The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. The Malaysian Ministry of Health responded by implementing, “The National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014”, and the “NCD Prevention 1Malaysia” (NCDP-1M) programme. This paper outlines the primary health system context in which the NCDP-1M is framed. We also discuss the role of community in facilitating the integration of this programme, and outline some of the key challenges in addressing the sustainability of the plan over the next few years. The paper thus provides an analysis of an integration of a programme that involved a multi-sectoral approach with the view to contributing to a broader discourse on the development of responsive health systems.

BackgroundDirty shared toilets are a health risk to users in urban slum settlements. For health and non-health benefits among users of shared toilets to be guaranteed, their cleanliness is important. The objective of this study was to investigate the cleanliness situation of shared toilets in Kampala’s slums and the psychological and social dilemma factors influencing users’ cleaning behaviour and commitment by using the risks, attitudes, norms, ability and self-regulation (RANAS) model and factors derived from the social dilemma theory.MethodsWe conducted a cross-sectional study in three slums of Kampala between December 2012 and January 2013. Data were collected from 424 household respondents that were primarily using shared toilets. Semi-structured questionnaires administered through face-to-face interviews were used in data collection. Linear regression was done for the multivariate analysis to test for the association between respondent cleaning behaviour and a combination of RANAS and social dilemma predictors.ResultsOut of 424 respondents interviewed, 44.3% reported cleaning the shared toilet daily, 34.4% cleaned once or several times a week, 1.4% cleaned every second week, 5.4% cleaned once or several times a month and 14.4% did not participate in cleaning. The main RANAS factors significantly associated with respondents’ cleaning behaviour were: attitudinal affective belief associated with cleaning a shared toilet (β = −0.13, P = 0.00) and self-regulating factors, such as coping planning (β = 0.42, P = 0.00), commitment (β = 0.24, P = 0.00), and remembering (β = 0.10, P = 0.01). For social dilemma factors, only the social motive factor was statistically significant (β = 0.15, P = 0.00). The R square for the linear model on factors influencing cleaning behaviour was 0.77 and R square for factors influencing cleaning commitment was 0.70.ConclusionThe RANAS factors provide a more robust understanding of shared toilet users’ cleaning behaviour than social dilemma factors. Self-regulating factors and changing the negative affective cleaning feelings are shown to be very important for interventions to increase shared toilet users’ collective participation in their cleaning. In addition to RANAS, social dilemma factors have an important influence on slum residents’ commitment to clean their shared toilets.

BackgroundSedentary behaviour (SB) has been implicated as a potential risk factor for chronic disease. Since children spend most of their awake time in schools, this study aimed to identify individual- and school-level correlates of sedentary time using a multilevel approach, and to determine if these correlates have a similar effect in normal weight (NW) and overweight/obese (O/O) children.MethodsSample comprised 686 Portuguese children aged 9-10 years from 23 schools that took part in the ISCOLE project. Actigraph GT3X + accelerometers were used 24 hours/day for 7 days to assess sedentary time (daily minutes <100 counts/min); BMI was computed and WHO cut-points were used to classify subjects as NW or O/O. Sex, BMI, number of siblings, family income, computer use on school days, and sleep time on school days were used as individual-level correlates. At the school level, school size (number of students), percentage of students involved in sports or physical activity (PA) clubs, school promotion of active transportation, and students’ access to equipment outside school hours were used. All multilevel modelling analysis was done in SPSS, WINPEPI, and HLM.ResultsSchool-level correlates explain ≈ 6.0% of the total variance in sedentary time. Results (β ± SE) showed that boys (-30.85 ± 5.23), children with more siblings (-8.56 ± 2.71) and those who sleep more (-17.78 ± 3.06) were less sedentary, while children with higher family income were more sedentary (4.32 ± 1.68). At the school level, no variable was significantly correlated with sedentary time. Among weight groups, variables related to sedentary time in NW were sex, sleep time and family income, while in O/O sex, number of siblings and sleep time were significant correlates. No school-level predictors were significantly associated in either of the weight groups.ConclusionNotwithstanding the relevance of the school environment in the reduction of children’s sedentary time, individual and family characteristics played a more relevant role than the school context in this study.

BackgroundUnderstanding of chronic sequelae development after Campylobacter infection is limited. The objective of the study was to determine via systematic review and meta-analysis the proportion of Campylobacter cases that develop chronic sequelae.MethodsA systematic review of English language articles published prior to July 2011 located using Pubmed, Agricola, CabDirect, and Food Safety and Technology Abstracts. Observational studies reporting the number of Campylobacter cases that developed reactive arthritis (ReA), Reiter’s syndrome (RS), haemolytic uraemic syndrome (HUS), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) ,Guillain Barré syndrome (GBS) or Miller Fisher syndrome (MFS) were included. Data extraction through independent extraction of articles by four reviewers (two per article). Random effects meta-analysis was performed and heterogeneity was assessed using the I2 value. Meta-regression was used to explore the influence of study level variables on heterogeneity.ResultsA total of 31 studies were identified; 20 reported on ReA, 2 reported on RS, 9 reported on IBS, 3 studies reported on IBD, 8 reported on GBS, 1 reported on MFS and 3 reported on HUS. The proportion of Campylobacter cases that developed ReA was 2.86% (95% CI 1.40% - 5.61%, I2 = 97.7%), irritable bowel syndrome was 4.01% (95% CI 1.41% - 10.88%, I2 = 99.2%). Guillain Barré syndrome was 0.07% (95% CI 0.03% - 0.15%, I2 = 72.7%).ConclusionsA significant number of Campylobacter cases develop a chronic sequela. However, results should be interpreted with caution due to the high heterogeneity.

BackgroundAcute disseminated encephalomyelitis (ADEM) is an autoimmune disease that typically follows a monophasic course and may affect any age group. The precise population-based incidence of ADEM is still unknown in most countries. In China, there is no ADEM surveillance system. The exact incidence of ADEM is difficult to estimate, and other epidemiological characteristics of ADEM are unknown. The purpose of this study is to investigate the epidemiological characteristics of ADEM in Nanchang, China.MethodsA retrospective investigation was conducted with ADEM patients admitted to second-level and third-level hospitals in Nanchang from 2008 to 2010, aiming to analyse the epidemiologic characteristics of ADEM in the population in Nanchang. ADEM patients, defined as patients who were diagnosed according to the consensus definition of ADEM provided by the International Pediatric MS Study Group, were enrolled in the study. The data were extracted from the ADEM patients’ medical records.ResultsForty-seven ADEM patients were investigated. The average annual incidence was 0.31/100,000; the incidence among males (0.31/100,000) was nearly equal to that among females (0.31/100,000). The median age of onset was 25.97 years old, and the peak incidence was observed in the 5- to 9-year-old age group (0.75/100,000), followed by the over-60 age group (0.55/100,000). ADEM occurs throughout the year, but it occurs most frequently in March (n = 7) and least frequently in April and July (both n = 2). The patient numbers are roughly even in the other months. In the 2 months before the onset of ADEM, 15 patients presented with a preceding infection, but none of the patients received a vaccination. An increased number of vaccination was not accompanied by a corresponding increased number of cases of ADEM.ConclusionsThe average annual incidence of ADEM was 0.31/100,000 in Nanchang. The incidence among males was nearly equal to that among females. The peak age of onset was 5–9 years old. The peak season of onset was not apparent. There was no evidence of an association between increased number of vaccines administered and number of cases of ADEM in Nanchang, China.

BackgroundThe objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students’ knowledge of occupational exposure to blood-borne viral infections.MethodsA cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted.ResultsAn overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections.ConclusionIt is mandatory to develop a structured program to raise awareness among HS, and current health colleges’ curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.