Prevalence Trend and Clinical Profile of Leprosy Among the Indigenous Penan Community in Rural Baram, Sarawak, Malaysia: A Retrospective Study

In Malaysia, despite achieving leprosy-elimination status in 1994, leprosy remains a public health issue among the indigenous Penan community in Sarawak. This study aimed to determine the prevalence trend and clinical profile of leprosy among the Penans in rural Baram, Sarawak, Malaysia. A retrospective records review was conducted on 10-year (2008-2018) time trend of annual prevalence rate and 5-year (2013-2018) Penan leprosy patient clinical profile. Out of the 257 new cases of leprosy reported in Sarawak, 42.8% were Penans, and 72.7% were from Baram. The annual Penan ethnic-specific prevalence rate ranged from 2.08 to 35.5/10 000. Forty-six cases were analyzed for clinical profile: There were more males, active case detection, and multibacillary leprosy. The prevalence trend of leprosy among the Penans in rural Baram exceeded recommended elimination targets. Majority of the cases were detected through active case detection, but cases were detected late. Interventions are needed to improve early diagnosis and detection to achieve elimination of leprosy.

The land snail fauna of Batu Kudik, isolated limestone outcrop near Simunjan, Sarawak, Malaysian Borneo (Mollusca, Gastropoda)

Background

The present study provides a checklist of land snails collected from Batu Kudik, a small and isolated limestone outcrop in Simunjan, Sarawak. A total of 24 species of land snails, representing 18 genera and 14 families were recorded, including one newly-described subspecies. The most species-rich of the families in Batu Kudik are Diplommatinidae (17%) and Chronidae (17%) with four recorded species from each of the families. Based on our analysis, Plectostomawallaceikudikense subsp. nov., Opisthostomajavanica and Georissapyrrhoderma were identified as the most abundant land snails at this isolated outcrop, whereas Diplommatinaonyx and Everettiaminuta were recorded as the least abundant. All of the land snails at Batu Kudik were exclusively found sheltered between limestone boulders, underscoring the critical role of this outcrop as their refuge for survival. Consequently, conserving this biodiversity-rich limestone area becomes paramount to prevent the local extinction of these land snail species and possibly other organisms that depend on the unique attributes of the limestone for their survival. We also provide detailed descriptions of Plectostomawallaceikudikense, a new subspecies of the genus Plectostoma which is endemic to Batu Kudik.

New information

A description of a new subspecies Plectostomawallaceikudikense subsp. nov.

The epidemiology of haematological cancers in Sarawak, Malaysia (1996 to 2015)

BACKGROUND

Published epidemiological studies of haematological cancers are few. Hereby we present a 20-year epidemiological data of haematological cancers in Sarawak from a population-based cancer registry.

METHODS

Haematological cancer cases with ICD-10 coded C81-C96 and ICD-O coded /3 diagnosed from 1996 to 2015 were retrieved from Sarawak Cancer Registry. Adult was defined as those 15 years and above. Incidence rate (IR) was calculated based on yearly Sarawak citizen population stratified to age, gender, and ethnic groups. Age-standardised IR (ASR) was calculated using Segi World Standard Population.

RESULTS

A total of 3,947 cases were retrieved and analysed. ASR was 10 and male predominance (IR ratio 1.32, 95%CI 1.24,1.41). Haematological cancers generally had a U-shaped distribution with lowest IR at age 10-14 years and exponential increment from age 40 years onwards, except acute lymphoblastic leukaemia (ALL) with highest IR in paediatric 2.8 versus adult 0.5. There was a significant difference in ethnic and specific categories of haematological cancers, of which, in general, Bidayuh (IR ratio 1.13, 95%CI 1.00, 1.27) and Melanau (IR ratio 0.54, 95%CI 0.45, 0.65) had the highest and lowest ethnic-specific IR, respectively, in comparison to Malay. The ASR (non-Hodgkin lymphoma, acute myeloid leukaemia, ALL, chronic myeloid leukaemia, and plasma cell neoplasm) showed a decreasing trend over the 20 years, -2.09 in general, while Hodgkin lymphoma showed an increasing trend of + 2.80. There was crude rate difference between the 11 administrative divisions of Sarawak.

CONCLUSIONS

This study provided the IR and ASR of haematological cancers in Sarawak for comparison to other regions of the world. Ethnic diversity in Sarawak resulted in significant differences in IR and ASR.

Prevalence of haemosporidia in Asian Glossy Starling with discovery of misbinding of Haemoproteus-specific primer to Plasmodium genera in Sarawak, Malaysian Borneo

BACKGROUND

Plasmodium, Haemoproteus and Leucocytozoon are three mainly studied blood parasites known to cause malarial and pseudomalarial infections in avian worldwide. Although Sarawak is a biodiversity hotspot, molecular data on blood parasite diversity in birds are absent. The objective of the study is to determine the prevalence of blood parasite in Asian Glossy Starlings (AGS), an urban bird with high population density in Sarawak and to elucidate the phylogenetic relationship with other blood parasite.

METHODS

Twenty-nine carcasses of juvenile AGS that were succumbed to death due to window collision were collected around the vicinity of Universiti Malaysia Sarawak. Nested-multiplex and nested PCR targeting the Cytochrome B gene were used to detect Plasmodium and Haemoproteus, and Leucocytozoon respectively. Two primer sets were used for Haemoproteus detection to increase detection sensitivity, with one being a genus-specific primer.

RESULTS

Fourteen samples (prevalence rate: 48.28%) were found positive for avian Plasmodium. Phylogenetic analysis divided our sequences into five lineages, pFANTAIL01, pCOLL4, pACCBAD01, pALPSIS01 and pALPSIS02, with two lineages being novel. No Haemoproteus and Leucocytozoon was found in this study. However, Haemoproteus-specific primer used amplified our Plasmodium samples, making the primer non-specific to Haemoproteus only.

CONCLUSION

This is the first blood parasite detection study on AGS using carcasses and blood clot as sample source in Sarawak. Due to the scarcity of longer sequences from regions with high genetic plasticity, usage of genus-specific primers should be validated with sequencing to ensure correct prevalence interpretation.

Profiling the imported human malaria in Sarawak, Malaysia in 2011-2019

OBJECTIVES

Malaysia has achieved the status of zero indigenous human malaria cases. Nevertheless, imported human malaria has increasingly been reported in Sarawak, Malaysian Borneo. As zoonotic malaria caused by Plasmodium knowlesi remains a major public health problem in Sarawak, the threat of imported malaria must be addressed as it can cause human malaria reintroduction, sustain transmission, and lead to complications. The objectives of this study were to investigate the epidemiological characteristics of imported malaria cases reported in Sarawak and to underline the challenge posed by imported malaria towards malaria elimination efforts.

METHODS

Imported malaria cases reported in Sarawak from 2011 to 2019 were collected from Sarawak State Health Department and analysed in this longitudinal retrospective study.

RESULTS

A total of 2058 imported malaria cases were registered in all districts in Sarawak. Highest number of cases were reported in Kapit (n = 559; 27.16%), followed by Sibu (n = 424; 20.6%), and Miri (n = 166; 8.07%). Based on the demographic profile, most of the patients constituted of either male sex (98.49%), age group of 40-49 years (39.6%), Iban ethnic (57.92%), worked in logging industry (88.58%), Malaysian nationals (91.84%), contracted malaria in Papua New Guinea (46.11%), uncomplicated disease (77.89%), or hospitalised cases (97.86%). The most prominent Plasmodium species diagnosed were P. vivax (52.67%) and P. falciparum (35.81%).

CONCLUSIONS

Surveillance, disease detection, and medical follow-up must be carried out thoroughly for individuals who returned from malaria-endemic countries. It is also necessary to promote pre-travel preventive education as well as chemoprophylaxis to travellers heading to endemic areas.

The dynamics of the microbiome in Ixodidae are shaped by tick ontogeny and pathogens in Sarawak, Malaysian Borneo

Tick-borne diseases have recently been considered a potential emerging public health threat in Malaysia; however, fundamental studies into tick-borne pathogens and microbiome appear limited. In this study, six tick species (Ixodes granulatus, Haemaphysalis hystricis, Haemaphysalis shimoga, Dermacentor compactus, Dermacentor steini and Dermacentor atrosignatus) collected from two primary forests and an oil palm plantation in Sarawak, Malaysian Borneo, were used for microbiome analysis targeting bacterial 16S rDNA using next-generation sequencing (NGS). In addition, bacterial species were further characterized in conventional PCRs to identify potential pathogens. Sequences generated from NGS were first filtered with the Decontam package in R before subsequent microbial diversity analyses. Alpha and beta analyses revealed that the genus Dermacentor had the highest microbial diversity, and H. shimoga significantly differed in microbial composition from other tick species. Alpha and beta diversities were also significantly different between developmental stages of H. shimoga. Furthermore, we observed that some bacterial groups were significantly more abundant in certain tick species and developmental stages of H. shimoga. We tested the relative abundances using pairwise linear discriminant analysis effect size (LEfSe), which also revealed significant microbial composition differences between Borrelia-positive and Borrelia-negative I. granulatus ticks. Finally, pathogenic and potentially pathogenic bacteria circulating in different tick species, such as Rickettsia heilongjiangensis, Ehrlichia sp., Anaplasma sp. and Bartonella spp. were characterized by PCR and sequencing. Moreover, Coxiella and Francisella-like potential symbionts were identified from H. shimoga and D. steini, respectively. More studies are required to unravel the factors associated with the variations observed in this study.

Ethnobotanical study of medicinal plants used by the Kenyah community of Borneo

ETHNOPHARMACOLOGICAL RELEVANCE

Sarawak is located in one of the world's most biodiverse regions and is home to more than 40 sub-ethnic groups that each have their own distinct culture, language and lifestyle. This has given rise to numerous, unique ethnobotanical systems. However, due to rapid urbanization, this traditional knowledge is at a risk of extinction. Yet, ethnobotanical studies in Sarawak are almost non-existent, especially among Orang Ulu communities like the Kenyah.

AIM OF STUDY

Therefore, this study was conducted to document the ethnomedicinal knowledge of the Kenyah community. The main objectives of this study are: 1) To determine and document the diversity of medicinal plants used by the Kenyah community, 2) To determine whether the availability of modern medicine has affected Kenyah traditional medicine, and 3) To identify plants which have not been previously cited or used for previously unreported medical uses.

MATERIALS AND METHODS

We conducted repeated interviews and field surveys at the Asap-Koyan Resettlement Area, Belaga Sarawak. A total of 24 respondents from four Kenyah longhouses were interviewed in this study. Individuals possessing extensive traditional medicinal knowledge were identified via preliminary interviews or by viva voce. Translators were employed to ensure that there was no miscommunication. The results were evaluated based on the plant's total use-reports and number of respondents citing the plant. The data was also evaluated based on use-reports by ailment category.

RESULTS

Over 95% of the respondents were 40 years and older (58.21 years old ± 11.21). This was due to the younger members of the community (40 years old and below) admitting that they had almost no knowledge regarding traditional medicine, as they preferred relying on modern medicine. A total of 61 plant species were mentioned by the 24 respondents Seven plants had five or more respondents citing it, which was more than 20% of the respondents. These plants were Piper betle, Homalomena cordata, Senna alata, Annona muricata, Derris elliptica, Blumea balsamifera and Coscinium fenestratum.

CONCLUSION

Almost all of the cited plants had been previously recorded to be used in either Ayurvedic, Chinese herbal medicine, Malay traditional medicine or other Asian ethnomedicinal systems. However, there were four highly cited species that were used for treatments that were scarcely reported in past literature. These were piper betle (used by Kenyah to treat fever), Sauropus andrognus (used by Kenyah to treat fever), Derris elliptica (used by Kenyah to treat fever and influenza) and Coscinuim fenestratum (used by Kenyah to treat toxic effects from non-medical substances).

Detection of a Babesia sp. genotype closely related to marsupial-associated Babesia spp. in male Haemaphysalis shimoga from Sarawak, Malaysian Borneo

In this study, Babesia screening was conducted in 55 rodents and 160 tick samples collected from primary forests and an oil palm plantation in Sarawak, Malaysian Borneo. PCR targeting the 18S ribosomal DNA revealed the presence of Babesia spp. DNA detected in two questing male Haemaphysalis shimoga ticks collected from the oil palm plantation. Sequence analysis revealed that both sequences were identical and had 98.6% identity to a Babesia macropus sequence obtained from Eastern grey kangaroos (Macropus giganteus) in Australia. Phylogenetic tree revealed clustering with marsupial-associated Babesia spp. in the Babesia sensu stricto clade. Whether or not H. shimoga is the competent vector and the importance of the Babesia sp. detected in this study warrants more investigation.

Genotype and organ effect on the occupancy of phyllosphere prokaryotes in different rice landraces

Bacteria community provides essential ecological services to rice plants. The bacterial diversity of rice varies across host plant genotype and organs. This study employed 16S rDNA amplicon sequencing to characterise the bacterial community associated with three rice landraces using leaf blade and stem samples. The prokaryotic community found in these rice landraces comprised of two kingdoms, 12 phyla, 25 classes, 40 orders, 80 families, and 118 genera. Proteobacteria (53.9%) was the most abundant phylum. The most abundant genus was an undefined genus under Cyanobacteria (33.0%). Homogeneity of prokaryotic community was observed across the three rice landraces, which may suggest a high similarity in biological and genetical properties of the rice landraces. The difference in prokaryotic composition between leaf blade and stem was depicted based on principal coordinate analysis. This study observed that the prokaryotic inhabitants in rice plants is predominantly determined by rice plant organs.

Epidemiology of indigenous Plasmodium knowlesi infection in Sarawak, 2011-2019

OBJECTIVES

To characterize the state-wide epidemiology of indigenous knowlesi malaria in Sarawak from 2011-2019.

METHODS

Longitudinal retrospective study based on Sarawak knowlesi malaria surveillance data recorded 2011-2019. Only indigenous cases were included and information extracted for analysis comprised age, sex, occupation, ethnicity, case severity, hospital admission, and parasite density.

RESULTS

Over the 9 years 8473 indigenous knowlesi malaria cases were recorded. Age group 40 to 49 years, males, plantation workers, and Iban communities recorded the highest percentage of cases in each demographic variable. Most of the cases were uncomplicated (85.9%) and 89.5% of the total cases were reported with ≤20,000 parasites/μL of blood. Age group and ethnic group are associated with severity of knowlesi malaria in Sarawak. Multivariable logistic regression indicated that the age group 60+ years had the highest odds of developing severe knowlesi malaria compared to other age groups (AOR 2.48; 95% CI 1.22, 5.02; p=0.012). Bidayuh patients were more likely to develop severe knowlesi malaria than Ibans, the largest ethnic group among knowlesi malaria patients (AOR 1.97; 95% CI 1.31, 2.97; p=0.001).

CONCLUSIONS

Identification of risk groups is important for the implementation of prevention programs and treatments targeting at specific group to combat knowlesi malaria effectively.

On the prediction of methane fluxes from pristine tropical peatland in Sarawak: application of a denitrification-decomposition (DNDC) model

Tropical peatlands have high potential function as a major source of atmospheric methane (CH₄) and can contribute to global warming due to their large soil carbon stock, high groundwater level (GWL), high humidity and high temperature. In this study, a process-based denitrification-decomposition (DNDC) model was used to simulate CH₄ fluxes in a pristine tropical peatland in Sarawak. To test the accuracy of the model, eddy covariance tower datasets were compared. The model was validated for the year 2014, which showed the good performance of the model for simulating CH₄ emissions. The monthly predictive ability of the model was better than the daily predictive ability, with a determination coefficient (R²) of 0.67, model error (ME) of 2.47, root mean square error (RMSE) of 3.33, mean absolute error (MAE) of 2.92 and mean square error (MSE) of 11.08. The simulated years of 2015 and 2016 showed the good performance of the DNDC model, although under- and overestimations were found during the drier and rainy months. Similarly, the monthly simulations for the year were better than the daily simulations for the year, showing good correlations at R² at 0.84 (2015) and 0.87 (2016). Better statistical performance in terms of monthly ME, RMSE, MAE and MSE at - 0.11, 3.38, 3.05 and 11.45 for 2015 and - 1.14, 5.28, 4.93 and 27.83 for 2016, respectively, was also observed. Although the statistical performance of the model simulation for daily average CH₄ fluxes was lower than that of the monthly average, we found that the results for total fluxes agreed well between the observed and the simulated values (E = 6.79% and difference = 3.3%). Principal component analysis (PCA) showed that CH₄, GWL and rainfall were correlated with each other and explained 41.7% of the total variation. GWL was found to be relatively important in determining the CH₄ fluxes in the naturally inundated pristine tropical peatland. These results suggest that GWL is an essential input variable for the DNDC model for predicting CH₄ fluxes from the pristine tropical peatland in Sarawak on a monthly basis.

Trend analysis of anthropogenic activities affecting trace metals deposition in core sediments from the coastal and four rivers estuary of Sarawak, Malaysia

This study reports the concentrations of trace metals in core sediments profile from the coastal and four rivers estuary in the Kuching Division of Sarawak, Malaysia, and the controlling mechanisms influencing their availability in sediments of the studied area. The bonding of trace metals with non-mobile fractions was confirmed with the sequential extraction. Inductively coupled plasma-optical emission spectroscopy (ICP-OES) was used to measure the concentrations of the trace metals. Granulometric analyses were performed using normalized sieve apertures to determine the textural characteristics of the sediments. Enrichment factor was used to evaluate the level of metal enrichment. Heavy metals concentrations in sediment samples varied in the range: Pb (8.9-188.9 mg/kg d.w.), Zn (19.4-431.8 mg/kg d.w.), Cd (0.014-0.061 mg/kg d.w.), Ni (6.6-33.4 mg/kg d.w.), Mn (2.4-16.8 mg/kg d.w.), Cu (9.4-133.3 mg/kg d.w.), Ba (1.3-9.9 mg/kg d.w.), As (0.4-7.9 mg/kg d.w.), Co (0.9-5.1 mg/kg d.w.), Cr (1.4-7.8 mg/kg d.w.), Mg (68.8-499.3 mg/kg d.w.), Ca (11.3-64.9 mg/kg d.w.), Al (24.7-141.7 mg/kg d.w.), Na (8.8-29.4 mg/kg d.w.), and Fe (12,011-35,124.6 mg/kg d.w.). The estimated results of the enrichment factor suggested enrichments of Pb, Zn, and Cu in all the core sediment samples and depths at all sites. The other trace metals showed no enrichments in almost all the sampled stations. Continuous accumulation of Pb, Zn, and Cu metals over a period can be detrimental to living organisms and the ecology. The results obtained from the statistical analyses suggested that the deposition of trace metals in the studied sites is due to anthropogenic inputs from the adjacent land-based sources.

Ecological surveillance of bat coronaviruses in Sarawak, Malaysian Borneo

Objective

Coronaviruses (CoVs) are natural commensals of bats. Two subgenera, namely Sarbecoviruses and Merbecoviruses have a high zoonotic potential and have been associated with three separate spillover events in the past 2 decades, making surveillance of bat-CoVs crucial for the prevention of the next epidemic. The study was aimed to elucidate the presence of coronavirus in fresh bat guano sampled from Wind Cave Nature Reserve (WCNR) in Sarawak, Malaysian Borneo. Samples collected were placed into viral transport medium, transported on ice within the collection day, and preserved at − 80 °C. Nucleic acid was extracted using the column method and screened using consensus PCR primers targeting the RNA-dependent RNA polymerase (RdRp) gene. Amplicons were sequenced bidirectionally using the Sanger method. Phylogenetic tree with maximum-likelihood bootstrap and Bayesian posterior probability were constructed.

Results

CoV-RNA was detected in ten specimens (47.6%, n  = 21). Six alphacoronavirus and four betacoronaviruses were identified. The bat-CoVs can be phylogenetically grouped into four novel clades which are closely related to Decacovirus-1 and Decacovirus-2, Sarbecovirus, and an unclassified CoV. CoVs lineages unique to the Island of Borneo were discovered in Sarawak, Malaysia, with one of them closely related to Sarbecovirus. All of them are distant from currently known human coronaviruses.

Leptospirosis infections among hospital patients, Sarawak, Malaysia

Background

Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years.

Methods

To better understand the burden of disease and associated risk factors, we evaluated 147 patients presenting with clinical leptospirosis to local hospitals in Sarawak, Malaysia for the presence of Leptospira and associated antibodies. Sera and urine specimens collected during the acute illness phase were assessed via a commercially available rapid diagnostic test (Leptorapide, Linnodee Ltd., Antrim, Northern Ireland), an ELISA IgM assay (Leptospira IgM ELISA, PanBio, Queensland, Australia) and a pan-Leptospira real-time PCR (qPCR) assay to estimate disease prevalence and diagnostic accuracy of each method. Microagglutination testing was performed on a subset of samples.

Results

Overall, 45 out of 147 patients (30.6%) showed evidence of leptospires through qPCR in either one or both sera (20 patients) or urine (33 patients), and an additional ten (6.8%) were considered positive through serological testing, for an overall prevalence of 37.4% within the study population. However, each diagnostic method individually yielded disparate prevalence estimates: rapid test 42.2% for sera and 30.5% for urine, ELISA 15.0% for sera, qPCR 13.8% for sera and 23.4% for urine. Molecular characterization of a subset of positive samples by conventional PCR identified the bacterial species as Leptospira interrogans in 4 specimens. A multivariate risk factor analysis for the outcome of leptospirosis identified having completed primary school (OR = 2.5; 95 CI% 1.0–6.4) and weekly clothes-washing in local rivers (OR = 10.6; 95 CI% 1.4–214.8) with increased likelihood of leptospirosis when compared with those who had not.

Conclusion

Overall, the data suggest a relatively high prevalence of leptospirosis in the study population. The low sensitivities of the rapid diagnostic test and ELISA assay against qPCR highlight a need for better screening tools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40794-021-00154-2.

Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Background

Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections.

Methods

We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016.

Results

One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections.

Conclusions

Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.

Spatiotemporal spread of chikungunya virus in Sarawak, Malaysia

BACKGROUND

We studied the spatiotemporal spread of a chikungunya virus (CHIKV) outbreak in Sarawak state, Malaysia, during 2009-2010.

METHODS

The residential addresses of 3054 notified CHIKV cases in 2009-2010 were georeferenced onto a base map of Sarawak with spatial data of rivers and roads using R software. The spatiotemporal spread was determined and clusters were detected using the space-time scan statistic with SaTScan.

RESULTS

Overall CHIKV incidence was 127 per 100 000 population (range, 0-1125 within districts). The average speed of spread was 70.1 km/wk, with a peak of 228 cases/wk and the basic reproduction number (R0) was 3.1. The highest age-specific incidence rate was 228 per 100 000 in adults aged 50-54 y. Significantly more cases (79.4%) lived in rural areas compared with the general population (46.2%, p<0.0001). Five CHIKV clusters were detected. Likely spread was mostly by road, but a fifth of rural cases were spread by river travel.

CONCLUSIONS

CHIKV initially spread quickly in rural areas mainly via roads, with lesser involvement of urban areas. Delayed spread occurred via river networks to more isolated areas in the rural interior. Understanding the patterns and timings of arboviral outbreak spread may allow targeted vector control measures at key transport hubs or in large transport vehicles.

Pregnant Women Are Iodine Deficient While School-Aged Children Demonstrate Adequate Iodine Status in Sarawak, Malaysia

BACKGROUND

A mandatory universal salt iodization (USI) has been implemented in Sarawak, Malaysia since 2008.

OBJECTIVES

The aim of this study is to assess the current iodine status among school-aged children (SAC) and pregnant women (PW) after 10 years of USI implementation in Sarawak.

METHODS

This cross-sectional survey among school-aged children and pregnant women was conducted between July and October 2018 in Sarawak. The multistage proportionate to population size sampling technique was used to select 30 schools and 30 maternal and child health care clinics. A total of 1200 children aged 8 to 10 years and 750 first-trimester pregnant women were randomly selected to participate in the study. Iodine excretion level in urine was determined according to the World Health Organization classification.

RESULTS

A total of 988 children and 677 PW participated in the study with a response rate of 82.3% and 90.2%, respectively. The overall median urinary iodine concentration (UIC) level among the children was 126.0 μg/L (interquartile range [IQR], 71.0-200.9 μg/L) and classified as adequate iodine status. The median UIC among PW was 123.9 μg/L (IQR, 56.5-192.1μg/L) indicating inadequate iodine status.

CONCLUSION

The present findings indicate that despite adequate iodine status in children, the majority of PW still showed inadequate iodine status. Thus, comprehensive monitoring of the iodine deficiency disorder problem among PW is warranted.

Nasopharyngeal carcinoma among the Bidayuh of Sarawak, Malaysia: History and risk factors

Nasopharyngeal carcinoma (NPC) is a cancer of the epithelial cells lining the nasopharynx. The incidence of NPC has a distinct geographical distribution, mainly affecting the Chinese population of Southern China. In Malaysia, this cancer is exceptionally prevalent among males. There is a high incidence rate of NPC among the Bidayuh natives in Sarawak, Malaysia. Other than epidemiology reports, there has not been an article describing plausible cancer risk factors contributing to NPC within this native group. Researchers are still trying to understand the reasons the Bidayuh and Southern Chinese are highly susceptible to NPC. This article discusses the risk factors of developing NPC: Epstein-Barr virus infection, genetic predisposition, diet, environmental exposure and tobacco smoking. There is a need to improve the understanding of the role of risk factors to identify new ways to prevent cancer, especially among high-risk groups.

Perception of menopause among women of Sarawak, Malaysia

Background

Various factors, including menopausal status, educational and social background, culture, and physical and emotional health, may influence women’s perceptions of menopause. This study documents the elements influencing attitudes towards menopause among women in Sarawak, Malaysia.

Methods

A face-to-face interview using a validated questionnaire was conducted with 324 Sarawakian women aged 40–65 to determine the mean age of menopause and perceptions and experiences of menopause among these women.

Results

The mean age ± standard deviation of the women was 51.37 ± 5.91 years. Ninety (27.8%) participants were premenopausal, 124 (38.5%) perimenopausal and 110 (33.7%) postmenopausal. The majority of these women (228; 70.4%) were local indigenous inhabitants of Sarawak. The findings show that 22.5% of the participants agreed that problems during menopause are a natural process. While 21.9% of the participants suggested that menopause should be treated medically, 32.3% argued that natural approaches for menopause symptoms are better than hormonal treatments. Seventy-five per cent of the women agreed that the absence of menses after menopause is a relief; meanwhile, 61.2% stated that menopause causes unpleasant symptoms. Notably, 51.7% were not sure whether women become less sexually attractive after menopause, and 51.1% were uncertain as to whether they feel less of a woman following menopause. Finally, 81.7% of participants were unsure if sexual activity is more enjoyable after menopause, and 71.9% were uncertain whether changes in life during menopause are more stressful. Among the different menopausal stages, the premenopausal group of women were noted to have more positive perceptions of menopause compared to the peri- and postmenopausal women. The study also observed that women with a better educational background generally had more positive perceptions of menopause.

Conclusions

The women’s perceptions of menopause in this study were found to correspond to those in other studies on Asian women. Women with higher levels of education and premenopausal women comparatively expressed more positive opinions regarding menopause. Lastly, most of the women noted that menopausal symptoms are unpleasant, but that the absence of menses after menopause is a relief.

Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

OBJECTIVES

Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak.

METHODS

For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality.

RESULTS

Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality.

CONCLUSION

Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.

First Bornean orangutan sighting in Usun Apau National Park, Sarawak

Wildlife surveys were conducted in Usun Apau National Park (UANP), Sarawak from Oct 2017 to Oct 2020. This was the first attempt to document fauna diversity in Usun Apau National Park on the UANP plateau at 1200-1400 m a.s.l. On 17 September 2020, 10 AM, we observed an orangutan individual, Pongo pygmaeus, over a period of one minute at Libut Camp UANP (E: 114039'.546, N: 2052'36.44) at 1,020 m a.s.l. We also recorded four nests and orangutan vocalisation twice. This observation is important for Bornean orangutan conservation as this was the first orangutan sighting in UANP and well outside the species distribution range for in Sarawak.

Acute decompensated heart failure in a non cardiology tertiary referral centre, Sarawak General Hospital (SGH-HF)

Background

Data on clinical characteristics of acute decompensated heart failure (ADHF) in Malaysia especially in East Malaysia is lacking.

Methods

This is a prospective observational study in Sarawak General Hospital, Medical Department, from October 2017 to September 2018. Patients with primary admission diagnosis of ADHF were recruited and followed up for 90 days. Data on patient’s characteristics, precipitating factors, medications and short-term clinical outcomes were recorded.

Results

Majority of the patients were classified in lower socioeconomic group and the mean age was 59 years old. Hypertension, diabetes mellitus and dyslipidaemia were the common underlying comorbidities. Heart failure with ischemic aetiology was the commonest ADHF admission precipitating factor. 48.6% of patients were having preserved ejection fraction HF and the median NT-ProBNP level was 4230 pg/mL. Prescription rate of the evidence-based heart failure medication was low. The in-patient mortality and the average length of hospital stay were 7.5% and 5 days respectively. 43% of patients required either ICU care or advanced cardiopulmonary support. The 30-day, 90-day mortality and readmission rate were 13.1%, 11.2%, 16.8% and 14% respectively.

Conclusion

Comparing with the HF data from West and Asia Pacific, the short-term mortality and readmission rate were high among the ADHF patients in our study cohort. Maladaptation to evidence-based HF prescription and the higher prevalence of cardiovascular risk factors in younger patients were among the possible issues to be addressed to improve the HF outcome in regions with similar socioeconomic background.

COVID-19 testing strategy in response to infection among healthcare workers in a large non-COVID-designated hospital

Sarawak General Hospital, which is the only public access tertiary referral center in Sarawak State for all clinical specialties, was designated a hybrid hospital to treat both COVID-19 and non-COVID-19 patients. During the initial surge of patients admitted with COVID-19, there was also a corresponding increase in health-care workers (HCWs) detected with COVID-19 infection. The latter being isolated, and the large number of staff members that had come into contact with COVID-19 being quarantined from work, placed further strain on the health-care services. The staff mass screening strategy was a policy decision made by the hospital in response to infection among HCWs, and it aimed to reduce in-hospital transmission (particularly among asymptomatic staff), mitigate workforce depletion due to quarantining, and protect the health-care workforce. In this study, we assessed the detection rate of COVID-19 infection from staff mass testing over a five-week period, and described our experience of adopting this surveillance screening strategy alongside ongoing contact tracing and symptomatic screening strategies. Although it was thought that such periodic staff surveillance might be helpful in protecting the health-care workforce within a short period, the long-term implications, especially in settings with limited resources, is significant and therefore explored in this paper. Our findings might provide an evidence-based reference for the future planning of an optimal strategy with the least compromise in care for a larger proportion of non-COVID-19 patients amid efforts against COVID-19 in a large non-COVID-designated hospital with hybrid status.

Copro-molecular identification of intestinal nematode infections in a rural community in East Malaysia

Soil-transmitted helminth (STH) infections are the most common intestinal parasitic infections of medical importance in humans. The infections are widely distributed throughout tropical and subtropical countries, particularly among disadvantaged and underprivileged communities. In Malaysia, STH infections is highly prevalent, especially among the indigenous groups. However, species identification through molecular studies is still lacking. Using molecular techniques, this study was conducted to identify STH species that infect humans. Faecal samples were collected from three Iban tribal longhouses in the rural area of Sarikei Division, Sarawak. Positive faecal samples by microscopy were subjected to PCR and sequenced for species identification. Based on the microscopy examination, the most prevalent STH infection was Ascaris, followed by hookworm and Trichuris. All microscopy-positive samples were then PCR-amplified. The amplicons were sequenced, aligned, and compared with other sequences in the GenBank database. The results showed that Ascaris lumbricoides was the predominant STH species, followed by Trichuris trichiura, Ancylostoma duodenale, and Necator americanus. Our findings were contradictory to past studies, as we showed that A. duodenale was more abundant than N. americanus. Socioeconomic improvement and health education programs should be included in the management and prevention of public health strategies against STH.

Detection of Borrelia burgdorferi Sensu Lato and Relapsing Fever Borrelia in Feeding Ixodes Ticks and Rodents in Sarawak, Malaysia: New Geographical Records of Borrelia yangtzensis and Borrelia miyamotoi

Members of the Borrelia burgdorferi sensu lato (Bbsl) complex are etiological agents of Lyme disease (LD), and Borrelia miyamotoi is one of the relapsing fever Borrelia (RFB). Despite the serological evidence of LD in Malaysia, there has been no report from Sarawak, Malaysian Borneo. Thus, this study aimed to detect and characterize Borrelia in rodents and Ixodes ticks from primary forests and an oil palm (OP) plantation in Sarawak. Borrelia yangtzensis (a member of the Bbsl complex) was detected in 43.8% (14/32) of Ixodes granulatus; most of the positive ticks were from the OP plantation (13/14). Out of 56 rodents, B. yangtzensis was detected in four Rattus spp. from the OP plantation and B. miyamotoi was detected in one rodent, Sundamys muelleri, from the primary forest. Further, the positive samples of B. yangtzensis were randomly selected for multilocus sequence analysis (MLSA). The MLSA results of successfully amplified tick samples revealed a clustering with the sequences isolated from Japan and China. This study is the first evidence of B. miyamotoi, a known human pathogen in Malaysia, and B. yangtzensis, which is circulating in ticks and rodents in Sarawak, Malaysian Borneo, and presenting a new geographical record of the Borrelia spp.

Genetic diversity and structure of the critically endangered Artocarpus annulatus, a crop wild relative of jackfruit (A. heterophyllus)

Limestone karsts of Southeast Asia can harbor high levels of endemism, but are highly fragmented, increasingly threatened, and their biodiversity is often poorly studied. This is true of the Padawan Limestone Area of Sarawak, Malaysia, home to the endemic Artocarpus annulatus, the closest known wild relative of two important and underutilized fruit tree crops, jackfruit (A. heterophyllus) and cempedak (A. integer). Identifying and conserving crop wild relatives is critical for the conservation of crop genetic diversity and breeding. In 2016 and 2017, five A. annulatus populations were located, and leaf material, locality information, and demographic data were collected. Microsatellite markers were used to assess genetic diversity and structure among populations, and to compare levels of genetic diversity to closely related congeneric species. Results indicate no evidence of inbreeding in A. annulatus, and there is no genetic structure among the five populations. However, diversity measures trended lower in seedlings compared to mature trees, suggesting allelic diversity may be under threat in the youngest generation of plants. Also, genetic diversity is lower in A. annulatus compared to closely related congeners. The present study provides a baseline estimate of A. annulatus genetic diversity that can be used for comparison in future studies and to other species in the unique limestone karst ecosystems. Considerations for in situ and ex situ conservation approaches are discussed.

Attitudes toward epilepsy in East Malaysia using the Public Attitudes Toward Epilepsy (PATE) scale

BACKGROUND

Epilepsy stigma is an important issue affecting people with epilepsy (PWE) in various social aspects of life. Most studies on stigma were among the metropolitan population but rarely on indigenous people. Hence, this study aimed to understand the attitudes toward epilepsy of the East Malaysians, comparing with the West Malaysians previously reported.

METHOD

This study was performed among the indigenous people in Kuching and Sibu (Sarawak) and Kota Kinabalu (Sabah) using the Public Attitudes Toward Epilepsy (PATE) scale. A higher score indicates poorer attitude.

RESULT

A total of 360 respondents (41.7% Kadazan-Dusun, 30.6% Bidayuh, and 24.7% Iban) aged 34.6 ± 12.6 years completed the questionnaire. They were predominantly females and had lower education level and income compared with the West Malaysians. The Sabah population had significantly lower mean scores (better attitudes) than those in Sarawak, in both personal and general domains (p < .001). As compared with West Malaysia, the mean score in the personal domain was significantly lower in Sabah, while Sarawak had significantly higher scores in general domain (p < .001). Subanalysis showed that the Sabah population had better attitudes toward marriage and employment in PWE than the West Malaysians, whereas Sarawak had poorer attitudes toward education and social contact in PWE.

CONCLUSION

The attitudes toward epilepsy were different among the indigenous populations in Sabah and Sarawak, and from the West Malaysians, which could be attributable to their sociocultural differences.

A hospital-based study on ischaemic stroke characteristics, management, and outcomes in Sarawak: Where do we stand?

BACKGROUND

Located on the Borneo Island, Sarawak is the largest state of Malaysia and has a population distinctive from Peninsular Malaysia. The ischaemic stroke data in Sarawak had not been reported despite the growing number of patients annually. We aimed to investigate patient characteristics, management, and outcomes of ischaemic stroke in Sarawak and benchmark the results with national and international published data.

METHODS

We included ischaemic stroke cases admitted to Sarawak General Hospital between June 2013 and August 2018 from Malaysia National Stroke Registry. We performed descriptive analyses on patient demographics, cardiovascular risk factors, prior medications, smoking status, arrival time, thrombolysis rate, Get With The Guidelines (GWTG)-Stroke measures, and outcomes at discharge. We also numerically compared the results from Sarawak with the published data from selected national and international cohorts.

RESULTS

We analysed 1435 ischaemic stroke cases. The mean age was 60.1±13.2 years old; 64.9% were male; median baseline National Institute of Health Stroke Scale was seven points. Hypertension was the most prevalent risk factor of ischaemic stroke; 12.7% had recurrent stroke; 13.7% were active smokers. The intravenous thrombolysis rate was 18.8%. We achieved 80-90% in three GWTG-Stroke performance measures and 90-98% in four additional quality measures in our ischaemic stroke management. At discharge, 57% had modified Rankin Scale of 0-2; 6.7% died during hospitalisation. When compared with selected national and international data, patients in Sarawak were the youngest; Sarawak had more male and more first-ever stroke. Thrombolysis rate in Sarawak was higher compared with most studies in the comparison. Functional outcome at discharge in Sarawak was better than national cohort but still lagging behind when compared with the developed countries. In-hospital mortality rate in Sarawak was slightly lower than the national data but higher when compared with other countries.

CONCLUSION

Our study described characteristics, management, and outcomes of ischaemic stroke in Sarawak. We achieved high compliance with most of GTWG-Stroke performance and quality indicators. Sarawak had better outcomes than the national results on ischaemic stroke. However, there is still room for improvement when compared with other countries. Actions are needed to reduce the cardiovascular burdens for stroke prevention, enhance healthcare resources for stroke care, and improve intravenous thrombolysis treatment in Sarawak.

Molecular phylogenetics and evolutionary history of the endemic land snail genus Everettia in northern Borneo

Borneo has gone through dramatic changes in geology and topography from the early Eocene until the early Pliocene and experienced climatic cycling during the Pleistocene. However, how these changes have shaped the present-day patterns of high diversity and complex distribution are still poorly understood. In this study, we use integrative approaches by estimating phylogenetic relationships, divergence time, and current and past niche suitability for the Bornean endemic land snail genus Everettia to provide additional insight into the evolutionary history of this genus in northern Borneo in the light of the geological vicariance events and climatic fluctuations in the Pleistocene. Our results show that northern Borneo Everettia species belong to two deeply divergent lineages: one contains the species that inhabit high elevation at the central mountain range, while the other contains lowland species. Species diversification in these lineages has taken place before the Pliocene. Climate changes during the Pleistocene did not play a significant role in species diversification but could have shaped contemporary species distribution patterns. Our results also show that the species-rich highland habitats have acted as interglacial refugia for highland species. This study of a relatively sedentary invertebrate supports and enhances the growing understanding of the evolutionary history of Borneo. Species diversification in Everettia is caused by geological vicariance events between the early Miocene and the Pliocene, and the distribution patterns were subsequently determined by climatic fluctuations in the Pleistocene.

Why girls get married early in Sarawak, Malaysia - an exploratory qualitative study

BACKGROUND

Child marriage, a marriage that involves someone under the age of 18 years, is a long-standing social issue in Sarawak state, Malaysia. The state has taken several measures to improve situations of inequity for women who get married early; however, the practice is still a common part of the tradition and culture. The aim of this study was to explore the factors leading to child marriage in Sarawak state, Malaysia.

METHODS

This was an exploratory qualitative study conducted via semi-structured interviews with twenty-two women who were married when they were younger than 18 years old in Kuching, Sarawak, Malaysia. Participants were recruited through purposive and convenient sampling with the use of data from a reproductive health clinic and recruitment in villages. Thematic analysis was used for data analysis.

RESULTS

Four overarching themes were identified: health risk behaviour, family poverty, early marriage as fate, and family disharmony.

CONCLUSIONS

In-depth understanding of the unique factors leading to child marriage locally will facilitate the introduction of new approaches to interventions to eradicate child marriage in Sarawak state, Malaysia.

Factors Affecting Voluntary HIV Testing Among General Adult Population: A Cross-Sectional Study in Sarawak, Malaysia

Objective: Voluntary HIV testing is one of the key strategies in the HIV/AIDS prevention and control program. New National Strategic Plan for 2016-2030 in Malaysia, adapt three zeros viz. 'zero new infections of HIV/AIDS, zero discrimination and zero AIDS-related deaths'. This study aimed to determine the predictors of voluntary HIV testing in Sarawak. Materials and methods: A cross-sectional study was conducted with a total of 900 respondents (450 males and 450 females) from the state of Sarawak, aged 18 years and above, who were selected by gender-stratified multistage cluster sampling. Data were obtained by face-to-face interview using a pretested questionnaire. Binary logistic regression analysis was done to determine the potential predictors for voluntary HIV testing. Results: The prevalence of HIV testing was higher among female respondents (26%) compared to male respondents (14.2%), and the difference was statistically significant (p < 0.001). Binary logistic regression analysis revealed that household income more than MYR 1501 (p = 0.009), not living with a partner (p < 0.001) and discussion on HIV/AIDS (p = 0.019) appeared to be predictors for the male respondents, while, ethnicity was statistically significant for female respondents (p < 0.001). Conclusion: The utilisation of HIV testing was low in both males and females. Thus, the finding of this study could be considered when designing HIV education and screening program in Sarawak.

Evidence of asymptomatic submicroscopic malaria in low transmission areas in Belaga district, Kapit division, Sarawak, Malaysia

BACKGROUND

Malaysia has declared its aim to eliminate malaria with a goal of achieving zero local transmission by the year 2020. However, targeting the human reservoir of infection, including those with asymptomatic infection is required to achieve malaria elimination. Diagnosing asymptomatic malaria is not as straightforward due to the obvious lack of clinical manifestations and often subpatent level of parasites. Accurate diagnosis of malaria is important for providing realistic estimates of malaria burden and preventing misinformed interventions. Low levels of parasitaemia acts as silent reservoir of transmission thus remains infectious to susceptible mosquito vectors. Hence, the aim of this study is to investigate the prevalence of asymptomatic submicroscopic malaria (SMM) in the District of Belaga, Sarawak.

METHODS

In 2013, a total of 1744 dried blood spots (DBS) were obtained from residents of 8 longhouses who appeared healthy. Subsequently, 251 venous blood samples were collected from residents of 2 localities in 2014 based on the highest number of submicroscopic cases from prior findings. Thin and thick blood films were prepared from blood obtained from all participants in this study. Microscopic examination were carried out on all samples and a nested and nested multiplex PCR were performed on samples collected in 2013 and 2014 respectively.

RESULTS

No malaria parasites were detected in all the Giemsa-stained blood films. However, of the 1744 samples, 29 (1.7%) were positive for Plasmodium vivax by PCR. Additionally, of the 251 samples, the most prevalent mono-infection detected by PCR was Plasmodium falciparum 50 (20%), followed by P. vivax 39 (16%), P. knowlesi 9 (4%), and mixed infections 20 (8%).

CONCLUSIONS

This research findings conclude evidence of Plasmodium by PCR, among samples previously undetectable by routine blood film microscopic examination, in local ethnic minority who are clinically healthy. SMM in Belaga district is attributed not only to P. vivax, but also to P. falciparum and P. knowlesi. In complementing efforts of programme managers, there is a need to increase surveillance for SMM nationwide to estimate the degree of SMM that warrant measures to block new transmission of malaria.

Elevated blood pressure and its predictors among secondary school students in Sarawak: a cross-sectional study

OBJECTIVES

Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia.

METHODS

A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0.

RESULTS

The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio=3.144), being male (adjusted odds ratio=3.073), being Chinese (adjusted odds ratio=2.321) or Iban (adjusted odds ratio=1.578), central obesity (adjusted odds ratio=2.145), being overfat (adjusted odds ratio=1.885), and being an older adolescent (adjusted odds ratio=1.109). Parental history of hypertension, locality, and physical activity showed no significant associations.

CONCLUSION

The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.

A molecular and conchological dissection of the "scaly" Georissa of Malaysian Borneo (Gastropoda, Neritimorpha, Hydrocenidae)

The Bornean hydrocenids have so far been understudied compared to other non-pulmonate snails in this region. In the present study, we review a first group of minute land snail species belonging to the genus Georissa (Gastropoda, Hydrocenidae) from Malaysian Borneo. This group is restricted to the species with conspicuous scale-like sculpture on the shell. Based on materials from recent fieldwork, museums, and personal collections, Malaysian Borneo hydrocenids are more complex and diverse in shell characters than previously anticipated. Here, a molecular, conchological, and biogeographic study of this “scaly group” is presented. We recognise 13 species of which six are new to science, namely Georissaanyiensissp. n., Georissamuluensissp. n., Georissabauensissp. n., Georissasilaburensissp. n., Georissakinabatanganensissp. n., and Georissasepulutensissp. n.

Melioidosis: an unusual cause of infective endocarditis: a case report

Introduction

As a causal organism in infective endocarditis, Burkholderia pseudomallei is rare. Burkholderia pseudomallei is intrinsically resistant to aminoglycosides but a gentamicin-susceptible strain was discovered in Sarawak, Malaysian Borneo in 2010. We report the first occurrence of infective endocarditis due to the gentamicin-susceptible strain of B. pseudomallei.

Case presentation

A 29-year-old man presented with pneumonia and melioidosis septicaemia. His condition was complicated with infective endocarditis and septic emboli to the brain. Despite difficulties in reaching a diagnosis, the patient was successfully treated using intravenous gentamicin and ceftazidime and was discharged well.

Discussion

The role of gentamicin in the treatment of the gentamicin-susceptible strain of B. pseudomallei remains unclear.

Morphological Characteristics and Habitats of Red Seaweed Gracilaria spp. (Gracilariaceae, Rhodophyta) in Santubong and Asajaya, Sarawak, Malaysia

Red seaweed Gracilaria, one of the largest genus in Division Rhodophyta inhabits Sarawak coastal water. This study was designed to identify the species of Gracilaria using morphological approach and to assess selected water quality parameters in Gracilaria habitats. Three field samplings were carried out in Santubong and Asajaya, Sarawak from November 2013 to December 2014. Overall, three species were identified namely Gracilaria changii, G. blodgettii and G. coronopifolia, attached to net of cage culture in Santubong and root of mangrove trees in Asajaya. In addition, three different taxa of aquatic macroinvertebrates (polychaete, small crab, bivalve) and single species of red seaweed (Acanthophora sp.) were observed in Gracilaria assemblages. An estimate of 37% to 40% of the upper part of the cage net in Santubong was covered by seaweeds and only 16% to 20% in Asajaya's mangrove. The study had provided better information on identification of Gracilaria and their habitat in Sarawak. Future work involving DNA barcoding of each species is in progress.

Barrier, weakness and utilization of pre-pregnancy clinic services

BACKGROUND

Despite being one of the plausible measures towards achieving Sustainable Development Goals (SDGs), various issues pertaining to pre-pregnancy clinic (PPC) services still need to be pondered upon. Based on this view, an attempt was made to identify and understand the barriers and weaknesses of current utilisation of pre-pregnancy care services, since its establishment and implementation in Sarawak from the year 2011.

MATERIALS AND METHODS

This cross-sectional study was conducted in selected health care facilities throughout Sarawak. A multistage cluster sampling technique was followed to select the health facilities. An unstructured open-ended questionnaire was administered as a part of quantitative data analysis. The open-ended questions were administered to get the in-depth perceived views and current practice of utilisation of pre-pregnancy clinic services. A total of 553 clients from nine selected health care facilities gave their feedback. The results of the study were narrated in textual form and a thematic analysis was done manually.

RESULTS

The identified themes for perceived barriers for utilisation of pre-pregnancy care were perception, attitude and acceptance of PPC services, socio-economic issues, services and client factors. The perceived weaknesses of the services are listed under two main themes: working environment and service factors, whereas, the strength of services produced three thematic areas which are preparation for pregnancy, prevention of mortality and morbidity and comprehensive services.

CONCLUSIONS

Though there is ample evidence that pre-pregnancy services are beneficial for maternal health and wellbeing, various issues still need to be addressed for the improvement of the quality of services. Lack of awareness among clients, socio-economic barriers, lack of resources, organisational barriers and perceptions towards family planning issues are some of the issues which need to be addressed. Nonetheless, promotional and health educational activities are important keys; in ensuring the sustainability of the services.

Over two decades of Plasmodium knowlesi infections in Sarawak: Trend and forecast

Malaria is still of great public health concern, especially in Malaysian Borneo. The aim of this study was to determine the trends of P. knowlesi infection in Sarawak, Malaysia and to forecast the incidence of P. knowlesi until the year 2040. Data on P. knowlesi malaria cases from 1992 to the year 2014 were obtained from the Sarawak Health Department, Malaysia. ARIMA model was applied to forecast the future incidence of P. knowlesi infection. The data for the whole of Sarawak and subsequently the selected six districts which have high incidence rates of P. knowlesi infection were analyzed. Results of the analysis showed that there was an increasing trend of P. knowlesi cases from the year 1992-2014 (p<0.001). The trend in the incidence started to increase in the year 2008 (p=0.029). The incidence rate per 100,000 populations was between 4.15 in the year 1992 and 42.03 in the year 2014. High incidence of P. knowlesi infections has been detected in the districts adjacent to each other within the interior region of Sarawak. The forecasted incidence and incidence rate per 100,000 populations in the year 2020 were 1229 and 44.04, respectively, while those in the year 2040 were 2056 and 62.91, respectively. The forecasted incidence showed an upward trend highlighting an urgent need to draw up strategic and holistic prevention plans to limit further the increase in P. knowlesi morbidity and mortality in Sarawak. It is imperative that these measures are customized taking into consideration the challenges faced in the interior areas of Sarawak and the behavior of the main vector of P. knowlesi (i.e., An. latens) in Sarawak.

Hiding in the dark: Local ecological knowledge about slow loris in Sarawak sheds light on relationships between human populations and wild animals

Local ecological knowledge (LEK) increases understanding of certain species and the threats they face, especially little-studied taxa for which data on distribution and conservation are often lacking. We conducted 111 semi-structured interviews in Sarawak, Malaysia, to collect local knowledge about the behavior and distribution of the Philippine slow loris (Nycticebus menagensis) from two ethnic groups, the Iban and the Penan. Our study revealed that male Penan respondents, generally hunters, who frequently go into the forest were better at identifying animals from pictures. Overall, the Penan have a more detailed knowledge of slow loris behaviors, habitat, and distribution than the Iban. The two ethnic groups have different attitudes towards slow loris as the Penan hunt, eat, or keep them as pets while the Iban consider them sacred and signifiers of good luck. We advocate the use of LEK for providing complementary information to scientific methods in the study of cryptic animals.

A preliminary checklist of the freshwater snails of Sabah (Malaysian Borneo) deposited in the BORNEENSIS collection, Universiti Malaysia Sabah

Sabah, a Malaysian state at the north-eastern tip of Borneo, is situated in one of the Earth’s biodiversity hotspots yet its freshwater gastropod diversity remains poorly known. An annotated checklist of the freshwater gastropods is presented, based on specimens deposited in the BORNEENSIS collection of the Institute for Tropical Biology and Conservation at Universiti Malaysia Sabah, Malaysia. A KMZ file is also provided, which acts as a repository of digital images and complete collection data of all examined material, so that it can be shared and adapted to facilitate future research.

Quantifying tropical peatland dissolved organic carbon (DOC) using UV-visible spectroscopy

UV-visible spectroscopy has been shown to be a useful technique for determining dissolved organic carbon (DOC) concentrations. However, at present we are unaware of any studies in the literature that have investigated the suitability of this approach for tropical DOC water samples from any tropical peatlands, although some work has been performed in other tropical environments. We used water samples from two oil palm estates in Sarawak, Malaysia to: i) investigate the suitability of both single and two-wavelength proxies for tropical DOC determination; ii) develop a calibration dataset and set of parameters to calculate DOC concentrations indirectly; iii) provide tropical researchers with guidance on the best spectrophotometric approaches to use in future analyses of DOC. Both single and two-wavelength model approaches performed well with no one model significantly outperforming the other. The predictive ability of the models suggests that UV-visible spectroscopy is both a viable and low cost method for rapidly analyzing DOC in water samples immediately post-collection, which can be important when working at remote field sites with access to only basic laboratory facilities.

Biomass and Habitat Characteristics of Epiphytic Macroalgae in the Sibuti Mangroves, Sarawak, Malaysia

Mangroves support diverse macroalgal assemblages as epibionts on their roots and tree trunks. These algae provide nutrients to the primary consumers in the aquatic food web and have been reported to be substantial contributors to marine ecosystems. The species diversity, biomass, and habitat characteristics of mangrove macroalgae were investigated at three stations in the Sibuti mangrove estuary, Sarawak, Malaysia, from November 2012 to October 2013. Three groups of macroalgae were recorded and were found to be growing on mangrove prop roots, namely Rhodophyta (Caloglossa ogasawaraensis, Caloglossa adhaerens, Caloglossa stipitata, Bostrychia anomala, and Hypnea sp.), Chlorophyta (Chaetomorpha minima and Chaetomorpha sp.), and Phaeophyta (Dictyota sp.). The biomass of macroalgae was not influenced (p>0.05) by the season in this mangrove forest habitat. The macroalgal species Hypnea sp. contributed the highest biomass at both Station 1 (210.56 mg/cm²) and Station 2 (141.72 mg/cm²), while the highest biomass was contributed by B. anomala (185.89 mg/cm²) at Station 3. This study shows that the species distribution and assemblages of mangrove macroalgae were influenced by environmental parameters such as water nutrients, dissolved solids, and salinity in the estuarine mangrove habitats of Sibuti, Sarawak.

Foraging ecology and occurrence of 7 sympatric babbler species (Timaliidae) in the lowland rainforest of Borneo and peninsular Malaysia

Understanding foraging strategies of birds is essential to understanding mechanisms of their community assembly. To provide such information on a key Southeast Asian rainforest family, the babblers (Timaliidae), we evaluated foraging behavior and abundance in 7 morphologically and behaviorally similar sympatric species (Cyanoderma erythropterum, C. rufifrons, Stachyris maculata, S. nigricollis, S. poliocephala, Macronus ptilosus, and Mixornis gularis) in 5 habitats defined by structural complexity: (1) continuous native rainforest, (2) logged native rainforest fragments, (3) mature industrial tree plantation, (4) young industrial plantation, and (5) oil palm plantation. Enough data were obtained to compare abundance in all 7 species and foraging behavior in 5. All species were common in forest fragments and mature industrial tree plantations and less so in continuous rainforest and young industrial plantations; only M. gularis occurred in oil palm. In terms of foraging, M. gularis was the greatest generalist; C. rufifrons foraged mainly on live leaves in the forest midstory; and S. maculata, C. erythropterum, and M. ptilosus foraged mainly on dead leaves suspended in understory vegetation at significantly different heights. The dead-leaf substrate depends on a rich supply of falling leaves and extensive understory structure, conditions most common in native forest and old industrial plantations, and less so in mature forest, young plantations, and oil palm. Because of the importance of foraging data to understanding and managing biodiversity, we encourage the development of foraging fields in eBird (ebird.org), so that birdwatchers may help collect these relatively rare data.

Factors affecting satisfaction on antenatal care services in Sarawak, Malaysia: evidence from a cross sectional study

Background

High levels of satisfaction among women with the antenatal care services will increase the compliance of antenatal visits during pregnancy. Thus, this study was done to assess the level of satisfaction among women on the quality of antenatal care received and the factors influencing thereof.

Methods

This was a cross-sectional study conducted in the three zones of Sarawak. Women aged 18 years and above, irrespective of ethnic groups, having children aged 3 years and below were included in the study. Data was collected by face-to-face interview using interview schedule. A validated Patient Satisfaction Questionnaire (PSQ-18) was used to assess the satisfaction with antenatal care. A total of 1236 data was analysed using IBM SPSS version 22.0. A p value <0.05 was considered as statistically significant.

Results

A multinomial logistic regression analysis revealed that Bidayuh 17.4 % was less likely to be highly satisfied with antenatal care. Similarly, respondents with secondary level of education 29.9 % were less likely to be highly satisfied, whereas, respondents having primary level of education, 1.6 % were less likely to be highly satisfied. However, those who did not spend any money as out of pocket expenses were 1.935 times more likely to be highly satisfied with antenatal care.

Conclusion

Overall the studied women were satisfied with the antenatal care services. Ethnicity, level of education and out of pocket expenses appeared to be important predictors of satisfaction with antenatal care. The finding recommends the community-based and language-specific interventions should be implemented to sustain the satisfaction of maternal care.

Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia

INTRODUCTION

Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak.

METHODS

Cross-sectional data were collected from 10 villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Nonprobability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software IBM SPSS 20.0 version.

RESULTS

Analysis showed that 28.8% of the respondents were current smokers, 7.8% were past smokers and the rest were non-smokers. Six items of pictorial health warnings were evaluated with five point Likert's scales for attractiveness, fearfulness and adequacy of the information. Analysis revealed that the majority of the respondents had perceived awareness on PHWs, but the smokers believed that this was not adequate to make them quit smoking. Only one-fifth (19.7%) of them reported that current pictorial health warnings were sufficient to motivate people to quit smoking.

CONCLUSION

Though the PHWs on cigarette packages are appealing, it is not sufficient as a reason to stop smoking. Thus, an approach using an integrated anti-tobacco public health programme should be focused into the specific targeted community.

Two new species of Hoya R.Br. (Apocynaceae, Asclepiadoideae) from Borneo

Two new Hoya R.Br. species from Borneo are described and illustrated. The first, Hoyaruthiae Rodda was collected in Sabah on Bukit Baturong, a limestone outcrop. It is one of the few species in the genus to have clear exudate. It is compared with the morphologically related Hoyauncinata Teijsm. and Binn. The other, Hoyabakoensis Rodda, was collected in the kerangas forests of Bako National Park. It belongs to HoyasectionAcanthostemma (Bl.) Kloppenb., a section with numerous members in the Philippines but under-represented in Borneo.

Impact of phytic acid on nutrient bioaccessibility and antioxidant properties of dehusked rice

Whole grains consumption promotes health benefits, but demonstrates controversial impacts from phytic acid in meeting requirements of good health. Therefore, this study was aimed to determine the nutrient bioaccessibility and antioxidant properties of rice cultivars named "Adan" or "Bario" and deduce the nutritional impact of phytic acid. Majority of the dehusked rice in the collection showed an acceptable level of in-vitro starch digestibility and in-vitro protein digestibility, but were poor in antioxidant properties and bioaccessibility of minerals (Ca, Fe and Zn). The drawbacks identified in the rice cultivars were due to relatively high phytic acid content (2420.6 ± 94.6 mg/100 g) and low phenolic content (152.39 ± 18.84 μg GAE/g). The relationship between phytic acid content and mineral bioaccessibility was strongest in calcium (r = 0.60), followed by iron (r = 0.40) and zinc (r = 0.27). Phytic acid content did not significantly correlate with in-vitro starch digestibility and in-vitro protein digestibility but showed a weak relationship with antioxidant properties. These suggest that phytic acid could significantly impair the mineral bioaccessibility of dehusked rice, and also act as an important antioxidant in non-pigmented rice. Bario rice cultivars offered dehusked rice with wide range of in-vitro digestibility of starch and protein, and also pigmented rice as a good source of antioxidants. However, there is a need to reduce phytic acid content in dehusked rice for improved mineral bioaccessibility among Bario rice cultivars.

Long-term disturbance dynamics and resilience of tropical peat swamp forests

1. The coastal peat swamp forests of Sarawak, Malaysian Borneo, are undergoing rapid conversion, predominantly into oil palm plantations. This wetland ecosystem is assumed to have experienced insignificant disturbance in the past, persisting under a single ecologically-stable regime. However, there is limited knowledge of the past disturbance regime, long-term functioning and fundamentally the resilience of this ecosystem to changing natural and anthropogenic perturbations through time. 2. In this study, long-term ecological data sets from three degraded peatlands in Sarawak were collected to shed light on peat swamp forest dynamics. Fossil pollen and charcoal were counted in each sedimentary sequence to reconstruct vegetation and investigate responses to past environmental disturbance, both natural and anthropogenic. 3. Results demonstrate that peat swamp forest taxa have dominated these vegetation profiles throughout the last c. 2000-year period despite the presence of various drivers of disturbance. Evidence for episodes of climatic variability, predominantly linked to ENSO events, and wildfires is present throughout. However, in the last c. 500 years, burning and indicators of human disturbance have elevated beyond past levels at these sites, concurrent with a reduction in peat swamp forest pollen. 4. Two key insights have been gained through this palaeoecological analysis: (i) peat swamp forest vegetation has demonstrated resilience to disturbance caused by burning and climatic variability in Sarawak in the late Holocene, however (ii) coincident with increased fire combined with human impact c. 500 years ago, these communities started to decline. 5.Synthesis. Sarawak's coastal peat swamps have demonstrated resilience to past natural disturbances, with forest vegetation persisting through episodes of fire and climatic variability. However, palaeoecological data presented here suggest that recent, anthropogenic disturbances are of a greater magnitude, causing the observed decline in the peat swamp forest communities in the last c. 500 years and challenging the ecosystem's persistence. This study greatly extends our knowledge of the ecological functioning of these understudied ecosystems, providing baseline information on the past vegetation and its response to disturbance. This understanding is central to developing management strategies that foster resilience in the remaining peat swamp forests and ensure continued provision of services, namely carbon storage, from this globally important ecosystem.

Soil carbon stocks in Sarawak, Malaysia

The relationship between greenhouse gas emission and climate change has led to research to identify and manage the natural sources and sinks of the gases. CO2, CH4, and N2O have an anthropic source and of these CO2 is the least effective in trapping long wave radiation. Soil carbon sequestration can best be described as a process of removing carbon dioxide from the atmosphere and relocating into soils in a form that is not readily released back into the atmosphere. The purpose of this study is to estimate carbon stocks available under current conditions in Sarawak, Malaysia. SOC estimates are made for a standard depth of 100 cm unless the soil by definition is less than this depth, as in the case of lithic subgroups. Among the mineral soils, Inceptisols tend to generally have the highest carbon contents (about 25 kg m(-2) m(-1)), while Oxisols and Ultisols rate second (about 10-15 kg m(-2) m(-1)). The Oxisols store a good amount of carbon because of an appreciable time-frame to sequester carbon and possibly lower decomposition rates for the organic carbon that is found at 1m depths. Wet soils such as peatlands tend to store significant amounts of carbon. The highest values estimated for such soils are about 114 kg m(-2) m(-1). Such appreciable amounts can also be found in the Aquepts. In conclusion, it is pertinent to recognize that degradation of the carbon pool, just like desertification, is a real process and that this irreversible process must be addressed immediately. Therefore, appropriate soil management practices should be instituted to sequester large masses of soil carbon on an annual basis. This knowledge can be used effectively to formulate strategies to prevent forest fires and clearing: two processes that can quickly release sequestered carbon to the atmosphere in an almost irreversible manner.

Metal concentrations in sediments from tourist beaches of Miri City, Sarawak, Malaysia (Borneo Island)

Forty-three sediment samples were collected from the beaches of Miri City, Sarawak, Malaysia to identify the enrichment of partially leached trace metals (PLTMs) from six different tourist beaches. The samples were analyzed for PLTMs Fe, Mn, Cr, Co, Cu, Ni, Pb, Sr and Zn. The concentration pattern suggest that the southern side of the study area is enriched with Fe (1821-6097 μg g(-1)), Mn (11.57-90.22 μg g(-1)), Cr (51.50-311 μg g(-1)), Ni (18-51 μg g(-1)), Pb (8.81-84.05 μg g(-1)), Sr (25.95-140.49 μg g(-1)) and Zn (12.46-35.04 μg g(-1)). Compared to the eco-toxicological values, Cr>Effects range low (ERL), Lowest effect level (LEL), Severe effect level (SEL); Cu>Unpolluted sediments, ERL, LEL; Pb>Unpolluted sediments and Ni>ERL and LEL. Comparative results with other regions indicate that Co, Cr, Cu, Ni and Zn are higher, indicating an external input rather than natural process.