Hand hygiene knowledge, perception, and self-reported performance among nurses in Kelantan, Malaysia: a cross-sectional study

Background

Nurses interact with patients 24 hours a day, and this connection has the potential to raise the risk of infection transmission to patients. Nursing plays a vital role in pre-venting healthcare-associated infections (HCAIs) by ensuring that hand hygiene (HH) practises are followed and maintained. The purpose of this study was to evaluate nurses’ knowledge, perceptions, and self-reported HH performance scores, as well as their correlation, in tertiary care hospitals in Kelantan, Malaysia.

Methods

A cross-sectional study was undertaken in all four Kelantan tertiary care hospitals from December 2019 to February 2020. A stratified random selection method was used to obtain a sample of 438 registered nurses. A validated WHO self-administered HH knowledge and perception questionnaire for healthcare personnel was used to measure HH knowledge, perception, and self-reported HH performance.

Results

The mean (SD) score of knowledge was 15.08 (1.96) out of the total 25. The score of perception participants towards HH was 68.02 (10.14) out of the total 81 and the average self-reported HH performance was 87.58 (12.03) out of 100. Pearson’s correlation analysis showed significant positive correlations between perception and knowledge scores; r (436) =0.17, p<0.001 and Perception and self-reported HH performance scores; r (436) =0.27, p<0.001.

Conclusions

There is a strong link between knowledge and perception scores. Lack of understanding of HH during patient care might lead to a negative perception, which can affect overall self-reported HH performance. The need of monitoring and maintaining HH knowledge among nurses was established in this study.

First Report of Trypanosoma theileri in Equine Host and Tabanus sp. in Malaysia

Trypanosoma (Megatrypanum) theileri is a non-pathogenic or weakly pathogenic parasite of domestic cattle that is cyclically transmitted by blood-sucking insects, mainly tabanid flies. It has been reported in several countries like Brazil, Venezuela, Japan, Taiwan, Thailand, Vietnam, and the Philippines. Although the ruminant industry is actively expanded in Malaysia, T. theileri and T. theileri-like trypanosomes have never been reported from Malaysia. The low pathogenicity of this species might be the main reason for overlooking T. theileri in this country. This paper describes an unforeseen finding of T. theileri from the outbreak of T. evansi in the state of Kelantan, Malaysia. This is the first time T. theileri reported in Malaysia, and also the first time T. theileri is reported in equid. Clinical signs compatible with infection by blood protozoa were observed; however, it was uncertain whether they were due to T. theileri infection. The detection of T. theileri from the blood sample and Tabanus sp. were confirmed through molecular analysis with PCR and DNA sequencing. In the present study, T. theileri from one horse and one Tabanus sp. were clustered with sequences of the previously described phylogenetic lineages from Japan, Chad and Brazil cattle. Even though this species is claimed to be host-specific with ruminant host restriction, the finding from this study suggested that T. theileri can infect equine whilst other isolates are known to infect ruminant species only. It is suspected there were two genotypes of T. theileri circulating in at least two districts of Kelantan. Thus, further study on multiple DNA regions should be conducted to determine the strains of detected T. theileri in Malaysia. Its impact on the horse and cattle industry should also be revised.

First case report on molecular detection of Trypanosoma lewisi in an urban rat in Kelantan, Malaysia: An accidental finding

Objective:

This case report highlights the first detection of Trypanosoma lewisi, a blood protozoan parasite found in an urban rat in Kota Bharu, Kelantan.

Materials and Methods:

Rat trapping was carried out within the Kota Bharu vicinity near a local wet market. A total of 38 rats were captured and subjected to peripheral blood smearing using Giemsa stain. Positive rats were sent for histopathological analysis for the evaluation of the organ samples.

Results:

The presence of trypanosomes was found in one sample from a blood smear. This was connected to a histological lesion on kidney tissues, which revealed a high concentration of trypanosomes. Additionally, the positive sample was confirmed as T. lewisi based on molecular diagnosis via polymerase chain reaction and subsequent sequencing and phylogenetic analysis.

Conclusions:

This finding serves as a baseline for further surveillance on T. lewisi population among urban rats in Kelantan and possible zoonotic transmission to humans.

Prevalence and Risk Factors of Bovine Fascioliasis in Kelantan, Malaysia: A Cross-Sectional Study

Bovine fascioliasis is an important zoonotic parasitic disease that causes significant economic losses to the livestock industry. The aim of this study was to determine the prevalence and risk factors of bovine fascioliasis in Kelantan. In this cross-sectional study, a total of 308 stool and blood samples of farmed cattle were collected from December 2017 to June 2018. The stool samples were examined microscopically for the presence of Fasciola spp. eggs following a formalin-ether sedimentation process. The blood samples were subjected to a commercial ELISA kit (Bio-X-Diagnostic, Rochefort, Belgium) for the detection of anti-Fasciola IgG antibody. The association between coprological findings and risk factors was determined using Pearson’s chi-square (χ²). The coproprevalence and seroprevalence of bovine fascioliasis was 14.6% and 37.3%, respectively. There were significant (P < 0.05) associations between the risk of infections and the sex, type of feedings, anthelmintic treatment and farm hygiene. Female cattle (OR: 3.104; 95% CI: 1.265, 7.615), feeding by grazing (OR: 4.458; 95% CI: 1.823, 10.90), untreated cattle (OR: 3.833; 95% CI: 1.620, 9.071), non-schedule anthelminthic treatment (OR: 3.927; 95% CI: 1.685, 9.152) and farm that have never been cleaned (OR: 2.829; 95% CI: 1.428, 5.608) showed higher odds of Fasciola spp. infection. These findings suggested bovine fascioliasis is a serious veterinary disease in Kelantan. Thus, appropriate control, prevention and monitoring strategies of this parasitic infection are urgently needed to reduce the burden of the disease.

First report of equine Setaria digitata (von Linstow 1906) infestation in Malaysia

The occurrence of Setaria digitata in a horse is reported for the first time in Malaysia. An 8-year-old Thoroughbred cross mare was referred to the University Veterinary Clinic with the primary complaint of corneal opacity and excessive eye discharge. After initial treatment with Terramycin eye ointment, corneal opacity cleared partially to reveal a moving thread-like cylindrical worm in the anterior chamber of the eye. The parasite was successfully removed surgically, and examination under the light microscope revealed that the isolated worm (length = 45 mm) was a 5th stage larva of S. digitata based on morphological criteria. Confirmation of the species of the worm was through molecular methods. The 12S rRNA gene was PCR-amplified, and the purified amplicon was directly sequenced. Phylogenetic analyses revealed that the isolated roundworm showed 100% sequence similarity with that of S. digitata in NCBI GenBank database (Accession no.: KY284626.1). This report is the first confirmed case of equine ocular setariasis by S. digitata in Malaysia. The current study provides evidence that S. digitata is an etiological agent of ocular infection and its presence in Malaysia.

The association between social cohesion and community disaster resilience: A cross-sectional study

A cross-sectional study design was created, using the Index of Perceived Community Resilience (IPCR) and Buckner's Index of Cohesion (BIC) to survey 386 flood evacuees from six communities in Kelantan, Malaysia, in 2015. The respondents were mostly female (54.7%); lived in basic housing (95.6%); average income (55.9%); secondary level schooling (81.1%); not involved with community organisations (95.1%), volunteering activities (91.2%), or emergency teams (96.9%); inexperience with injury during flooding (94%); experienced the emergency disaster (61.6%); and their mean age was 49 years old. Overall, respondents scored a high level of community disaster resilience (CDR) (mean 3.9) and social cohesion (mean 3.79). Also, respondents' housing type, event of injury during disaster, volunteering in post-disaster activities, and emergency team participation were significantly associated with CDR (p = 0.001-0.002), organisational involvement (p = 0.016), and emergency disaster experience (p = 0.028) were significantly associated with social cohesion. The Pearson correlation coefficient results mostly showing a moderate, weak, and one with a strong relationship. There is a strong relationship between community participation (CDR) in events and BIC variables (r = 0.529, p = 0.001). Other analysis shows a moderate but significant relationship with BIC; is open to ideas (r = 0.332, p = 0.001); community has similar values/ideas (r = 0.421, p = 0.001); sense of pride (r = 0.389, p = 0.001); strong leadership (r = 0.339, p = 0.001); positive change (r = 0.484, p = 0.001); and able to handle problems (r = 0.454, p = 0.001). Overall, the results show that respondents had high levels of CDR and social cohesion, while the demographic characteristics show the impact of CDR and social cohesion. In conclusion, the data gives original insight into the level of association between social cohesion and disaster resilience, which could be used as a building block in sustainable disaster recovery. There is a need to explore this further on programmes designed to improve social cohesion across communities.

Seasonal variation of heavy metals and metallothionein contents in Asian swamp eels, Monopterus albus (Zuiew, 1793) from Tumpat, Kelantan, Malaysia

BACKGROUND

Levels of toxic metal exposure in indigenous inhabitants are key bioindicators of the severity of environmental contamination. This study measured the seasonal variation of heavy metals and metallothionein (MT) contents in Asian swamp eels (Monopterus albus) from a paddy field situated in Tumpat, Kelantan, Malaysia, to identify prevalence, patterns and associations and togain insight on the suitability of MT as a biomarker for metal exposure.

METHODS

Gill, muscle and liver tissues of M. albus (n = 50) sampled during the ploughing, seedling, growing and harvesting phases of rice growing were collected. The concentrations of copper (Cu), zinc (Zn), lead (Pb), nickel (Ni), and cadmium (Cd) in these tissues were determined by flame atomic absorption spectrometry. MT from each sample was isolated and purified, and subsequently quantitated using UV spectrophotometry. Associations between metal and MT concentrations, season and tissue type were evaluated using Pearson correlation and ANOVA with post-hoc Tukey HSD analysis.

RESULTS

Zn was present in higher quantities in gill and liver tissues, while Cu levels were elevated solely in liver. Patterns of non-essential metal accumulation were varied: Cd was detected in low concentrations in all tissues, while Pb and Ni were abundant in gill tissues across all seasons. MT concentration in liver tissue was consistently higher than that found in muscle or gill tissue, except during the growing phase. Moreover, significant correlations (P < 0.05) were observed for Cd, Ni, and Zn when MT was employed as metal exposure biomarker. However, no significant association was found between high Pb and Ni levels and MT concentration in gill tissue.Variation of bioaccumulation rates of heavy metals among the different tissues was observed. Some of these metal concentration differences were found to be associated with MT concentration and, by extension, to its high metal-binding capacity.

CONCLUSIONS

Significant liver MT-Zn, MT-Cd, and MT-Ni correlations found in this study emphasised the role of metallothionein as a biomarker for exposure of zinc, cadmium and nickel metals in M. albus.

Non-specificity of sequence characterised amplified region as an alternative molecular epidemiology marker for the identification of Salmonella enterica subspecies enterica serovar Typhi

Objective

Identification of Salmonella Typhi by conventional culture techniques is labour-intensive, time consuming, and lack sensitivity and specificity unlike high-throughput epidemiological markers that are highly specific but are not affordable for low-resource settings. SCAR, obtained from RAPD technique, is an affordable, reliable and reproducible method for developing genetic markers. Hence, this study investigated the use of SCAR as an alternative molecular epidemiological marker for easy identification of S. Typhi in low-resource settings.

Results

One hundred and twenty RAPD primers were screened through RAPD-PCR against a panel of common enterobacteriaceae for the best RAPD band pattern discrimination to develop SCAR primers that were used to develop a RAPD-SCAR PCR. Of this number, 10 were selected based on their calculated indices of discrimination. Four RAPD primers, SBSA02, SBSA03, SBSD08 and SBSD11 produced suitable bands ranging from 900 to 2500 bp. However, only SBSD11 was found to be specific for S. Typhi, and was cloned, sequenced and used to design new SCAR primers. The primers were used to amplify a panel of organisms to evaluate its specificity. However, the amplified regions were similar to other non-Typhi genomes denoting a lack of specificity of the primers as a marker for S. Typhi.

Vatica najibiana (Dipterocarpaceae), a new species from limestone in Peninsular Malaysia

Vatica najibiana Ummul-Nazrah (Dipterocarpaceae), from the Relai Forest Reserve, Gua Musang, Kelantan and Gua Tanggang, Merapoh, Pahang, is described and illustrated. This species is Endangered and known from small populations restricted to two isolated karst limestone hills. The type locality, Relai Forest Reserve limestone, is currently under threat from encroaching oil palm plantations and ongoing logging, which, if it continues, will threaten the Kelantan population with extinction. The morphology of V. najibiana and the similar V. odorata subsp. odorata and V. harmandiana is compared.

HIV-related characteristics among female partners of injecting drug users in Kelantan, Malaysia: a descriptive study

Kelantan, a northeastern state in Peninsular Malaysia, is one of the states that has been acutely hit by injecting drug user (IDU)-driven HIV epidemic, in addition to having a high number of infected women in Malaysia. This cross-sectional study describes the socio-demographic characteristics, HIV risk factors, risk perception, and adoption of preventive behaviors among female partners of IDUs in Kelantan. Out of 101 women, the majority of them are from low socioeconomic background and have no other risk factors besides heterosexual HIV transmission from their male IDU partners. Although 45.5% have not been tested for HIV and more than half (53.5%) of them did not use condoms during sexual intercourse, only 44.6% of the women perceived themselves to be at risk of being infected with HIV. Most of the women (86.1%) were willing to undergo voluntary counseling and testing (VCT). Female partners of IDUs continue to be vulnerable to HIV due to having sexual contact with IDUs, and also due to their socioeconomic position in the community. To prevent HIV transmission among female partners of IDUs, consolidating HIV prevention efforts from multiple approaches is needed.

Determination of Heavy Metal Levels in Fishes from the Lower Reach of the Kelantan River, Kelantan, Malaysia

This study aimed to assess the concentrations of cadmium (Cd), nickel (Ni) and lead (Pb) in the tissues of fish collected from the lower reach of the Kelantan River, Malaysia. Fishes were collected using gill nets during the dry and wet seasons. A total of 78 individual fish were caught and comprised 6 families, 11 genera and 13 species. The dorsal muscle was analysed using a graphite furnace Atomic Absorption Spectrometer (AAS). The mean concentration of Cd in Chitala chitala (0.076 mg/kg) was above the critical limit values of the European Commission (EC), World Health Organization (WHO) and Food and Agriculture Organization (FAO). The mean concentrations of Cd in Barbonymus gonionatus and Tachysurus maculatus were already at the level of concern, whereas the other species were approaching the limits of permissible levels. No fish samples were found to have a Ni level higher than the permissible limit of 0.5-0.6 mg/kg set by the WHO (1985). Osteochilus hasseltii (0.169 mg/kg) and T. maculatus (0.156 mg/kg) showed high Pb concentrations. The concentrations of heavy metals were found to be elevated in the wet season (p<0.05). Omnivorous fish were detected with elevated concentrations of Cd and Ni, whereas carnivorous fish had the highest concentration of Pb. The concentrations of Cd and Pb in fish tissues were positively correlated with fish weight (p<0.05). This study determined that the fish species caught in the Kelantan River were contaminated with non-essential metals (Cd, Ni and Pb). Nevertheless, the heavy metal concentration in the fish tissues, with the exception of C. chitala, O. hasseltii and T. maculatus, did not exceed the EC, FAO, Malaysian Food Act (MFA) or WHO guidelines.

Genetic, historical and linguistic perspectives on the origin of the Kelantanese Malays

The Kelantanese Malays who resided in the remote northeastern regions of the Malay Peninsula in the Kelantan state are believed to have a unique genetic signature. The objective of this review is to analyze the populational sub-structure of the Kelantanese Malays from historical, genetic and linguistic perspectives. Historical data suggest that the Semang were composed of the Jahai, Bateq and Kensiu sub-tribes, whereas the Senoi were composed of only the Temiar sub-tribe. The Mendriq sub-tribe is believed to be the first group of aborigines to land in Kelantan. Subsequently, genetic analysis showed that the Kelantanese Malays are an independent clade at the base of the phylogenetic tree and contain genetic material similar to that of the Semang, specifically the Jahai and the Kensiu sub-tribes. The genetic data are supported by the fact that the Aslian language, a branch of the Austroasiatic languages that is widely spoken by the Semang, was potentially transmitted through agricultural activities. However, the potential limitation of this mini-review is the lack of primary reliable sources covering the historical, linguistic and genetic features of the Kelantanese Malays.

The Effectiveness of Methadone Maintenance Therapy Among Opiate - Dependants Registered with Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan

BACKGROUND

The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu, Kelantan.

METHODS

The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st Jan 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status, and level of education.

RESULTS

A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score, HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status, and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26), and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79).

CONCLUSION

This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.