The Institute for Global Health and Development
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Item Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study(BioMed Central, 2025-01-06) Tan, Michelle M. C.; Hanlon, Charlotte; Muniz-Terrera, Graciela; Benaglia, Tatiana; Ismail, Roshidi; Mohan, Devi; Konkoth, Ann Breeze Joseph; Reidpath, Daniel; Pinho, Pedro José M. Rebello; Allotey, Pascale; Kassim, Zaid; Prina, Matthew; Su, Tin TinBackground: We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods: Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results: Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions: Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.Item Equity in decline: illustrating fairness in a worse-off world. [Commentary](2023-10-30) Reidpath, Daniel; Khosla, Rajat; Gruskin, Sofia; Dakessian, Arek; Allotey, PascaleItem Equity in decline: fair distribution in a worse-off world.(2023-06-28) Reidpath, Daniel; Gruskin, Sofia; Khosla, Rajat; Dakessian, Arek; Allotey, PascaleItem Nutritional Interventions for the Prevention of Cognitive Impairment and Dementia in Developing Economies of East Asia: Systematic Review and Meta-analysis(Cambridge University Press, 2020-06-10) McGrattan, Andrea; van Aller, Carla; Narytnyk, Alla; Reidpath, Daniel; Allotey, Pascale; Mohan, Devi; Stephan, Blossom; Robinson, Louise; Siervo, MarioItem Alcohol Consumption Patterns and Associated Risk Behaviors in Three Ethnic Groups of Malaysian Millennials(Openventio Publishers, 2020-04-24) Singh, Sangeeta K.; Yap, Kwong H.; Natarajan, Peter; Allotey, Pascale; Reidpath, DanielObjectives To gain further insights into factors associated with harmful alcohol consumption patterns and other associated behaviours among Malaysians millennials. Methods The United States Centre for Disease, Control, and Prevention (CDC) Youth Risk Behaviour Survey was adapted and translated into Bahasa Malaysia language. The self-administered questionnaire collected information on socio-demographic characteristics and risk behaviours associated with alcohol consumption. Multi-facet sampling was used to recruit participants across six sites in the Klang Valley, Malaysia. There were 326 respondents: 103 Malays, 111 Chinese and 112 Indians; with 171 (52%) male and 155 (48%) female. Results Mean age of the respondents was 21-years. Twenty percent of the millennials surveyed were binge consumers: 79% of binge drinkers were male. More than half (54%) of the binge drinkers were Indians followed by Chinese at 39% and Malays at 8%. Binge consumers were at increased odds (OR=7.58: 95% CI=3.88-14.80) of driving a vehicle under the influence of alcohol and at increased odds (OR=6.88: 95% CI=3.40-13.90) of being driven by someone drunk. Those who were binge drinkers were also at higher odds than non-drinkers of being forced into sexual intercourse (OR=3.16: 95% CI=1.25-7.97) or other sexual acts (OR=3.84: 95% CI=1.74-8.47). Binge drinkers were also more prone to smoking compared to current drinkers (OR=10.82 9% CI=4.85-24.12). Conclusion Binge consumption among millennials was associated with a myriad of behavioural risk factors and harmful alcohol-related consequences. Multiple strategic approaches are needed that address respective cultural norms, enhancement of millennials socialisation and engagement skills within communities to improve the efficacy of preventive interventions.Item Unequal Access to Vaccines Will Exacerbate Other Inequalities(SAGE Publications, 2020-07-25) Cheong, Mark Wing Loong; Allotey, Pascale; Reidpath, DanielThe COVID-19 pandemic has changed the world. In addition to disrupting health care systems, it has negatively affected the economic and social life of countries. According to the United Nations, the economic cost of this pandemic is estimated to be at least US$1 trillion for the year 2020, with global economic growth slowing down to 2%.1 The economic disruption has been driven by restrictions imposed to control the spread of the virus, and “buy time” for the development of a vaccine. There is a consensus that a vaccine, and the immunity that it confers, is required for countries to lift their restrictions and restart their economies. This has led to countries competing for supplies of potential COVID-19 vaccines.2 A corresponding surge of activism has occurred to ensure that vaccines will be equitably distributed. Equal access to a vaccine will be needed to prevent the development of health disparities between the vaccinated and unvaccinated. Unfair access to vaccines will also create inequalities in rights and freedom. There are numerous reports of communities who are perceived to be at higher risk of being infected, being targets of discrimination, and having their rights curtailed. It requires no stretch of the imagination to see how unequal access to a vaccine will result in the rise of a 2-caste system: the clean, who are immune and noncontagious, and the untouchables, who are nonimmune and a feared source of infection. Those who are unable to obtain the vaccine may find their privacy threatened with temporary monitoring measures becoming permanent fixtures in the lives of the unvaccinated, exposing details of their movements and activities. The unvaccinated may also find themselves restricted from travel, public areas, and health care facilities. Their children may be restricted from nurseries. Employment opportunities may be closed for them, as employers may preferentially hire those who can demonstrate documented vaccinations and immunity to COVID-19. This may seem farfetched, but we know that these things can happen—we saw it happen to people living with HIV/AIDS.3 Unequal access to a vaccine may create rifts between nations with higher rates of vaccination and those with lower rates. People living in the latter countries may be refused entry into the former and may face additional discrimination from the global community. We saw this happen to Chinese nationals at the early stages of the pandemic, as well as people coming from African countries during the last Ebola epidemic.4,5 If equal access to an effective vaccine cannot be provided, the economic and social disadvantages of being unvaccinated will create an incentive for people to try and obtain a vaccine or an immunity status by unlawful means. We can then expect to see the rise of black market or fake vaccines or perhaps the sale of false documents that certify vaccinations. All of these will further threaten public health as well as the rise in crime. It has been said that the novel coronavirus does not discriminate. We must ensure that access to vaccination is the same.Item Feasibility and acceptability of a dietary intervention study to reduce salt intake and increase high-nitrate vegetable consumption among middle-aged and older Malaysian adults with elevated blood pressure: a study protocol(BMJ Publishing Group, 2020-08-27) McGrattan, Andrea; Mohan, Devi; Chua, Pei Wei; Hussin, Azizah Mat; Soh, Yee Chang; Alawad, Mawada; Kassim, Zaid bin; Ghazali, Ahmad Nizal Mohd; Stephan, Blossom; Allotey, Pascale; Reidpath, Daniel; Robinson, Louise; Siervo, MarioIntroduction Global population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations’ health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure. Methods and analysis Primary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete postintervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes.Item Religion and mental health among older adults: ethnic differences in Malaysia(Taylor and Francis Group, 2020-08-03) Tan, Min Min; Su, Tin Tin; Ting, Rachel Sing-Kiat; Allotey, Pascale; Reidpath, DanielObjectives Religion and spirituality gain importance as a person ages. Research has shown that religion has a salutary effect on mental health, and it is associated with health differently across ethnic groups. The current study examined ethnic differences in the association between religion and mental health among older adults in a predominantly Muslim population and multicultural setting. Methods Data of 7068 participants (4418 Malays, 2080 Chinese and 570 Indians) aged ≥55 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory (SEACO) were analyzed using bivariate and multiple regressions. Analyses were stratified by ethnicity. Results The importance of having an enriched religious/spiritual life was associated with higher scores of depression, anxiety and stress among Chinese and higher score of depression among Malays, while belief in a higher power was associated with better mental health among Malays, Chinese and Indians. Conclusion The current study showed that there were ethnic variations in the associations between religion and mental health, and the associations depended on the religious variable included in the analysis. The findings of this study showed that religion could be another potential channel to improve mental health among older adults by accommodating and understanding their religious beliefs.Item Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji(BMJ Publishing Group, 2021-01-08) Leder, Karin; Openshaw, John; Allotey, Pascale; Ansariadi, Ansariadi; Barker, S. Fiona; Burge, Kerrie; Clasen, Thomas F.; Chown, Steven L.; Duffy, Grant A.; Faber, Peter A.; Fleming, Genie; Forbes, Andrew B.; French, Matthew; Greening, Chris; Henry, Rebekah; Higginson, Ellen; Johnston, David W.; Lappan, Rachael; Lin, Audrie; Luby, Stephen; McCarthy, David; O'Toole, Joanne E.; Ramirez-Lovering, Diego; Reidpath, Daniel; Simpson, Julie A.; Sinharoy, Sheela S.; Sweeney, Rohan; Taruc, Ruzka R.; Tela, Autiko; Turagabeci, Amelia R.; Wardani, Jane; Wong, Tony; Brown, RebekahIntroduction Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries. Methods and analysis RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.Item Undoing supremacy in global health will require more than decolonisation [Correspondence](Elsevier, 2021) Allotey, Pascale; Reidpath, Daniel
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