Health, access and nutritional issues among low-income population in Malaysia: introductory note

What drives low-income older adults' intention to use mobility applications?

AIM

Mobility applications have the potential to support low-income older adults in facing mobility challenges. However, there is a generally lower uptake of technology in this segment. To understand factors affecting the intention to use a mobility app, we drew upon the Protection Motivation Theory, and tested a model of low-income older adults' technology adoption.

METHODS

A cross-sectional survey was conducted across seven states in Malaysia among community-dwelling low-income older adults aged ≥60 years old (n = 282). Measurement items were adapted from pre-validated scales and 7-point Likert Scales were used. Partial least squares structural equation modeling was utilized to assess the hypothesized model.

RESULTS

Mobility technology awareness was found to shape an individual's threat and coping appraisals associated with their intention to use a mobility app. The decision of a low-income older adult to adopt a mobility app as a protective action is not a direct function of threat and coping appraisals but is indirect, and mediated by the underlying cost-benefit perceptions of non-adoption and adoption of the mobility app. In terms of technology perceptions, perceived usefulness is a significant predictor, but not perceived ease of use.

CONCLUSIONS

This study entails a new model by uncovering the psychological factors encompassing mobility technology awareness, threat-coping appraisals, and cost-benefit perceptions on Technology Acceptance Model studies. These insights have important implications for the development and implementation of a mobility app among low-income older adults. Geriatr Gerontol Int 2024; 24: 342-350.

Inequalities in Consumption Expenditure on Pharmaceuticals: Evidence from Malaysia

Pharmaceuticals play an important role in health improvements. This study is the first of its kind to examine the influences of household heads' sociodemographic characteristics and household profiles on pharmaceuticals expenditure among households of different income levels. The country of interest is a fast-growing developing country. Data from the Malaysian Household Expenditure Surveys 2014 and 2016 were used in the pooled cross-sectional analyses. Double-hurdle models were used to analyze consumption and amount decisions of pharmaceuticals. Analyses stratified by income were conducted. Results showed that households headed by younger adults (<60 years), males, less educated individuals, Bumiputera, and divorced/widowed adults were less likely to consume and spent less on pharmaceuticals compared with households headed by older adults (≥60 years), females, more educated individuals, non-Bumiputera, and single adults. These differentials varied across income groups. In conclusion, household heads' age, gender, educational levels, ethnicity, marital status, and household profiles are important determining factors of expenditure on pharmaceuticals among low-, middle- and high-income households.

Health-Related Quality of Life of Patients and Families with Primary Immunodeficiency in Malaysia: a Cross-Sectional Study

PURPOSE

Primary immunodeficiency disease (PID) affects various aspects of a patient's life. However, the health-related quality of life (HRQOL) of PID among Malaysian patients is poorly described. This study aimed to determine the quality of life of PID patients and their respective parents.

METHOD

This cross-sectional study was performed from August 2020 to November 2020. Patients with PID and their families were invited to answer the PedsQL Malay version (4.0) questionnaire, the tool used to assess the HRQOL. A total of 41 families and 33 patients with PID answered the questionnaire. A comparison was performed with the previously published value of healthy Malaysian children.

RESULT

Parents of respondents recorded a lower mean of total score than the parents of healthy children (67.26 ± 16.73 vs. 79.51 ± 11.90, p-value = 0.001, respectively). PID patients reported lower mean total score to healthy children (73.68 ± 16.38 vs. 79.51 ± 11.90, p-value = 0.04), including the psychosocial domain (71.67 ± 16.82 vs. 77.58 ± 12.63, p-value = 0.05) and school functioning (63.94 ± 20.87 vs. 80.00 ± 14.40, p-value = 0.007). No significant difference of reported HRQOL when comparing between subgroup of PID on immunoglobulin replacement therapy and those without immunoglobulin replacement (56.96 ± 23.58 vs. 65.83 ± 23.82, p-value 0.28). Socioeconomic status was found to be predictive of the lower total score of PedsQL in both parent and children reports.

CONCLUSION

Parents and children with PID, especially those from middle socioeconomic status, have lower HRQOL and school function impairment than healthy children.

Barriers to Breast Cancer-Screening Adherence in Vulnerable Populations

Breast cancer screening through periodic mammography has been effective in decreasing mortality and reducing the impact of this disease. However, adherence to screening does not meet the desired expectations from all populations. The main objective of this review is to explore the barriers that affect adherence to breast cancer-screening programs in vulnerable populations according to race and/or ethnicity in order to propose measures to reduce the lack of adherence. We conducted a search of publications in the PubMed Central and Scopus databases. The eligible criteria for the articles were as follows: original quantitative studies appearing in SJR- and/or JCR-indexed journals from 2016 to 2021 in English or Spanish. Most of them present common barriers, such as race/ethnicity (47%), low socioeconomic (35.3%) and educational levels (29.4%), no family history of cancer and being single (29.4%), medical mistrust and a health information gap (23.5%), lack of private health insurance (17.6%) and not having annual health checks (17.6%). The target populations with the lowest adherence were Black, Asian, Hispanic and foreign women. Implementing awareness campaigns focused on these populations should be promoted, as well as working on diversity, cultural acceptance and respect with healthcare workers, in order to improve breast cancer-screening adherence worldwide.

The Association Between Bangladeshi Adults' Demographics, Personal Beliefs, and Nutrition Literacy: Evidence From a Cross-Sectional Survey

Background

Poverty and health illiteracy, combined with inappropriate systems to track disease and infection rates, contribute to children-and-mothers' poor adherence to nutrient-rich foods intake in Bangladesh. Although risk factors for child and pregnant women malnutrition have been explored, the relationship between Bangladeshi adults' nutrition literacy and their demographics and personal beliefs remains unknown. The purpose of this study was to examine the association between adults' nutrition literacy, demographics and personal beliefs in a large sample of Bangladeshi adults.

Methods

Four hundred adults from two districts (Dhaka and Chattogram) of Bangladesh participated in a cross-sectional survey. Data were collected by interviews using a structured questionnaire containing the Nutrition Literacy Scale. Multiple linear regression models were employed to analyze associations between nutrition literacy and related factors.

Results

The mean nutrition literacy score was 21.6 (SD: 3.7; range: 11-32) on a scale of 32. Multiple linear regression revealed that being a businessman (β = 1.66, p = 0.013) or private employee (β = 1.08, p = 0.030), having a higher family income (β = 1.17, p = 0.009), and a higher educational level were positively associated with higher nutrition literacy scores compared to their counterparts. Participants who had ever completed a nutrition-related course (β = 4.95, p < 0.001), and who perceived themselves as having a need for accessing nutrition-related information were positively associated with the higher nutrition literacy compared to their counterparts.

Conclusion

Findings from this study suggest the need for an integrated response plan involving educational interventions and accessible dietary plans targeting adult populations to enhance their nutritional literacy.

Aged Persons Living with HIV and Nutritional Wellness: Analysis of 2013 South Africa-SAGE Well-Being of Older People Study (WOPS) Wave 2

Introduction

This study sought to examine the nutritional wellness among aged persons living with HIV in Somkhele, South Africa.

Methods

Data were extracted from the 2013 South Africa-SAGE Well-Being of Older People Study (WOPS) Wave 2. The study sampled 440 aged persons (50 years and above). The proportion of the aged persons with high nutritional wellness by key covariates was reported with chi-square and p-values (p < 0.05). Two-level binary logistic regression models were fitted.

Results

Results show that there were more aged women (79.8%) than men (20.2%) and the younger old (50–64) dominated (65.7%) in the ages, among the respondents. A higher percent of the aged persons were widows (39.5%) and had no formal education (46.1%). Six in 10 aged persons were HIV infected (59.5%). Percentage distribution of men with high nutrition was higher (78.7%). Regression results show that having nutritional wellness was low for aged persons who were infected by HIV (OR = 0.74, 95% CI = 0.69, 1.26) when compared to those who were not infected. Regarding ages of respondents, having high nutritional wellness was higher for young old (65–74 years) (OR = 1.21, 95% CI = 0.65, 2.25) compared to younger old (50–64 years).

Conclusion

This study suggests that age, education, source of drinking water, household source of income, and financial situation are important for nutritional wellness of aged persons who are HIV infected in South Africa. Moreover, having HIV infection is associated with low nutritional wellness. Being a young old (65–74 years) and receiving government grants and with better financial situation is associated with high nutritional wellness. Stakeholders and agencies who have interest in aged persons affected by HIV must understand the socioeconomic status in relation to their nutritional wellness. The results are of great importance to ageing policies, specifically in health and nutrition.

Effects of 12 Weeks Cosmos caudatus Supplement among Older Adults with Mild Cognitive Impairment: A Randomized, Double-Blind and Placebo-Controlled Trial

Cosmos caudatus (CC) contains high flavonoids and might be beneficial in neuroprotection. It has the potential to prevent neurodegenerative diseases. Therefore, we aimed to investigate the effects of 12 weeks of Cosmos caudatus supplement on cognitive function, mood status, blood biochemical profiles and biomarkers among older adults with mild cognitive impairment (MCI) through a double-blind, placebo-controlled trial. The subjects were randomized into CC supplement (n = 24) and placebo group (n = 24). Each of them consumed one capsule of CC supplement (250 mg of CC/capsule) or placebo (500 mg maltodextrin/capsule) twice daily for 12 weeks. Cognitive function and mood status were assessed at baseline, 6th week, and 12th week using validated neuropsychological tests. Blood biochemical profiles and biomarkers were measured at baseline and 12th week. Two-way mixed analysis of variance (ANOVA) analysis showed significant improvements in mini mental state examination (MMSE) (partial η² = 0.150, p = 0.049), tension (partial η² = 0.191, p = 0.018), total mood disturbance (partial η² = 0.171, p = 0.028) and malondialdehyde (MDA) (partial η² = 0.097, p = 0.047) following CC supplementation. In conclusion, 12 weeks CC supplementation potentially improved global cognition, tension, total mood disturbance, and oxidative stress among older adults with MCI. Larger sample size and longer period of intervention with incorporation of metabolomic approach should be conducted to further investigate the underlying mechanism of CC supplementation in neuroprotection.

The Covid Impact to Public Healthcare Utilization Among Urban Low-Income Subsidized Community in Klang Valley Malaysia

BACKGROUND

Appropriate level of healthcare utilization is one of the aims in translating health system inputs into improving the outcome of population health. Healthcare utilization services in Malaysia remains relatively low as compared to the rate in most high-income countries and some gaps exist across socioeconomic status. After the financial handouts deemed Household Living Aid (HLA) to low-income earners, Malaysia has recently implemented a financial health protection scheme toward for low-income group known as PeKa B40 to improve their access for healthcare services. This study aims to determine the healthcare utilization among the low-income population living in urban Klang Valley, and to explore the relationship between healthcare utilization with the demographic characteristics of this population.

MATERIAL AND METHODS

A cross-sectional study using face to face structured questionnaire. All 447 respondents included were low-income earners enrolled in the HLA. Chi-square analysis and multiple logistic regression were used to examine association between the risk factors and healthcare utilization.

RESULTS

The response rate was 93.5%. The healthcare utilization among the respondents during the partial lockdown period was 19.5% and 33.1% during the recovery lockdown period. Enrollment in the PeKa B40 scheme among the 7.6% respondents was not associated with healthcare utilization. After controlling for the variables, those aged 60 years and above [AOR: 1.87; 95% (CI): (1.07; 3.27)], self-rated poor health status [AOR: 2.16; 95% (CI): (1.07; 4.34)], having NCDs [AOR: 4.21; 95% (CI): (2.23; 7.94)], and being hospitalized in the past 12 months [AOR: 3.54; 95% (CI): (1.46; 8.62)], were more likely to utilize healthcare services as compared to their counterparts.

CONCLUSION

The results from this study is valuable for policy recommendations to improve on the coverage of the PeKa B40 scheme and healthcare access for the low-income population especially during the pandemic.

Do not neglect the indigenous peoples when reporting health and nutrition issues of the socio-economically disadvantaged populations in Malaysia

The purpose of this correspondence is to express our disappointment with the coverage of the BMC Public Health supplement: Vol 19 (4) titled “Health and Nutritional Issues Among Low Income Population in Malaysia”, which neglected to include the fundamental health and nutrition issues that are adversely affecting the lives and livelihood of the indigenous peoples. The Supplement comprised 21 papers. Two of these papers included indigenous peoples as study subjects. These two papers addressed peripheral, albeit important health issues, namely visual impairment and quality of life, and not the persistent and rising health concerns impacting this population. We will provide evidence from research and reports to justify our critique that the Supplement missed the opportunity to spotlight on the serious extent of the health and nutritional deprivations of the indigenous peoples of Malaysia. As researchers of the indigenous peoples, we ought to lend our voice to the “silenced minority” by highlighting their plight in the media including scientific journals.