to-population ratios. Spatial autocorrelation analysis was performed using GeoDa 1.20 software. Univariate Local Indicators of Spatial Association (LISA) with Local Moran's I statistic was applied to identify statistically significant (p\<0.05) spatial clusters [high-high(HH), low-low(LL)] and outliers [high-low(HL), low-high(LH)] of the dental facility density ratios for both public and private sectors, using Queen contiguity spatial weights. Results: The overlay of facility distribution with population data showed that both public and private dental clinics are predominantly situated in more densely populated regions across the states of Malaysia. Public dental facilities (Moran’s I=0.103) with HH clusters are primarily located in parts of Kelantan, Terengganu, and Pahang. Conversely, significant LL clusters, indicating low ratios of public facility-to-population, are shown in parts of Selangor, Kuala Lumpur, Johor, Sabah and Sarawak. The private sector (Moran’s I=0.360), meanwhile, exhibits different clustering patterns, with high numbers of significant LL clusters in Sabah and Sarawak, as well as Pahang, Terengganu, Kelantan, and Perak. Spatial outliers were also identified, with HL patterns showing isolated service-adequate areas within areas of low ratios of facility-to-population, particularly in Sabah and Sarawak for both sectors, and LH patterns revealing underserved pockets within high-ratio areas, in parts of Kelantan, Terengganu, Perak and Negeri Sembilan. Conclusion: The analysis demonstrates statistically significant spatial patterns in dental clinics across Malaysia, underscoring complex regional disparities in access to dental care services. Closing this public health gap requires a synergistic partnership between public planning and private sector engagement, guided by informed decision-making in service delivery and planning. To ensure equitable access to dental services, targeted public sector expansion in the identified areas and incentives for private dental practices to offer services in underserved areas are recommended to ensure an integrative approach promoting balanced distribution of dental services and to improve oral health outcomes nationwide.},

note = {Type: Oral Presentation; Organisation: 1Centre for Health Equity Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia; Corresponding author: Nur Elina Abdul Mutalib, nurelina.am@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-580,

title = {Maternal Deaths Beyond Delivery: Postnatal Risk and Missed Opportunities in Care in Kota Kinabalu, Sabah, Malaysia},

author = {Nirmal Kaur1 1 Pejabat Kesihatan Kawasan Kota Kinabalu Mohd Shamril bin Mohd Nawi1 Nur Aishah binti Shaharuddin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Maternal mortality remains as a critical indicator of health system performance under Sustainable Development Goal (SDG), reflecting both the quality of clinical care and the effectiveness of health system delivery. While Malaysia has achieved substantial reductions in maternal mortality at the national level, subnational disparities persist, particularly in geographically and socioeconomically diverse regions such as Sabah. This study aimed to examine the timing of maternal deaths and identify missed opportunities in care within an urban district setting in Kota Kinabalu. Materials and Methods: A retrospective review was conducted on all maternal deaths recorded between 2021 and 2025 using district-level maternal death surveillance data in Kota Kinabalu, Sabah. Variables analysed included socio-demographic characteristics, phase of death (antenatal, intrapartum, postnatal, and post-abortion), classification of cause (direct, indirect, and fortuitous), preventability of death status and documented health system shortfalls based on maternal death reviews done. A descriptive statistical analysis was performed, and evaluation of recurring gaps in care was undertaken to identify patterns of missed opportunities across the continuum of maternal healthcare. Results: A total of 38 maternal deaths were recorded over the 5-year period. The majority of deaths occurred during the postnatal phase (52.6%},

note = {Type: Poster Presentation; Corresponding author: Nur Aishah binti Shaharuddin, nuraishahar911@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-707,

title = {Maternal Factors Contributing to Small for Gestational Age (SGA) Newborns In Pendang District, Kedah},

author = {Intan Melati A. B. 1 Nurul Najuwa S.1 Nur Wahidda A.1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Small for gestational age (SGA) is a major indicator of neonatal health and is associated with increased risks of morbidity, mortality, and long-term adverse outcomes. Globally, SGA contributes significantly to neonatal complications, particularly in low- and middle-income countries. In Malaysia, despite improvements in maternal and child healthcare services, the prevalence of low birth weight and SGA remains a public health concern. Identifying maternal risk factors is essential for developing targeted interventions, especially in high-prevalence areas such as Pendang District, Kedah. Materials and Methods: A retrospective cohort study was conducted using antenatal records from January to December 2021 across three primary healthcare clinics in Pendang District (Klinik Kesihatan Pendang, Kubur Panjang, and Sungai Tiang). The study included 680 pregnant women aged 15\textendash50 years who received antenatal and postnatal care under the Maternal and Child Health programme. Data collected included maternal sociodemographic characteristics, obstetric history, clinical conditions during pregnancy, and neonatal outcomes. Exclusion criteria were mothers with pre-existing chronic diseases, multiple pregnancies, assisted conception, and late antenatal booking (\>12 weeks). Data were analysed using SPSS version 26. Logistic regression analysis was performed to determine associations between maternal factors and SGA, with statistical significance set at p\<0.05. Results: The prevalence of SGA among the study population was 10.4% (n=71). The majority of mothers were Malay (94.7%), and most were aged 20\textendash30 years (56.9%). More than half of the mothers (54.4%) were classified as overweight or obese at booking. Logistic regression analysis demonstrated significant associations between SGA and parity (p=0.030) as well as gestational diabetes mellitus (GDM) (p=0.013). Mothers with GDM had a higher likelihood of delivering SGA infants (OR=1.797; 95% CI: 1.067, 3.025). Lower parity appeared to have a protective effect against SGA (OR=0.504; 95% CI: 0.271, 0.937). No significant associations were found between SGA and maternal age, ethnicity, body mass index, gestational age at booking, anaemia, or pregnancy-induced hypertension. Discussion/ Conclusion: The prevalence of SGA in Pendang District is comparable to national estimates but remains a concern due to its implications for neonatal and long-term health outcomes. The significant association between GDM and SGA highlights the importance of early detection and effective glycaemic control during pregnancy. The association between parity and SGA is consistent with previous findings, suggesting increased risk among primiparous women. Other maternal factors such as anaemia and hypertension were not significant predictors in this study, which may reflect differences in population characteristics or healthcare access. These findings underscore the importance of strengthening antenatal care services and risk stratification during pregnancy. SGA remains prevalent in Pendang District, with gestational diabetes mellitus and parity identified as key contributing factors. Early identification and management of high-risk pregnancies, along with improved antenatal care interventions, are essential to reduce the incidence of SGA and improve maternal and neonatal outcomes. These findings provide baseline evidence for future research and policy planning in maternal and child health.},

note = {Type: Poster Presentation; Organisation: 1Pendang District Health Office, 06700 Pendang, Kedah, Malaysia.; Corresponding author: Nur Wahidda Azmi, nurwahidda@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-673,

title = {Measles Resurgence in an Urbanized Malaysian State: A Ten-Year Retrospective Study},

author = {Noor Farhana Binti Mohd Fathil1 Rozaini Binti Mat Shah1 Kang Chia Yee1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Measles is a highly contagious disease in which each measles case estimated to transmit to 12 to 18 individuals. There was an increasing number of measles outbreaks in Penang since 2023 despite of high coverage of measles vaccine which raised the public health concern. This study aimed to study the epidemiological trend of measles transmission in Penang for year 2015 to 2024. The studied variables included social demographic characteristics, measles vaccination status, travel history and school holidays or festival seasons. Materials and Methods: This was a retrospective cross-sectional study on all the measles cases notified in Penang state, Malaysia from year 2015 to 2024. Data was retrieved from e-Measles surveillance database. Data entry and analysis were performed using the SPSS 30.0 software. During the descriptive analysis, the frequency and percentage of all variables were analysed to study the epidemiological trend of measles infection in Penang. The dependent variable of this study was presence or absence of measles infection. The presence of measles infection including laboratory confirmed measles, epidemiologically linked measles and clinically compatible with measles. The non-measles cases are the vaccine-associated measles cases and the cases with absence of measles infection. Results: From year 2015 to 2024, a total of 825 measles cases were notified in Penang. About 22.2% (183 cases) of these cases were registered as measles cases. From these 183 measles cases, majority of them (53.3%) were aged below 7 years old, including 33.3% aged within 1 to 6 years and 20.2% aged below 1 year. More than three quarters of measles cases were Malaysians (79.8%) and slightly more than half were female (55.2%). About 66.1% of the measles cases were from Malay ethnicity. As for measles vaccination status of the measles cases, 45.9% were unvaccinated and 13.1% were age non-eligible. Nearly 60.0% of the measles cases were not vaccinated. About 41.0% of measles cases were occurred during school holidays or festival seasons. Seberang Perai Tengah district had the highest measles cases being reported for these 10 years. Almost all the measles cases were presented with fever (99.5%) and rashes (100%). Discussion/ Conclusion: The findings of this ten-year study directly implied that the public health strategies have to strengthen the measles vaccination uptake especially among children below 7 years. Besides, the individuals surrounding these children should be vaccinated to protect the age non-eligible for measles vaccination group in view of this virus is highly transmissible. Further studies needed to be conducted to understand deeply the barriers of vaccine uptake among the age-eligible but unvaccinated group. Targeted health education, community engagement and supplementary immunization activity should be emphasized in the high-risk districts. Public awareness needed to be strengthened in term of recognizing the symptom of measles and early seeking treatment behaviour. Physicians need to have highly suspicious of measles when noted fever and rashes among the patients. In conclusion, measles mainly infected those unvaccinated and the children below 7 years old. Measles vaccination is still the key solution for measles transmission.},

note = {Type: Poster Presentation; Organisation: 1Division of Public Health, Penang State Health Office, KOMTAR, 10590 Georgetown, Penang, Malaysia.; Corresponding author: Kang Chia Yee, chiayeekang@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-679,

title = {Menopause, Gestational Diabetes, and Type 2 Diabetes in Malaysian School Teachers},

author = {2 Noran Naqiah Hairi1 Cia Vei Tan1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Although individual reproductive factors have been associated with metabolic health, their combined effect on Malaysian women has not been sufficiently explored. Considering that type 2 diabetes mellitus disproportionately affects this population, this study aimed to investigate the association between reproductive factors and risk of type 2 diabetes mellitus among female schoolteachers in Malaysia. Materials and Methods: This was a prospective cohort study with baseline data collected in 2013/2014 and were follow-up for a median duration of 10.5 years. The incident type 2 diabetes mellitus was identified through the National Diabetes Registry. Telephone interviews, and REDCap were used to supplement the missing information on reproductive factors, such as age of menarche and breastfeeding duration. The primary exposures of interest included age of menarche, pregnancy history, parity, breastfeeding duration, history of gestational diabetes mellitus, pregnancy induced hypertension, oral contraceptive pills use, menopausal status, and biological lifespan, while accounting for potential confounders. The associations between reproductive factors and type 2 diabetes mellitus incidence were examined using Cox proportional hazards regression to estimate both crude and adjusted hazard ratios (HRs). Results: Among the 11,464 teachers participating in the study, 5.5% developed type 2 diabetes mellitus during the follow-up. The incidence density was 5.38 per 1,000 person-years, while the age-standardized incidence was 5.12 per 1,000 person-years. In the fully adjusted model, the strongest predictors of type 2 diabetes mellitus were age ≥40 years (HR 5.62, 95% CI: 2.56, 12.33), overweight (HR 3.01, 95% CI: 2.28, 3.99) and obesity (HR 5.49, 95% CI: 4.13-7.30). Malay ethnicity (HR 1.59, 95% CI: 1.00, 2.51) and a family history of diabetes (HR 1.67, 95% CI: 1.35, 2.09) were also significantly associated with increased risk. Among the reproductive factors examined, postmenopausal status (HR 1.91, 95% CI: 1.26, 2.91) and a history of gestational diabetes mellitus (HR 1.86, 95% CI: 1.45, 2.39) remained independently associated with type 2 diabetes mellitus incidence. Conclusion: Menopausal status and a history of gestational diabetes mellitus serve as independent reproductive predictors of type 2 diabetes mellitus, alongside age, body mass index, ethnicity and family history as other important determinants. These findings underscore the importance of targeted weight management, better menopausal health awareness, and timely postpartum metabolic monitoring among teachers with a history of gestational diabetes mellitus.},

note = {Type: Oral Presentation; Organisation: 1 Centre of Epidemiology and Evidence based practice, Department of Social \& Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia. 2 Social Wellbeing Research Centre, Universiti Malaya, Kuala Lumpur, Malaysia. 3 Institute for Medical Research (IMR), Ministry of Health Malaysia, Setia Alam, Malaysia; Corresponding author: Cia Vei Tan, drciavei@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-603,

title = {Mental Health Help-Seeking Gap Among Malaysian Adolescents: A Socio-Behavioural Analysis of Knowledge, Attitudes, and Barriers},

author = {Norli Abdul Jabbar3 Mohd Pilus Abdullah2 Logeswary Krisnan1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Despite the increasing prevalence of mental health challenges among Malaysian adolescents, a significant intention-behaviour gap persists in service utilisation. Within the framework of the COM-B model (Capability, Opportunity, Motivation, and Behaviour), help-seeking is often inhibited by perceived barriers that act as behavioural friction. This study examines how internal cognitive drivers, specifically Mental Health Literacy (Psychological Capability) and Attitude (Reflective Motivation), associate with and predict the perception of structural and social barriers to accessing care. Materials and Methods: A cross-sectional study was conducted among 6,735 adolescents (mean age 14.91±1.36 years) across six Malaysian states (Johor, Pahang, Perak, Sabah, Sarawak, and Selangor). Participants completed a self-administered online questionnaire featuring validated instruments to measure mental health knowledge, attitudes toward mental healthcare, and perceived barriers to access (domain Cronbach’s alpha coefficients ranging from 0.805 to 0.938). Data were analysed using Pearson correlation and multiple linear regression to determine the extent to which sociodemographic factors and cognitive drivers predict the perceived weight of these structural and psychological barriers. Result: The findings revealed that mental health knowledge showed no significant correlation with perceived barriers (r = 0.022},

note = {Type: Oral Presentation; Organisation: 1Institute for Health Behaviour Research, National Institute of Health, Ministry of Health, Selangor, Malaysia, 2Counselling and Student Career Management Unit, Student Affairs Management Sector, School Management Division, Ministry of Education, Putrajaya, Malaysia, 3 National Centre of Excellence Mental Health (NCEMH), Ministry of Health, Cyberjaya, Selangor, Malaysia; Corresponding author: Logeswary Krisnan, logeswary.k@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-501,

title = {Metabolic Risk Pattern Among Healthcare Workers: Association Between Body Mass Index and Lipid Profile in Pejabat Kesihatan Daerah Rembau},

author = {Datin Ariza binti Zainudin1 Farah Edura binti Ibrahim1 Zaishafiqah Binti Zainal Abidin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Overweight and obesity are increasing public health challenges globally and contribute significantly to the burden of non-communicable diseases, particularly cardiovascular disease. Dyslipidaemia is a key modifiable metabolic risk factor closely linked to excess body weight. Healthcare workers represent an important occupational group as they serve as health role models and key drivers of health promotion. Studies have shown that workplace-related factors such as sedentary duties, occupational stress, and irregular dietary patterns increase the risk of metabolic disorders. However, local occupational health data on the association between body mass index and lipid abnormalities in this population remain scarce. This study aimed to examine the association between body mass index categories and lipid profile among staff in Pejabat Kesihatan Daerah Rembau. Materials and Methods: A cross-sectional study was conducted using routinely collected workplace health screening data among Pejabat Kesihatan Daerah Rembau staff from February to October 2025. Body mass index was categorised using Asian Body Mass Index categories. Lipid parameters including total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were classified according to Malaysian Clinical Practice Guidelines screening cut-offs. Descriptive statistics summarised participant characteristics. Association between body mass index categories and lipid abnormalities was analysed using Chi-square test, while Spearman correlation assessed the relationship between continuous body mass index values and lipid levels. Statistical significance was set at p \< 0.05. Results: A total of 171 staff were included, of whom 69 percent were female with a mean age of 38.7 years. The mean BMI was 27.86 ± 6.30 kg/m², indicating a predominance of overweight population. Mean lipid levels were 5.50 mmol/L for total cholesterol, 1.13 mmol/L for triglycerides, 3.57 mmol/L for low-density lipoprotein and 1.41 mmol/L for high-density lipoprotein. BMI category was significantly associated with triglyceride (TG) abnormality (p = 0.034), with prevalence increasing from 3.4% among individuals with normal BMI to 22.8% among obese individuals. A significant association was also observed between BMI category and low high-density lipoprotein (HDL) levels (p = 0.017), increasing from 10.3% among individuals with normal body mass index to 32.9% among obese individuals. No significant association was observed between body mass index category with total cholesterol (p = 0.194) and low-density lipoprotein (p = 0.144). A significant positive correlation was observed only between BMI and triglyceride levels (r = 0.448, p \< 0.001), with no significant correlations found for other lipid parameters. Conclusion: Higher body mass index is significantly associated with adverse triglyceride and high-density lipoprotein profiles among healthcare workers, reflecting early metabolic risk clustering linked to obesity. These findings highlight the importance of strengthening workplace health promotion, routine metabolic screening, and preventive interventions among healthcare staff to reduce long-term cardiovascular disease burden and improve workforce health sustainability in workplace.},

note = {Type: Poster Presentation; Organisation: ¹ Pejabat Kesihatan Daerah Rembau, Negeri Sembilan, Malaysia,2 Environmental Health Research Centre, National Institute of Health, Malaysia; Corresponding author: Zaishafiqah Binti Zainal Abidinn, fiqasha.iaz@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-571,

title = {Microplastics and Early-Onset Colorectal Cancer : A Neglected Marker for Carcinogenesis?},

author = {Mohd Fuad Miskon3 Asmah Hanim Hamdan2 Edre Mohammad Aidid1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Early-onset colorectal cancer, defined as colorectal cancer occurring in individuals under 50, is increasingly recognised as a global health challenge. Malaysia has experienced a significant rise in early-onset colorectal cancer cases, with many patients presenting at advanced stages, complicating treatment and reducing survival rates. While genetic predisposition contributes to some cases, environmental and dietary factors are emerging as critical determinants. Among these, microplastic exposure has gained attention as a potential risk factor. Microplastics, which are plastic particles less than 5 mm in size, have become a pervasive contaminant in food, water, and air. These particles are associated with inflammation, oxidative stress, and gut microbiome disruption, all of which are implicated in colorectal cancer. However, the specific link between microplastic exposure and early-onset colorectal cancer remains under-researched, especially in regions like Pahang, Malaysia, where local dietary and environmental factors may play a role. The main objective of the research was to find the link between early-onset colorectal cancer and microplastics. Specifically, the aim was to see whether the microplastic load and types of microplastics in colorectal tissue samples has any association with early-onset colorectal cancer, controlling for age and gender as the common confounders. Materials and Methods: This study adopted a hospital-based case-control design conducted at Sultan Ahmad Shah Medical Centre @ International Islamic University Malaysia with an estimated 10 cases and 40 controls. Early-onset colorectal cancer cases were identified through histopathological examination of tissue samples obtained during surgery or colonoscopy, while controls included non-cancer patients undergoing colonoscopy biopsy for benign conditions. Three grams of tissue samples from both groups were processed using a modified microplastic extraction method and analysed through stereoscopic microscopy and Attenuated Total Reflection - Fourier Transform Infrared Spectroscopy to identify the load and type of microplastics. Data analysis involved univariate analysis first, then multivariate logistic regression to estimate the independent risk of early-onset colorectal cancer associated with microplastic exposure. The study was approved by IIUM Research Ethics Committee (IREC-2025-151) and SASMEC@IIUM Research Committee (SRG25-131-0131). Results: Univariate analysis revealed a significant association between age, gender, total microplastic number, minimum microplastic size, fibre load and fragment load with early-onset colorectal cancer. Three multivariate regression models were created, which included total microplastic number, fibre load and fragment load. The best regression model showed higher microplastic fragment load as the only independent risk factor of early-onset colorectal cancer (Nagelkerke R2= 0.84},

note = {Type: Oral Presentation; Organisation: 1Department of Community Medicine, Kulliyyah of Medicine, IIUM Kuantan, Malaysia, 2Department of Pathology and Laboratory Medicine, SASMEC@IIUM, Malaysia, 3Department of Marine Science, Kulliyyah of Sciences, IIUM Kuantan, Malaysia, 4Department of Surgery, Kulliyyah of Medicine, IIUM Kuantan, Malaysia, 5Research Assistant, IIUM Kuantan, Malaysia; Corresponding author: Edre Mohammad Aidid, edreaidid@iium.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-662,

title = {Miles to Go, Minds at Risk: How Commuting Shapes the Mental Wellbeing of Public Health Workers in Bandar Baharu, Kedah},

author = {Naim Abhar Hashim¹ Fadli Zulfaiz Zanudin¹ Nurul Afzan Aminuddin¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Bandar Baharu is a rural district in Kedah where healthcare workers face unique commuting challenges due to dispersed facilities and limited public transport. This study aimed to determine the prevalence of poor mental wellbeing and identify the association between long commuting and mental wellbeing status among healthcare workers in Bandar Baharu, addressing a critical gap in workforce sustainability for underserved areas. Materials and Methods: A cross-sectional study was undertaken over the period 16 November\textendash1 December 2025. Using a census approach, the study population included all healthcare workers employed at Bandar Baharu District Health facilities (N=270) who met the inclusion criteria. Data were analysed from socio-demographic profiles, the World Health Organization Well-Being Index, and the Modified Multimodal Commuting Stress Scale. Data were collected via an anonymous online survey with implied consent. Statistical analysis, including Chi-square tests and Forward Stepwise Logistic Regression, was performed using SPSS v27 to identify independent predictors and control for confounding factors like work, family and financial issues. Results: The prevalence of poor mental wellbeing among the staff was 13.8%. Significant bivariate associations were found between poor wellbeing and jammed traffic (p=0.001), longer commute duration (p\<0.001), and greater distance (p\<0.001). Furthermore, all four commuting stress factors (inefficiency, congestion, physical strain, and unsafety) were highly correlated with poor mental health (p\<0.001). In the final multivariate model, commute distance remained a significant independent predictor (OR 1.035, 95% CI: 1.013, 1.058},

note = {Type: Poster Presentation; Organisation: ¹Bandar Baharu District Health Office, Kedah, Malaysia ²Serdang Health Clinic, Kedah, Malaysia ³Bandar Baharu Health Clinic, Kedah, Malaysia.; Corresponding author: Nurul Afzan Aminuddin, drnurulafzan.a@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-737,

title = {Mixed outbreak of acute respiratory infection with an environmentally linked melioidosis subset in a semi-closed training institution, Johor, Malaysia},

author = {Hazlin binti Abu Bakar1 Cheah Yong Xiang1 Nadrah binti Abdul Rahim1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: In July 2025, a semi-closed training institution in Johor, Malaysia, reported a cluster of acute respiratory infection (ARI) among trainees, prompting an outbreak investigation. The setting involved shared accommodation, close interpersonal contact, and structured group activities, all of which were conducive to respiratory spread. However, the occurrence of several severe cases with clinical features atypical for uncomplicated ARI raised concern for a possible concurrent environmental exposure, including melioidosis. This study describes the epidemiological, clinical, laboratory, and environmental features of the outbreak and highlights the public health implications of managing concurrent respiratory and environmental infectious risks in a tropical institutional setting. Materials and Methods: A retrospective outbreak investigation with institution-based analytic components was conducted. To address both suspected transmission pathways, the investigation integrated active and passive case detection, clinical record review, exposure assessment based on daily institutional activities, environmental assessment and sampling, and laboratory analysis, including pulsed-field gel electrophoresis (PFGE) of clinical and environmental B. pseudomallei isolates. The study population comprised all 764 individuals linked to the institution during the outbreak period, including a small number of non-resident staff who commuted daily but shared the same daytime environmental and interpersonal exposures as the trainee population. Cases were defined as individuals with clinician-diagnosed ARI and/or culture-confirmed melioidosis. Risk factors for ARI were assessed using modified Poisson regression to estimate adjusted risk ratios (aRRs). The study population comprised 764 individuals; the median age was 22 years (IQR 20\textendash24), 94.4% were male, and 86.9% were trainees. Results: Overall, 278 individuals met the ARI case definition (attack rate: 36.4%), while 3 had culture-confirmed melioidosis (0.4%). Among ARI cases, symptom onset clustered from late June to mid-July 2025, with a median onset date of 5 July 2025, consistent with propagated person-to-person transmission in a semi-closed setting. In adjusted analysis, each additional year of age was associated with a 8% lower risk of ARI (aRR 0.92, 95% CI: 0.88, 0.96). Trainee status was also associated with illness, although the estimate was imprecise (aRR 15.79, 95% CI: 2.13, 116.96). Any Friday mosque exposure, defined as attendance at least once on 20 June, 27 June, or 4 July 2025, was independently associated with ARI (aRR 4.49, 95% CI: 3.34, 6.02), whereas hill run and swimming pool exposures were not significantly associated. In contrast, all three confirmed melioidosis cases were epidemiologically distinct from the ARI transmission pattern, occurring exclusively among participants with mud exposure involving the nose and/or oral cavity. Environmental investigation identified B. pseudomallei in soil from the training field, and PFGE demonstrated \>85% similarity between the environmental isolate and all three clinical isolates, supporting a common environmental source of infection. Discussion/ Conclusion: The findings are consistent with a mixed outbreak involving propagated ARI transmission alongside a concurrent, environmentally acquired melioidosis cluster. This highlights the importance of considering both epidemiological and environmental exposures when severe or atypical cases arise within a respiratory outbreak. We recommend that outbreak investigations in similar settings incorporate parallel assessment of person-to-person and environmental transmission pathways, with early environmental sampling and molecular comparisons, where feasible, to guide targeted control measures.},

note = {Type: Poster Presentation; Organisation: 1Kota Tinggi District Health Office, Kota Tinggi, Johor Darul Ta'zim, Malaysia. 2 Johor State Health Department, Johor Bahru, Johor Darul Ta'zim, Malaysia.; Corresponding author: Nadrah binti Abdul Rahim, drnadrah@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-454,

title = {Mobile Mammography as a Model for Equity in Breast Cancer Screening: Findings from Rural Communities in Malaysia},

author = {Muhammad Faiz B. Md Taib¹ Shaminee A/P Chandran¹ Ainul Basyirah Binti Justi¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Breast cancer is the most common cancer among women in Malaysia, with late diagnosis more frequently observed in rural communities due to barriers including travel distance, financial constraints, and limited awareness. To improve access to screening services, the National Cancer Council (MAKNA) implemented a mobile mammography program in 2011, delivering free breast cancer screening in underserved areas, with expansion to East Malaysia in 2023. This study aimed to evaluate two-year program outcomes in screening participation, abnormal findings, cancer detection, and implications for equitable healthcare delivery. Materials and Methods: A retrospective descriptive study was conducted using screening data collected from January 2023 to December 2024. Free digital mammography was offered to women aged forty years and above. Complementary portable ultrasound was provided for immediate triage of abnormal mammography findings. Descriptive analysis was performed on demographic characteristics, abnormal findings, referral rates, and confirmed cancer cases. Results: A total of 13,343 mammograms were performed across 80 screening events, of which 63 (78.8%) were conducted in rural locations. Participants from rural communities comprised 9,848 women (73.8%). The majority of women screened were between forty and fifty-nine years old. Abnormal findings were identified in 3,693 women (27.7%). Among these, 1,682 (45.5%) underwent ultrasound assessment, and 180 (1.3% of all screened; 4.9% of abnormal findings) were referred for hospital evaluation. Thirty-three breast cancer cases were diagnosed (0.25% of all screened). Early-stage cancer accounted for 48.5% of cases, while 51.5% were diagnosed at late stages. Conclusion: Mobile mammography provides a practical approach to improving equitable access to breast cancer screening for rural populations in Malaysia. However, the continued occurrence of late-stage diagnoses indicates the need for enhanced follow-up systems and community awareness strategies.},

note = {Type: Poster Presentation; Organisation: ¹National Cancer Council Kuala Lumpur, 50450, Malaysia; Corresponding author: Ainul Basyirah Binti Justi, ainul.basyirah@makna.org.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-475,

title = {Mobile Targeted Active Case Detection to Susceptible Populations In Hotspot Localities and Treatment Outcomes for Tuberculosis In Sabah},

author = {Richard Avoi 1 2 Yau-Chun Liaw1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Tuberculosis is an ancient disease that continues to pose a major global public health threat. Early diagnosis remains a challenge, even in regions with advanced medical infrastructure. A key objective of Malaysia's National Strategic Plan for Tuberculosis Control (2016-2020) is to reach a tuberculosis notification rate of 100 per 100,000 people by the year 2020 and the World Health Organization End Tuberculosis Strategy target of ≥90% of treatment success rate. It is challenging to achieve this goal using passive case detection (PCD) alone. Thus, implementing multiple active case detection approaches is necessary to achieve the targets. In 2016, Sabah launched mobile targeted active case detection (MTACD) buses equipped with digital chest X-rays for one-stop diagnostics. This early detection strategy might increase tuberculosis notification rates and treatment success while reducing mortality. This study’s objective was to determine MTACD’s effectiveness in improving tuberculosis treatment outcomes in Sabah’s hotspot localities. Materials and Methods: A bidirectional cohort study. All forms of tuberculosis cases detected through MTACD and PCD between 1st January 2019 and 31st December 2020 (retrospective cohort) and between 1st January 2021 and 31st December 2022 (prospective cohort) were included. Logistic regression was used to determine the association of detection methods (PCD and MTACD) with successful treatment outcomes, while Cox proportional hazards regression analysed their association with tuberculosis mortality. Results: A total of 1,221 adult tuberculosis patients were included in this study, with 612 detected through MTACD and 609 through PCD. In the logistic regression model, patients identified by MTACD had significantly higher odds of successful treatment compared with PCD. The crude and adjusted odds ratios indicate that, even after controlling for confounders, MTACD detection was associated with about a sevenfold higher likelihood of treatment success. Similarly, Cox regression results suggest reduced mortality risk among MTACD-detected cases. The crude hazard ratio and adjusted hazard ratio show a substantially lower hazard of mortality compared with PCD. Conclusion: Overall, MTACD appears more effective in identifying tuberculosis cases with better prognosis, potentially due to earlier diagnosis, timely treatment initiation, or systematic outreach, highlighting the value of MTACD strategies in tuberculosis control programs. In conclusion, MTACD detection was associated with higher treatment success and lower mortality risk than PCD, underscoring the importance of proactive case detection strategies to improve tuberculosis treatment outcomes and survival.},

note = {Type: Oral Presentation; Organisation: 1Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University of Malaysia Sabah, Sabah, Malaysia. 2Papar District Health Office, Sabah, Malaysia; Corresponding author’s email: Yau-Chun Liaw, Liaw608@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-686,

title = {Monoclonal Antibody Therapies for Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Cost-Effectiveness Analysis},

author = {Izzuna Mudla binti Mohamed Ghazali1 Mohamad Baihaqi bin Mohamad Basri1 Syaharatul Patimah binti Kamarudin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Neuromyelitis optica spectrum disorder is a rare autoimmune disease of the central nervous system, mainly affecting the optic nerves and spinal cord through inflammation and demyelination. Its severe, relapsing course often leads to disability, making relapse prevention essential. Monoclonal antibody therapies have emerged as promising options in reducing relapse episodes, though their high cost remains a major challenge. Hence, the objective of this study was to evaluate the effectiveness, safety and cost-effectiveness of rituximab, satralizumab and eculizumab compared with best supportive care for neuromyelitis optica spectrum disorder treatment, from the Malaysian healthcare system perspective. Materials and Methods: A systematic review was conducted to evaluate the effectiveness and safety of rituximab, satralizumab and eculizumab in the treatment of neuromyelitis optica spectrum disorder. Systematic searches were performed across MEDLINE®, PubMed, USFDA, and INAHTA databases up to 25 August 2024. Eligible studies were those published in English involving neuromyelitis optica spectrum disorder populations treated with these monoclonal antibodies. Subsequently, a cost-effectiveness analysis was conducted to estimate the cost per relapse avoided. The monoclonal antibodies evaluated were assumed to be used as the first-line therapy. The analysis covered six years in duration with three percent discount for both annual incremental cost and annual incremental relapse. Clinical data, epidemiological data and disease-related information were sourced from local settings whenever possible or through literature review when local data were unavailable. Resources and economic data were obtained from Ministry of Health sources, namely Pharmaceutical Services Programme, Malaysian Casemix Diagnosis-Related Group, and Ministry of Health Clinical Practice Guidelines. Results: The systematic review included nine studies. All three monoclonal antibodies (rituximab, satralizumab and eculizumab) were effective in reducing relapse rate in patients with neuromyelitis optica spectrum disorder. For disability outcomes, rituximab demonstrated mixed findings, while satralizumab and eculizumab showed no significant improvement. Across studies, all therapies were generally well tolerated and had favourable safety profiles. Cost-effectiveness analysis demonstrated that biosimilar rituximab had the lowest cost per relapse avoided (MYR12,385.00) compared with rituximab (original), satralizumab and eculizumab. Discussion/Conclusion: This study demonstrates that among the monoclonal antibodies evaluated, biosimilar rituximab provides the most favourable cost per relapse avoided for neuromyelitis optica spectrum disorder treatment in Malaysia. Although satralizumab and eculizumab are clinically effective, their substantially higher costs limit affordability and accessibility within the local healthcare system. These findings support the prioritisation of biosimilar rituximab as the most cost-effective option for relapse prevention in resource-constrained settings. Expanding access to affordable therapies is essential to improve patient outcomes, and effective price negotiations should be pursued to enhance sustainability within the Malaysian healthcare system.},

note = {Type: Poster Presentation; Organisation: 1Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health, Putrajaya, Malaysia; Corresponding author: Syaharatul Patimah binti Kamarudin, dr.syaharatul@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-784,

title = {More Than Just Knowledge: Understanding Behavioural Determinants of Effective Contraceptive Uptake},

author = {Abdul Mu’eez Bin Ahmad Shahbuddin1 Chandramalar Kanthavelu1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The utilisation of highly effective Code 1 contraception plays a crucial role in reducing unintended pregnancies and improving maternal and child health outcomes, particularly among high-risk women. Despite the availability of pre pregnancy care services in Malaysia, contraceptive prevalence remains suboptimal, with persistent gaps in uptake among women with underlying medical conditions. Various studies suggest that, modifiable behavioural factors, including knowledge, attitudes, social norms and self-efficacy, may influence contraceptive utilisation. However, local evidence on these associated factors within primary care settings remains limited. Therefore, this study aimed to determine the prevalence and factors associated with Code 1 contraceptive utilisation among pre pregnancy care clients in Tampin District. Materials and Methods: A cross-sectional study was conducted among pre pregnancy care clients clients in Tampin District. A total of 81 respondents were recruited. Data were collected using a structured and validated questionnaire assessing socio-demographic characteristics, reproductive history, knowledge, attitudes, social norms, and contraceptive self-efficacy. Descriptive statistics were used to summarise the data. Bivariate analysis was performed using Chi-square, Fisher’s exact test and Mann\textendashWhitney U test as appropriate. Variables with p \< 0.25 were included in multivariate analysis. Binary logistic regression was conducted to identify independent predictors of Code 1 contraception utilisation, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. Statistical significance was set at p \< 0.05. Results: The prevalence of Code 1 contraceptive utilisation among pre-pregnancy care clients in Tampin was 45.1% (n=37). History of contraception use, attitudes towards contraception and social norms were significant predictors for Code 1 contraception use while other variables were not significantly associated. Respondents with a history of contraception use were significantly more likely to utilise Code 1 contraception (AOR = 73.81, 95% CI: 1.50\textendash3640.35},

note = {Type: Oral Presentation; Organisation: 1Tampin District Health Office , 73000, Tampin, Negeri Sembilan, Malaysia; Corresponding author: Chandramalar Kanthavelu, chandramalar@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-745,

title = {Mortality in Young- vs. Usual-Onset Type 2 Diabetes: A Malaysian Registry Cohort Study},

author = {Ang Swee Hung1 Norshahiratul Atiqah Mohd Zaidi1 Mohamad Zulfikrie Abas1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Young-onset Type 2 diabetes (YOD) has been increasingly associated with a higher risk of complications and mortality compared to usual-onset Type 2 diabetes (UOD). However, this remains debated, as the apparent excess risk may be confounded by longer disease duration or differences in age structure. Since age at onset, current age, and diabetes duration are mathematically interdependent, their simultaneous inclusion in regression models introduces collinearity, complicating causal interpretation. This study aimed to determine whether all-cause mortality differs between YOD and UOD patients, and whether the difference persists after accounting for key clinical and demographic factors, including stratification by diabetes duration. Materials and Methods: We conducted a retrospective cohort study using data from the Malaysian National Diabetes Registry (southern region), with mortality linkage from the national death registry updated to 2021. The study population comprised Type 2 diabetes from routine clinical audits. YOD was defined as diabetes onset before 40 years of age, and UOD as onset at 40 years and above. Crude mortality rates per 1,000 patient-years (PY) were calculated overall and by group. Age-standardised mortality rates (ASMR) were estimated using internal standardisation. Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) for YOD versus UOD, adjusting for baseline age, sex, ethnicity, smoking status, HbA1c, blood pressure, LDL-C, and diabetes complications (ischaemic heart disease, cerebrovascular disease, retinopathy, nephropathy). Subgroup analyses were conducted by stratifying baseline diabetes duration into \<5, 5\textendash\<10, 10\textendash\<20, and ≥20 years. Results: A total of 90,933 patients were analysed with a mean follow-up period of 7.55±2.80 years. Among them, 9.92% had YOD. Mean age was 59.09±10.85 years; YOD patients were younger (41.70±8.52) than UOD patients (61.00±9.26). Mean diabetes duration was longer in YOD (7.77±7.54 years) than UOD (5.26±4.48 years). Overall crude mortality rate was 28.72 per 1,000 PY, with 16.43 in YOD and 30.20 in UOD. However, ASMR was higher in YOD (47.76 per 1,000 PY) than UOD (30.47 per 1,000 PY). After adjustment, YOD was associated with higher mortality risk compared with UOD (HR 1.74, 95% CI 1.62\textendash1.87; p\<0.01). In stratified analyses, elevated risk persisted in most duration groups: \<5 years (HR 1.78, 95% CI 1.50\textendash2.11), 5\textendash\<10 years (HR 1.80, 95% CI 1.55, 2.09), and 10\textendash\<20 years (HR 1.48, 95% CI 1.29, 1.69), all p\<0.01, but not in ≥20 years (HR 1.06, 95% CI 0.87, 1.28; p=0.58). Conclusion: This large cohort study shows that YOD is independently associated with higher all-cause mortality compared to UOD, even after adjustment for major clinical and demographic factors. Although crude mortality appeared lower in YOD, this was driven by a younger age distribution, while age-standardised analyses revealed a higher underlying risk. The persistence of elevated hazard across most diabetes duration strata suggests that excess mortality in YOD is not solely explained by longer disease duration. However, attenuation of risk in long-duration diabetes (≥20 years) may indicate survivor bias or convergence of risk over time. These findings support YOD as a distinct high-risk phenotype requiring earlier and more aggressive intervention strategies.},

note = {Type: Poster Presentation; Organisation: 1Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia.; Corresponding author: Mohamad Zulfikrie Abas, zulfikrie@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-742,

title = {Nationwide prevalence and determinants of inappropriate antibiotic use in Malaysia: Findings from NHMS 2020},

author = {Chong Zhuo Lin1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Antimicrobial resistance (AMR) is a severe global health threat driven primarily by the inappropriate use of antibiotics. Understanding the factors associated with inappropriate use at the population level is crucial for closing public health gaps and informing targeted interventions. The main objective of this study was to determine the nationwide prevalence of inappropriate antibiotic use, and to identify its associated sociodemographic and knowledge-related factors among the general community-dwelling population in Malaysia. Materials and Methods: Data were derived from the National Health and Morbidity Survey (NHMS) 2020, using a nationwide population-based cross-sectional design. To ensure national representativeness, a two-stage stratified random cluster sampling design was employed to select participants aged ≥15 years across Malaysia. Sociodemographic data were collected via face-to-face structured interviews using mobile tablets, and questions adapted from the World Health Organization Antibiotic Resistance Public Awareness Survey were administered through computer-assisted telephone interviews. Knowledge regarding antibiotic use was assessed using six items, with ≤4 correctly answered items categorized as lower knowledge scores, as this cut-off minimised random error and increased model robustness and stability. Inappropriate use was defined as self-reported antibiotic use for a common cold or sore throat over the past 12 months. Data were analyzed using complex sampling analysis with applied weights for multivariable logistic regression in STATA version 18. Results: A total of 3,051 individuals participated, representing an estimated 24.6 million people in Malaysia. The weighted prevalence of inappropriate antibiotic use in the past 12 months was 25.0%. The majority of the population (90.8% weighted) demonstrated lower knowledge scores regarding antibiotic use. Multivariable analysis identified age, ethnicity/nationality, and knowledge scores as factors associated with inappropriate antibiotic use; while sex, location, and education and income levels were not significant. Younger populations had substantially higher odds of inappropriate use compared with those ≥60 years, with an aOR of 3.73 (95%CI 2.04, 6.81) for ages 15-17, and an aOR of 2.26 (95%CI 1.47, 3.47) for ages 18-59 (both p\<0.001). Lower knowledge scores also predicted misuse compared with higher scores, with an aOR of 2.38 (95%CI 1.37, 4.15) (p\<0.01). Conversely, being a foreigner or non-citizen emerged as a significant protective factor compared with bumiputera, with an aOR of 0.47 (95%CI 0.27, 0.82) (p\<0.01). Conclusion: One-quarter of the general population in Malaysia used antibiotics inappropriately. Younger age and lower knowledge scores were independent predictors of misuse. While it is crucial to close the huge knowledge gaps through educational campaigns, these alone are insufficient to prevent misuse in younger demographics. For younger populations, interventions must incorporate non-knowledge-based strategies, such as mitigating parental demand for antibiotics and improving provider-patient communication. Conversely, being a foreigner is a protective factor against misuse. This likely reflects structural barriers, such as financial disincentives, combined with strict local regulations that make antibiotics prescription-only. Closing the public health gap on AMR requires multipronged, people-centred strategies that simultaneously address population-wide knowledge gaps and mitigate non-indicated demands among younger populations. This can be achieved by leveraging technology and partnerships to better implement the Malaysian Action Plan on Antimicrobial Resistance (MyAP-AMR) 2022-2026.},

note = {Type: Poster Presentation; Organisation: 1Centre for Communicable Disease Epidemiology Research, Institute for Public Health, National Institutes of Health, Ministry of Health, Malaysia; Corresponding author: Chong Zhuo Lin, chongzl@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-762,

title = {Nonlinear Associations Between Meteorological Factors and Hand, Foot, and Mouth Disease (HFMD) Cases in Perlis, Malaysia, 2016\textendash2025: Effect Modification by School Holidays},

author = {Nor Atiqah MT1 Arini Dahlia S1 Ku Mohd Saifullah KI1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: HFMD remains a significant public health concern in Malaysia, particularly among children. Perlis has consistently reported a high burden of HFMD and is recorded as the state with the highest incidence rate nationwide in 2025, with 1,180 cases per 100,000 population. Meteorological factors such as temperature, rainfall, and relative humidity, as well as behavioural changes during school holidays, may influence HFMD transmission dynamics. However, evidence on the combined effects of these factors at the local level remains limited. This study aimed to access whether school holiday status modifies the nonlinear associations between weekly meteorological parameters and HFMD incidence in Perlis from 2016 to 2025. Materials and Methods: A retrospective ecological study was conducted using weekly HFMD surveillance data in Perlis from 2016 to 2025. Daily meteorological data, including mean temperature, total rainfall, and mean relative humidity, were obtained from the NASA POWER database and aggregated to the weekly level. Weekly mean values were calculated for mean temperature and mean relative humidity, while daily precipitation values were cumulatively summed to obtain total weekly rainfall. The school week and school holiday were classified based on official Ministry of Education calendars. Generalized additive models with a negative binomial distribution were applied to examine nonlinear associations between several combinations of meteorological variables and HFMD cases, while adjusting for seasonal and long-term trends. Results: Temporal patterns of HFMD cases showed distinct fluctuations over time, with several upsurges of HFMD cases observed following certain school-holiday periods. In addition, increases in HFMD cases generally aligned with rising weekly mean temperature and early uptrend of weekly mean relative humidity, whereas weekly rainfall exhibited more irregular patterns with no consistent temporal correspondence to hand, foot, and mouth disease cases. Model M6, which includes weekly mean temperature and weekly mean relative humidity, provided the best overall fit based on model selection criteria. Nonlinear associations were observed between meteorological factors and HFMD incidence, with temperature and relative humidity showing distinct patterns modified by school-holiday status. HFMD risk increased within the temperature range of 26.0\textendash27.5 °C, peaking at approximately 27.0 °C, and was associated with relative humidity less than 70 percent during school-holiday periods compared with non-holiday weeks. The model explained 45.1% of the deviance in its incidence, indicating that meteorological factors, together with seasonal and long-term trends, accounted for a substantial proportion of the observed variability. Conclusion: This study demonstrates that temperature and relative humidity are associated with HFMD cases in Perlis in a nonlinear manner. The modifying effect of school holidays suggests that population movement patterns, including increased interstate travel, may play a role in introducing and amplifying HFMD cases in Perlis. Together, these findings indicate that HFMD transmission is shaped by the interaction between climatic conditions and human mobility patterns. Future research incorporating lagged analyses is warranted to improve predictive modelling and guide more targeted control strategies.},

note = {Type: Poster Presentation; Organisation: 1Kangar District Health Office, Jalan Abi Tok Hashim, 01000 Kangar, Perlis, Malaysia. 2Jejawi Health Clinic, Jalan Jejawi Sematang, Kawasan Perindustrian Jejawi, 02600 Arau, Perlis. Malaysia.; Corresponding author: Ku Mohd Saifullah KI, drsaiful@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-555,

title = {Obesity as a Contributing Comorbidity to Dengue Mortality in Selangor, 2022-2025},

author = {Qamruddin AA1 Edwin AR1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Dengue remains a major public health concern in Selangor, accounting for a significant share of dengue-related illness and deaths in Malaysia, with the state contributing nearly half of national cases. While comorbidities such as diabetes, hypertension, and cardiovascular disease are known to worsen dengue outcomes, the role of obesity is less clearly understood. In Asian populations, obesity (BMI \>27.5 kg/m²) is linked to systemic inflammation, metabolic imbalance, and immune changes that may increase disease severity. Understanding its impact on dengue mortality is important for improving public health strategies and clinical management. This study aims to determine the contribution of obesity as a comorbid factor among dengue mortality cases in Selangor over a four-year period (2022\textendash2025), and to compare its prevalence with other major comorbidities. Materials and Methods: A retrospective analysis was conducted using dengue mortality records obtained from health facilities across Selangor between January 2022 and December 2025. Demographic information, clinical characteristics, and comorbidities were extracted from hospital records and death review forms (DIX/01/2021 Rev 5). Comorbid conditions analysed included obesity (BMI \>27.5 kg/m²), diabetes mellitus, hypertension, renal failure, and heart disease. Descriptive statistical methods were applied to calculate the prevalence of each comorbidity for each year, and trends over time were assessed. The analysis focused on identifying the most prevalent comorbid conditions and highlighting patterns that may inform clinical risk stratification. Results: A total of 57 dengue-related deaths were reviewed during the study period. Obesity was identified as the most frequent comorbid condition across three out of the four years studied, with prevalence rates increasing from 36.0% in 2022 to 55.6% in 2025. In contrast, diabetes mellitus accounted for 21.4%, 33.3%, 12.5%, and 11.1% of deaths across the same years, while hypertension accounted for 14.3%, 44.4%, 25.0%, and 22.2%. Other comorbidities, including renal failure and heart disease, were less commonly reported. These results indicate that obesity not only represents the leading comorbid factor in dengue mortality but also shows a rising trend over time, surpassing other established risk factors. Conclusion: Obesity is the leading comorbid contributor to dengue mortality in Selangor and demonstrates a clear increasing trend from 2022 to 2025. This finding shows the importance of early risk stratification and targeted clinical monitoring for obese dengue patients, who may be at higher risk of severe outcomes. Public health strategies should consider integrating obesity prevention and management into dengue control programs, including community-based awareness campaigns and clinical guidelines to reduce mortality. Further research is warranted to explore the underlying mechanisms linking obesity to severe dengue outcomes and to evaluate interventions that could mitigate this risk in high-burden regions.},

note = {Type: Poster Presentation; Organisation: 1Vector-Borne Disease Control Unit, Selangor State Health Department, Ministry of Health Malaysia; Corresponding author: Annabella Ruth Edwin, annabella@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-787,

title = {Occupational Burnout and Its Associated Factors Among Primary Healthcare Workers in Kota Kinabalu, Sabah.},

author = {Khalid bin Mokti1 Rafidah Lamit1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Occupational burnout among primary healthcare workers is a serious public health issue worldwide with implications for both individual well-being and the quality of healthcare services. Materials and Methods: This cross-sectional study was conducted from April 2024 until June 2024 involving specialists, medical officers, nurses, assistant medical officers, and others to determine the prevalence and the factors associated with occupational burnout among the primary healthcare workers under Kota Kinabalu District Health Office, Sabah. Self-administered questionnaire and the Maslach Burnout Inventory \textendash Human Service Survey were used for data collection, then analyzed using SPSS. Multivariable logistic regression analysis was applied to investigate the association of the factors and occupational burnout among primary healthcare workers in Kota Kinabalu, Sabah. Results: A total of 270 respondents were involved with this study. Prevalence of occupational burnout is 87.8% (95% CI: 83.9%, 91.7%), which is higher than previous studies. The findings also indicated that married respondents (aOR: 3.349, 95% CI : 1.225, 9.154},

note = {Type: Poster Presentation; Organisation: 1Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah Malaysia.; Corresponding author: Rafidah Lamit, rafidahlamit@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-604,

title = {Occupational Noise-Induced Hearing Loss Among Vector Control Personnel in Sabah With Insecticide Co-Exposure: A Sequential Explanatory Mixed-Methods Study.},

author = {Pravina Deligannu 3 Khamisah Awang Lukman 2 Alagi Selvy Perumal 1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Occupational hearing loss is a major workplace health problem, and noise-induced hearing loss (NIHL) remains one of the most common preventable occupational health conditions worldwide. Vector control personnel involved in fogging operations represent a unique occupational group exposed to hazardous noise from thermal fogging machines, alongside concurrent insecticide exposure. However, evidence on the combined influence of noise and insecticide co-exposure on hearing outcomes within public health operational settings remains limited. This study aimed to assess occupational hearing loss and develop an internally validated multivariable risk prediction model examining noise and insecticide co-exposure among vector control unit personnel in Sabah using a sequential explanatory mixed-methods approach. Materials and Methods: This study was conducted in five districts in Sabah using purposive sampling. A total of 135 vector control personnel were included after applying eligibility criteria. Data collection involved sociodemographic characteristics, occupational history, cumulative insecticide exposure indices, and audiometric screening results. Occupational noise exposure was measured using Personal Noise Dosimeters (PND) and expressed as eight-hour equivalent continuous noise levels (Lex,8h), while environmental noise measurements were obtained using a Sound Level Meter. Among the 135 personnel, 80 had valid PND measurements and were included in the multivariable logistic regression analysis. An embedded mini-intervention involving dual hearing protection reinforcement was implemented to guide the qualitative phase. Semi-structured interviews with 15 personnel explored behavioural determinants influencing hearing protection use, including discomfort, communication challenges, and organisational reinforcement. Results: The prevalence of NIHL among vector control personnel was 41.5%. Among participants with valid dosimetry data, the mean Lex,8h was 90.12 ± 2.95 dB(A), with most personnel exposed above 85 dB(A). In the adjusted multivariable logistic regression model, occupational noise exposure was significantly associated with NIHL, where each 1 dB increase in Lex,8h increased the odds of NIHL (AOR = 1.22, 95% CI: 1.02, 1.51},

note = {Type: Oral Presentation; Organisation: 1Department of Public Health Medicine, Faculty of Medicine and Health Sciences Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, 2Centre for Occupational Safety \& Health, Universiti Sabah Malaysia, Kota Kinabalu, Sabah, Malaysia, 3Department of Chemical Engineering, Faculty of Engineering Technology, Universiti Tun Hussein Onn Malaysia, Pagoh, Malaysia.; Corresponding author: Alagi Selvy Perumal, alagi_86@yahoo.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-574,

title = {Older adults Digital Health Literacy (ODDHeaL) Module: A Social Cognitive Theory\textendashBased Study Protocol},

author = {Lim Poh Ying Halimatus Sakdiah Minhat1 Nor Hazimah Rosle1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Digital health literacy (DHL) plays an important role in healthy ageing by influencing older adults’ ability to navigate digital healthcare. However, despite widespread internet access, DHL remains low, with limited theory-based interventions in Malaysia. This study aims to develop and evaluate the effectiveness of the Older Adults Digital Health Literacy (ODDHeaL) module, a Social Cognitive Theory (SCT)-based health education intervention, among community-dwelling older adults in Johor, Malaysia. Materials and Methods: A single-blinded, two-arm cluster randomised controlled trial will be conducted among older adults (≥55 years) recruited from six randomly selected senior citizen activity centres (PAWE) in Johor. Eligible participants must own a smartphone, have internet access, be independent in daily activities, and have no cognitive impairment. Clusters will be randomised (1:1) into intervention and control groups. The ODDHeaL module, developed using the ADDIE model, will be evaluated at baseline, post-intervention, and 2-month follow-up. Primary outcome is digital health literacy; secondary outcomes include health literacy, perception towards online health information, confidence in using smartphones, and health information-seeking behaviour. Results: This study may reveal the positive effects of the ODDHeal intervention module on digital health literacy among older adults, as well as health literacy, perception towards online health information, self-efficacy and health information-seeking behaviour (HISB). Conclusion: ODDHeaL is expected to improve digital health literacy and related outcomes among older adults. By incorporating Social Cognitive Theory, the intervention addresses personal, behavioral, and environmental factors influencing digital health literacy. Improved digital health literacy may enhance self-management and empower older adults to take a more active role in their health.},

note = {Type: Poster Presentation; Organisation: 1Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.; Corresponding author: Nor Hazimah Rosle, n.hazimahrosle@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-493,

title = {One in Three Arrive Late: Behavioural Patterns in Dengue Care-Seeking - A District-Level Survival Analysis in Seberang Perai Tengah},

author = {Farzaana Adam1 Lavanyah Sivaratnam1 Mohd Ikhwan Azmi1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Timely care-seeking during dengue illness reflects behavioural responses to perceived risk and symptom appraisal. Within the Health Belief Model, factors such as perceived susceptibility, severity, and cues to action may influence the decision to seek early treatment. This study examined behavioural patterns in dengue care-seeking and quantified determinants of delayed diagnosis in Seberang Perai Tengah. Materials and Methods: A retrospective cohort study was conducted using all confirmed dengue cases notified in Seberang Perai Tengah between 2021\textendash2025 (n=5,926). Time from symptom onset to diagnosis (patient delay) was used as a proxy indicator of care-seeking behaviour, while time from symptom onset to notification (total delay) reflected combined behavioural and reporting processes. Kaplan\textendashMeier survival curves and log-rank tests were used to compare timeliness across transmission contexts. Multivariable Cox proportional hazards models estimated adjusted hazard ratios (aHR), controlling for age and gender. Clinically significant delay was defined as ≥4 days. All analyses were conducted using R version 2026.01.1. Results: Median patient delay was 2 days (IQR 1\textendash4), and median total delay was 3 days (IQR 2\textendash4). Approximately one in three cases experienced clinically significant delay. Care-seeking timeliness differed by transmission context: sporadic cases demonstrated longer delays compared to outbreak-associated cases (log-rank p=0.0034). In adjusted models, outbreak-related cases had 8% faster diagnosis (aHR 1.08, 95% CI: 1.03, 1.14) and 9% faster notification (aHR 1.09, 95% CI: 1.03, 1.15). Proportional hazards assumptions were satisfied. Conclusion: Although responsiveness improves during outbreaks, delayed care-seeking remains common during non-outbreak periods. The observed patterns are consistent with behavioural activation under heightened perceived risk, suggesting that sustained risk communication and symptom awareness strategies beyond outbreak cycles may strengthen dengue control effectiveness.},

note = {Type: Poster Presentation; Organisation: 1Seberang Perai Tengah District Health Office, 14000 Bukit Mertajam, Pulau Pinang; Corresponding email: ikhwanazmi69@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-690,

title = {Optimising Methadone Maintenance Therapy in Malaysian Primary Care: A Multi-Centre Census Study Protocol on Treatment Adequacy, Quality of Life, and Integrated Care Gaps},

author = {Nur Afiqah Mohd Salleh 2 Mohd Faris Mahmud1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Methadone maintenance therapy is a key primary care and harm reduction intervention for opioid use disorder, yet evidence on treatment adequacy, patient-centred outcomes, and integration with broader health services remains limited in routine government practice. This study aims to characterise treatment adequacy and quality of life among active methadone maintenance therapy clients across four government primary care clinics in Penang, Malaysia; examine their associations with clinical and psychosocial factors; and quantify gaps in tobacco dependence management, mental health screening, and infectious disease-related care. Materials and Methods: This protocol describes a multi-centre cross-sectional census study with an embedded retrospective clinical record review. All active methadone maintenance therapy clients across four government primary care clinics under one district health office will be invited to participate. Data will be collected through structured face-to-face interviews and concurrent chart abstraction. The co-primary outcomes are the proportion of opioid-negative urine drug screening results in the preceding six months and quality of life domain scores. Secondary measures include probable depression, perceived social support, tobacco use and nicotine dependence, readiness to quit, and documented exposure to stop-smoking advice and referral. Service integration gaps will be quantified as programme quality indicators, and associations will be analysed using descriptive and multivariable methods. Ethical review and national protocol registration are pending, and data collection will begin only after approval. Results: Data collection has not commenced. The planned primary outputs are estimates of treatment adequacy, opioid use control, quality of life, and service integration gaps across the study population. Discussion and Conclusion: This study is expected to generate district-level evidence on methadone maintenance therapy treatment adequacy, quality of life, tobacco burden, and service integration gaps in Malaysian government primary care. Findings may inform dose optimisation, stronger integration of stop-smoking and mental health services, and more systematic documentation of infectious disease-related care, supporting more people-centred, equitable, and integrated primary care for a highly underserved population.},

note = {Type: Poster Presentation; Organisation: ¹ Klinik Kesihatan Sungai Dua, 13800 Butterworth, Penang, Malaysia. ² Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.; Corresponding author: Mohd Faris Mahmud, farismahmud@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-756,

title = {Outbreak Investigation of Norovirus Gastroenteritis in an Urban High School in Kuala Lumpur: The Critical Role of Standardized Environmental Disinfection},

author = {Atiqah Abdul Wahab1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: On 15th January 2026, Pejabat Kesihatan Cheras was notified of a cluster of acute gastroenteritis cases at a high school in Kuala Lumpur, following a sharp rise in student absenteeism. This study aimed to investigate the outbreak, identify contributing risk factors, and evaluate the effectiveness of environmental control measures. Materials and Methods: A descriptive epidemiological investigation and environmental risk assessment were conducted. A case was defined as any individual at the school presenting with vomiting, diarrhea, abdominal pain, nausea, dizziness, or fever from 12 January 2026 onwards. Active case detection was performed on-site. Rectal swabs (n=15) were collected for virological analysis. Environmental inspections assessed food premises and sanitation facilities. Results: A total of 209 cases (203 students, 6 staff) were identified among 3,487 individuals (attack rate: 6.0%). The most common symptoms were vomiting (66.5%), abdominal pain (60.8%), and diarrhea (60.8%). Norovirus was detected in clinical samples, while food premises demonstrated satisfactory hygiene compliance, suggesting person-to-person transmission rather than a foodborne source. Key environmental gaps included inadequate health screening, allowing symptomatic individuals to remain in school, and insufficient hand hygiene facilities, particularly lack of soap. Despite an initial mass cleaning activity, cases continued to rise, likely due to improper disinfection practices. Outbreak control was achieved only after implementation of standardized disinfection using appropriate sodium hypochlorite concentrations. Conclusion: This outbreak highlights the role of Norovirus transmission in high-density institutional settings and underscores the importance of proper environmental disinfection. Effective outbreak control requires not only frequent cleaning but strict adherence to standardized disinfection protocols, alongside early case detection and isolation measures.},

note = {Type: Poster Presentation; Organisation: 1Cheras District Health Office, Wilayah Persekutuan Kuala Lumpur \& Putrajaya Health Office, WP Kuala Lumpur, Malaysia.; Corresponding author: Atiqah Abdul Wahab, atiqah.aw@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-515,

title = {Outbreak Management of Tuberculosis in a Residential Drug Rehabilitation Centre: The Pendang Experience},

author = {Muhammad Ikhwan Ismail 1 Noor Shela Radzuan1 Nurul Najuwa Sazali1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Tuberculosis (TB) poses a significant challenge in institutional settings like drug rehabilitation centres, where overcrowding, poor ventilation, and the compromised immune systems of drug-dependent individuals facilitate transmission. This study describes the management of a TB outbreak at Pusat Pemulihan Dadah Nurul Saadah, a private rehabilitation centre in Pendang, with a focus on inter-agency collaboration and public health interventions. Materials and Methods: The study was conducted at Pusat Pemulihan Nurul Saadah, a private drug rehabilitation centre under National Anti-Drug Agency (AADK) supervision, housing approximately 200 trainees. Active TB cases were defined as clients or staff with a positive Mycobacterium tuberculosis culture or bacteriologically confirmed by GeneXpert within a 2-year period from onset of 1st case, while Latent TB Infection (LTBI) was identified via a positive Tuberculin Skin Test (TST) with an induration of ≥10mm or ≥5mm for immunocompromised patients. Contact tracing involved screening 192 individuals using TST and Chest X-rays, with symptomatic individuals undergoing sputum culture and sensitivity (C\&S) testing. Results: The outbreak was identified following the notification of a smear-positive index case (a 40-year-old male) on October 1, 2025. Subsequent screening of 192 contacts revealed two additional bacteriologically confirmed cases (one GeneXpert-positive, one sputum C\&S-positive), leading to an outbreak declaration. A total of 120 contacts tested positive for LTBI. All active cases commenced treatment, and 110 of the LTBI cases agreed to a 3-month prophylaxis regimen. Conclusion: Institutional outbreaks are exacerbated by high population density and the congregating nature of rehabilitation activities, which limit personal space to approximately \<1 square metre. Effective management requires coordinated efforts between health authorities and institutional supervisors to handle the logistical challenges of mass screening and treatment. Improving ventilation and implementing strict screening protocols upon admission are essential strategies to mitigate future transmission risks.},

note = {Type: Poster Presentation; Organisation: 1Pendang Health District, Kedah Darul Aman, Malaysia; Corresponding author: Nurul Najuwa Sazali, drnurulnajuwa@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-451,

title = {Outcome of Early Insulin Administration on Anxiety Associated Newly Diagnosed Type 2 Diabetes Mellitus Patients: An Interventional Study},

author = {Chowdhury Md Navim Kabir},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The prevalence of Diabetes Mellitus in South Asian countries is a burning issue. In recent times, the association of anxiety with newly diagnosed type 2 diabetes mellitus patients have been increasing. In this regard, insulin therapy for treating anxiety can be more effective on both glycemic control and anxiety reduction. Materials and Methods: Approximately 1535 patients [age range (27-45) ± 2 years] came to the Medicine outdoor patient department with complaints of insomnia and anxiety from February 2024 to August 2025. A printed questionnaire was used for data collection. Participants were advised to do an Oral Glucose Tolerance Test (OGTT) as a diagnostic tool. Patients with other systemic diseases were excluded to avoid bias in outcomes. Finally, 1470 patients were included for the study who were advised to start subcutaneous insulin (3 times per day according to requirement) and follow up after 1 month. Results: The average fasting blood sugar value of 37% of patients (Group A) was 7.5 mmol/L, 45% (Group B) was 9.5 mmol/L, and the remaining were 12 mmol/L. The 2-hour post-breakfast glucose (2HABFS) was 12 mmol/L for Group A, 13.7 mmol/L for Group B, and 14.6 mmol/L for Group C. In group A, the anxiety-affected rate was 29%, group B 41% and group C it was 30%. During follow-up, the FBS reduction was 25% in group A, 33% in group B, and 38% in group C. In 2HABFS, the reduction rate was 25% for group A, 31% for group B, and 39% for group C. In anxiety, group A became 10%, group B 15% and group C 12.5%. Conclusion: Anxiety is individually controlled by oral drugs, but when it is associated with diabetes, its management should be started earlier with insulin for its proven reduction capability.},

note = {Type: Oral Presentation; Organisation: Department of Casualty and Emergency, Government Employee Hospital, Fulbaria, Dhaka, Bangladesh; Corresponding author: Chowdhury Md Navim Kabir, protik167@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-786,

title = {Outpatient Healthcare Utilisation Among Adults with Diabetes: Insights from Malaysia},

author = {Sanjay Rampal¹ Ainol Haniza² Devi Peramalah¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Diabetes is highly prevalent in Malaysia and places a substantial burden on outpatient healthcare in the country’s mixed healthcare system. Outpatient healthcare utilisation (OPHCU) is expected to be higher among individuals with diabetes than those without, reflecting complex disease management and frequent comorbidities, consistent with Andersen’s Behavioral Model in which diabetes functions as a need factor for care. Population-level estimates of outpatient utilisation by diabetes status and across sociodemographic, socioeconomic, and comorbidity strata, however, remain limited, and this study addresses these gaps using nationally representative survey data. Materials and Methods: This retrospective secondary data analysis used data from the National Health and Morbidity Survey 2015, a nationally representative cross-sectional household survey of 18,616 Malaysian adults aged 18\textendash90 years. OPHCU was the outcome, diabetes status was the primary independent variable, and sociodemographic, socioeconomic, and clinical factors were examined as effect modifiers. Survey-weighted logistic and multinomial logistic regression analyses were performed. Results: Diabetes prevalence was 21.8%. OPHCU was utilised by 11.8% (95% CI: 10.5\textendash13.3) of adults with diabetes versus 8.1% (95% CI: 7.5\textendash8.8) of non-diabetics (p\<0.05). After adjustment for sociodemographic and clinical factors, people with diabetes had higher odds of OPHCU use (aOR = 1.24; 95% CI: 1.07\textendash1.45). Higher utilisation was observed among Malays, while age, sex, education, and income were not significant. A significant interaction (p for heterogeneity = 0.002) indicated that the association between diabetes and OPHCU varied across comorbidity profiles defined by combined hypertension and hypercholesterolemia, rather than being uniform across all diabetes patients. Conclusions: People living with diabetes utilised outpatient healthcare more than non-diabetics, and the strength of this association varied by comorbidity profile. Addressing utilisation disparities through integrated, equity-oriented policies is key to optimising diabetes management in Malaysia.},

note = {Type: Poster Presentation; Organisation: ¹ Centre for Epidemiology and Evidence-based Practice (CEBP), Universiti Malaya, Kuala Lumpur, Malaysia. ² Department of Community Oral Health \& Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.; Corresponding author: Devi Peramalah, devi@ummc.edu.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-624,

title = {Outpatient Healthcare Utilisation During the COVID-19 Pandemic: Trends and Changes in Lithuania},

author = {Skirmante Sauliune1 Aurimas Galkontas1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The COVID-19 pandemic highlighted important challenges in the functioning of healthcare systems, particularly in the provision and utilisation of outpatient services. However, empirical evidence on how outpatient healthcare utilisation changed over time and across service levels remains limited. This study examines these changes in Lithuania, focusing on the health system response during the pandemic. The aim of this study is to assess changes in outpatient healthcare utilisation before and during the COVID-19 pandemic across different levels of care and to analyse temporal trends in service utilisation. Materials and Methods: National data on outpatient healthcare utilization in Lithuania during 2017\textendash2023 were analysed. The main outcome was the number of outpatient visits per 100 residents. Differences between the pre-pandemic (2017\textendash2019) and pandemic (2020\textendash2023) periods were assessed using the Mann\textendashWhitney U test. Due to non-normal data distribution, results are presented as medians and interquartile ranges. Effect sizes (r) were calculated to evaluate the magnitude of differences. Temporal trends and change-points were analysed using Joinpoint regression, with annual percentage change (APC) estimated. Results: Outpatient healthcare utilisation remained relatively stable during the pre-pandemic period but declined sharply in 2020, followed by a gradual recovery that did not return to pre-pandemic numbers by 2023. Comparative analysis showed a statistically significant decrease in primary healthcare utilisation (−24.26%; p = 0.001; r = 0.55) and in total outpatient healthcare utilisation (−22.66%; p = 0.001; r = 0.47). Secondary and tertiary healthcare utilisation also declined (−22.27%; p = 0.027; r = 0.30), although with a smaller effect size. Trend analysis confirmed an overall declining pattern in outpatient healthcare utilisation during the pandemic period. Joinpoint regression identified a change in trend around 2021. A statistically significant decreasing trend was observed for secondary and tertiary healthcare utilisation (APC = −8.71; p = 0.01) and for total outpatient healthcare utilisation (APC = −10.71; p = 0.04). A declining trend in primary healthcare utilisation was also observed (APC = −12.06), although it did not reach statistical significance (p = 0.08). Conclusion: The COVID-19 pandemic was associated with a marked decline in outpatient healthcare utilisation in Lithuania, particularly in primary healthcare services, with only partial recovery observed in subsequent years. Joinpoint analysis confirmed statistically significant declining trends in secondary and tertiary healthcare, as well as in overall outpatient healthcare utilisation, indicating sustained changes in service utilisation patterns beyond the initial pandemic period. The persistence of lower healthcare utilisation compared to pre-pandemic levels suggests longer-term changes in healthcare utilisation and highlights challenges in maintaining continuity of healthcare services during health system disruptions. These findings underscore the need to strengthen health system resilience and ensure the stable provision of outpatient healthcare services across all levels during public health crises.},

note = {Type: Poster Presentation; Organisation: 1Lithuanian University of Health Sciences, Kaunas, Lithuania; Corresponding author: Aurimas Galkontas, aurimas.galkontas@lsmu.lt},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-578,

title = {Outpatient Parenteral Antimicrobial Therapy Guidelines: A systematic review},

author = {Peter Seah Keng Tok1 Norazida Ab Rahman1 Audrey Huili Lim1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Since its initial description in the 1974 for treatment of cystic fibrosis in paediatric patients, outpatient parenteral antimicrobial therapy (OPAT) has expanded substantially, supported by advances in antimicrobial agents, vascular access devices, and ambulatory care infrastructure. Current OPAT guidelines provide structured recommendations to standardise patient selection, antimicrobial management, monitoring, and governance. Systematic evaluation of guideline quality is essential to inform clinicians, policymakers, and guideline developers on best practices and priorities. This study aims to identify, synthesise, and critically appraise published OPAT clinical practice guidelines. Materials and Methods: Four bibliographic databases were searched for OPAT guidelines from inception to 11 February 2026, complemented by hand-searching. All guidelines in English were included. Reporting and methodological quality were evaluated using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) and Appraisal of Guidelines for Research and Evaluation II (AGREE II) tools respectively. Standardised scores for each domain and overall guidelines score were summarised as means with standard deviations for continuous variables, and as frequencies with percentages for categorical variables. Correlations between AGREE II and RIGHT domain scores were investigated using Spearman’s correlation. Inter-rater agreement was assessed using intraclass correlation coefficients estimated with a two-way random effects model. Results: Of the seven included guidelines, three were from European countries. The first guideline was published in 2004; almost all guidelines were published or revised in the last ten years. Most guidelines aimed to standardise the delivery, safety, and effectiveness of OPAT in their respective healthcare settings. All the guidelines require OPAT patients to be clinically and hemodynamically stable before transfer from inpatient care or direct initiation in an outpatient setting, while emphasizing the importance of ongoing follow-up and monitoring during OPAT, typically regular weekly clinical and laboratory monitoring. The average overall score for all guidelines evaluated using the AGREE II instrument was 81.3% where five of the guidelines were of high methodological quality. Inter-rater reliability was excellent for all domains and overall scores. When evaluated using the RIGHT instrument, the average overall reporting quality score of guidelines was 61.6%. Domain 1 (basic information) and domain 2 (background) scored the highest mean reporting rates at 85.7%, while domain 5 (review and quality assurance) had the lowest mean reporting rate of 28.6%. There was also an overall positive correlation between AGREE II and RIGHT domain scores. Conclusion: The included OPAT guidelines demonstrated substantial heterogeneity in methodological quality and reporting completeness. While clear clinical recommendations were noted, lack of evidence syntheses methods and quality assurance were identified. This review’s strengths include a systematic search strategy, independent dual appraisal, use of validated instruments, and quantitative assessment of inter-rater agreement. Robust and transparent OPAT guidelines are critical to ensure safe, sustainable, and equitable expansion of outpatient antimicrobial care worldwide. Given the increasing reliance on OPAT globally to optimise bed capacity, this review offers timely insights to inform clinicians, policymakers, and future guideline developers by serving as a reference for future updates or national adaptations.},

note = {Type: Oral Presentation; Organisation: 1Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia, 2Pharmacy Department, Hospital Selayang, Selangor, Malaysia,.3Medical Department, Hospital Sungai Buloh, Selangor, Malaysia.; Corresponding author: Audrey Huili Lim, audreylim.moh@gmail.com},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-512,

title = {Palliative Care in Shanghai Communities: Needs, Influencing Factors and Preferences Among Older Adults with Chronic Diseases},

author = {Zhenqing Tang2 Jiangjiang He2 Author: Jiameng Li1},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Palliative care is essential for improving the quality of life of older adults with chronic diseases, yet its coverage in China remains limited. With a rapidly ageing population and high burden of chronic conditions, Shanghai faces increasing demand for such services. However, limited evidence exists on the palliative care needs, influencing factors, and preferences among community-dwelling older adults. This study aimed to assess palliative care needs in this population and identify associated determinants and care preferences. Materials and Methods: A cross-sectional survey was conducted among community-dwelling older adults with chronic diseases in Shanghai. Data on sociodemographic characteristics, palliative care needs, and care preferences were collected. Descriptive statistics summarised participant characteristics; chi-square tests examined group differences; and logistic regression identified predictors of palliative care needs. Results: A total of 611 older adults participated, with 6.5% identified as having palliative care needs. Dependency in activities of daily living (p=0.024) and poorer self-rated health (p=0.001) were significantly associated with increased palliative care needs. Participants expressed a greater preference for comfort-oriented care for themselves than for family members. Gender differences in care setting preferences emerged: females were more likely to prefer palliative care institutions, while males tended to choose non-palliative care wards in general hospitals. Conclusions: Even in Shanghai, where palliative care services are relatively advanced compared to other regions in China, awareness and utilisation remain low among older adults with chronic conditions. Functional decline and negative self-rated health were key factors associated with palliative care needs, highlighting the importance of incorporating functional and health assessments into community health services for early identification. The discrepancy between self-reported and functional health may reflect age-related changes in physical function and mobility. These findings underscore the need for targeted strategies to improve access and align services with patient preferences.},

note = {Type: Poster Presentation; Organisation: 1School of Psychology, Shanghai Normal University, 2 Shanghai Health Development Research Center (Shanghai Medical Information Center), 3 School of Public Health, Shanghai Jiao Tong University School of Medicine; Corresponding author: Jiameng Li, jiamengli@zju.edu.cn},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-O-609,

title = {Path to Preparedness: Short-Term Outcomes of X-SIAGA, a Novel Household Outbreak Preparedness Intervention for the Orang Asli in Selangor},

author = {Khalid Ibrahim 1 Mariam Mohamad 1 Ameerah Su’ad Abdul Shakor 1*},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: The recent COVID-19 pandemic demonstrated how a localised outbreak can rapidly escalate into a pandemic, highlighting the critical importance of preparedness for novel threats and outbreaks such as Disease X. The Orang Asli community in Selangor, Malaysia, is highly susceptible to outbreaks; their reliance on forest foraging increases zoonotic spillover risk, and residing in a densely populated state can accelerate pathogen spread to the broader community. Despite these vulnerabilities, Orang Asli communities generally exhibit low preparedness, lack interest in current initiatives, and there are currently no tailored, engaging preparedness programs for Disease X and potential outbreaks. Therefore, this study aimed to assess the one-month effectiveness of X-SIAGA, a novel intervention designed to improve household outbreak preparedness for Disease X and other potential outbreaks in the Orang Asli community of Selangor. Materials and Methods: A single-blinded, parallel cluster-randomised trial was conducted, involving 85 households from randomly selected Orang Asli settlements in Selangor. The intervention group received the X-SIAGA intervention package alongside standard educational brochures, while the control group received standard educational brochures only. Data collected at baseline, immediately post-intervention, and one month post-intervention were analysed using Generalised Estimating Equations in the SPSS software. A Preparedness Matrix was also plotted using Microsoft Excel to visually represent household progression by categorising household outbreak preparedness scores into “Prepared,” “Committed,” “Aware,” or “Unprepared” quadrants. Results: At one month, X-SIAGA significantly improved household outbreak preparedness scores (B=30.79, 95% CI=26.21\textendash35.37, p\<0.001) from baseline. The Preparedness Matrix demonstrated a positive progression among households that received X-SIAGA, shifting from predominantly “Unprepared” and “Aware” quadrants at baseline towards the “Fully Prepared” quadrant at the one-month follow-up. Conclusion: The X-SIAGA intervention was effective in enhancing short-term household outbreak preparedness among Orang Asli in Selangor. These findings suggest potential for longer-term evaluation, adaptation, and broader implementation of the X-SIAGA program.},

note = {Type: Oral Presentation; Organisation: 1Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Jalan Hospital,Sungai Buloh, Selangor, Malaysia, 2Hospital Orang Asli, Gombak, 53100 Kuala Lumpur, Malaysia; Corresponding author’s email: Ameerah Su’ad Abdul Shakor, ameerahsuad@moh.gov.my},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}

@proceedings{APCPH2026-P-708,

title = {Patient's Willingness to Pay for Medications in the Public Health Clinics in Tangkak and Segamat, Johor, Malaysia},

author = {Anis Ismail¹ Aimi Abdul Rahim¹ Teong Win Wei¹},

year  = {2026},

date = {2026-07-06},

urldate = {2026-07-08},

journal = {9th Asia-Pacific Conference on Public Health 2026 - Proceedings},

issue = {9},

abstract = {Introduction: Copayment systems have been introduced in many countries to reduce financial burdens and medicine wastage in the healthcare system, but such systems may affect medication access and adherence, particularly among vulnerable populations. Evidence on patients’ willingness to pay (WTP) for medications in Johor, Malaysia, is currently lacking. This study aims to determine patients’ willingness to pay for their medications and the amount they are willing to pay in public health clinics in Tangkak and Segamat, Johor. It also seeks to identify factors associated with patients’ willingness to pay (WTP) and the extent of the amount they are willing to pay. Materials and Methods: A questionnaire-based, cross-sectional study is conducted using convenience sampling and face-to-face interviews among patients attending public health clinics in Tangkak and Segamat from May to September 2025 using a validated questionnaire from a previous study. Bidding technique is employed to determine the maximum amount respondents are willing to pay for medications. Results: 409 samples were analysed for this study. The majority of respondents disagree (n = 163, 39.9%) to strongly disagree (n= 64, 15.5%) on paying medication charges. However, the majority agree (n = 191, 46.7%) to strongly agree (n = 45, 11.0%) to purchase medication at a private pharmacy if the needed medication is not listed in the Ministry of Health’s (MOH) formulary. The median amount respondents are willing to pay for chronic medication is MYR10.00 per month, and MYR5.00 one-off for acute medications. Various factors affect WTP and the amount of WTP for medications. Discussion/ Conclusion: The majority of primary care patients are not willing to pay for medication charges. Citizens are willing to purchase medication at a private pharmacy if the required medication is not available in the MOH formulary. The median amount respondent willing to pay for chronic medication is MYR10.00 per month, and MYR5.00 one-off for acute medications.},

note = {Type: Poster Presentation; Organisation: 1Pharmacy Department, Tangkak Health District Office, Tangkak, Johor Darul Ta'zim, Malaysia. 2Pharmacy Department, Segamat Health District Office, Segamat, Johor Darul Ta'zim, Malaysia.},

keywords = {},

pubstate = {published},

tppubtype = {proceedings}

}