As the global battle against COVID-19 rages on, Malaysia’s concerted effort in stemming the spread is commendable. This study characterized the epidemiology of COVID-19 aiming towards understanding the disease in a local setting for better preparation and management. A nation-based e-COVID reporting system was used to collect data on laboratory-confirmed COVID-19 cases in Kelantan from January to July 2020. Information from investigation reports was also reviewed. Analyses comprised of the estimation of incidence and case-fatality rate, summary of demographic and clinical characteristics including the age and sex distributions, construction of the epidemiological curve and choropleth map, and appraisal of healthcare usage. Multiple logistic regression was used to determine the risk factors for Intensive Care Unit (ICU) admission. A total of 166 cases reported in Kelantan until July 2020. Cases peaked during March before steadily declining and were concentrated in the capital. The age-adjusted incidence rate was 9.4/100,000 populations with a case-fatality rate of 2.4%. The median age was 37 years and 78% were male. The predominant symptoms were fever and cough while 25% of cases were asymptomatic. About 57% of cases were identified by active case detection and 97% had exposure risk. Potentially infected cases were isolated within a median of 7 days after exposure, even before the diagnosis. All cases were hospitalized with a median of 14 bed days, while 12% admitted to ICU, and 3% required mechanical ventilators. Significant factors for ICU admission were older age (AOR: 1.05, 95% CI: 1.02, 1.09, P = 0.001) and diabetes mellitus (AOR 4.55, 95% CI: 1.36, 15.25, P = 0.014). Although all ages appeared susceptible to COVID-19, older age and diabetic patients were more vulnerable. Kelantan’s targeted approaches of prompt identification and isolation of potentially infected individuals have been effective in limiting the transmission, allowing sufficient healthcare capacity in managing the pandemic.

Background and aims: Accurate and timely diagnosis is crucial for coronavirus disease 2019 (COVID-19) outbreaks. Antigen-detecting rapid diagnostic tests (Ag-RDTs) are easily accessible and affordable, producing rapid results. They are an alternative to the limited gold-standard real-time reverse-transcription polymerase chain reaction (rRT-PCR) tests. This study assessed the performance of Ag-RDTs for COVID-19 outbreaks in institutional settings with high disease prevalence in Kelantan State, Malaysia. Methods: This study analyzed a total of 303 individuals from five institutional outbreaks with paired nasopharyngeal specimens tested for COVID-19 by Ag-RDTs and rRT-PCR. The diagnostic performance of Ag-RDTs was evaluated through rRT-PCR as the gold standard based on cycle threshold (Ct) value, disease prevalence, and manufacturers. Results: There was a moderate agreement between Ag-RDTs and RT-PCR (κ=0.603; 95% CI: 0.520- 0.686; P<0.001). The overall specificity was 97.9% (95% CI: 94.1%-99.6%), sensitivity was 63.3% (95% CI: 55.3%-70.8%), accuracy Ag-RDTs was 81.2% (95% CI: 76.4%-85.5%), while positive and negative predictive value was 96.6% (95% CI: 90.2%-98.9%) and 74.1% (95% CI: 70.0%-77.9%), respectively. Further, lower median Ct was reported in 100 (33.0%) true-positive cases compared to 58 (19.1%) false-negative cases (20.3 vs 31.4, P<0.001). The sensitivity was higher (P<0.001) in those with high viral load (Ct value≤25.0) with better performance and a prevalence>10%. In addition, no significant difference was observed between the studied manufacturers. Conclusion: The Ag-RDTs performed well in diagnosing COVID-19 among outbreaks with higher viral load and disease prevalence. High-risk cases tested negative by Ag-RDTs may have low viral load and require confirmation by rRT-PCR.

Introduction: Prolonged neonatal jaundice is affecting 15-40% of breastfed new-borns. Although breastmilk jaundice is the common aetiology, undetected pathological causes could lead to unfavourable sequelae. This study described the characteristics, aetiology and burden of prolonged neonatal jaundice investigated at the primary care level in Kota Bharu district. Methods: This crosssectional study was done from July till December 2019, involving 14 health clinics in Kota Bharu. Selection criteria involved term new-borns at day 14 of life or preterm at day 21 of life that had visible jaundice or serum bilirubin >85?mol/l. Clinical details, investigations, and management were carried out based on normal practice at the clinics. A registry was established to capture the burden. Results: Prolonged jaundice were detected among 22.5% [95% CI 21.5, 23.6] of new-borns attending primary health clinics in Kota Bharu. A total of 291 cases were further analysed; 275 (94.5%) were term newborns and 243 (83.5%) were breastfed. Affected new-borns underwent blood and urine sampling with multiple follow-ups. On average, jaundice subsided within 12 days [SD=5.5, 95% CI:11.7, 13.1] after detection of this condition. Majority had prolonged unconjugated hyperbilirubinemia (98.6%) and main aetiology was breastmilk jaundice (84.5%). Minority had hypothyroidism (3.4%) and conjugated hyperbilirubinemia (1.7%). Out of 129 cases sent for urine culture, 12 (9.3%) had significant growth, mostly E.coli. Conclusion: The majority of neonates with prolonged jaundice were term and breastfed. While the main aetiology was breastmilk jaundice, other underlying pathologies were also identified. As the burden of this condition is high, multistage investigation is strongly recommended. Urinary tract infections screening should be routinely considered.