Daud Mohd Rujhan Hadfi Mat, Yaacob Nor Azwany, Arifin Wan Nor, Sani Jamiatul Aida Md, Ibadullah Wan Abdul Hannan Wan
Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Biostatistics and Research Methodology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Osong Public Health Res Perspect. 2024 Oct;15(5):429-439. doi: 10.24171/j.phrp.2024.0156. Epub 2024 Aug 21.
Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions.
This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk.
Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02-1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42- 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07-2.69), travel history (aOR, 2.30; 95% CI, 1.13-4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72-0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16- 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97-0.99) were significant determinants.
This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.
尽管有有效的疫苗接种策略，但麻疹仍然是一项全球公共卫生挑战。该研究探讨了2018年至2022年马来西亚与麻疹感染相关的个体因素和环境因素，为制定有针对性的公共卫生干预措施提供依据。
这项横断面研究利用了马来西亚卫生部、统计局和环境部的数据。采用多水平逻辑回归分析来检验个体层面的因素，包括年龄、性别、种族、国籍、接触史、旅行史和疫苗接种状况。同时，评估环境因素，包括地区层面的决定因素，如人口密度、家庭收入中位数、城市化程度、健康诊所和乡村诊所数量、疫苗接种率、小于2.5微米的细颗粒物（PM2.5）水平、相对湿度和温度，以确定它们对麻疹感染风险的影响。
麻疹感染与多种个体因素显著相关。这些因素包括年龄（调整后的优势比[aOR]，1.02；95%置信区间[CI]，1.02 - 1.03）、种族、非马来西亚国籍（aOR，34.53；95% CI，8.42 - 141.51）、之前接触过麻疹病例（aOR，2.36；95% CI，2.07 - 2.69）、旅行史（aOR，2.30；95% CI，1.13 - 4.70）和疫苗接种状况（aOR，0.76；95% CI，0.72 - 0.79）。在环境因素中，城市化程度（aOR，1.56；95% CI，1.16 - 2.10）和诊所数量（aOR，0.98；95% CI，0.97 - 0.99）是显著的决定因素。
这项多水平逻辑回归分析揭示了麻疹传播的复杂性，倡导针对个体和环境脆弱性制定公共卫生干预措施。研究结果强调需要采取一种协同方法，将疫苗接种运动、改善医疗服务可及性和社会经济干预措施结合起来，以有效抗击麻疹。
