Background: Caregivers of children with autism spectrum disorder (ASD) experience increased stress and more significant negative caregiving consequences than those with typically developing children. There is a lack of studies specifically focusing on stress among caregivers with ASD children in Asian countries. The current study examines levels of perceived stress and factors associated with it among caregivers in Kelantan, Malaysia. Methods: In a cross-sectional study, the Malay version of the Perceived Stress Scale (PSS) was administered to 227 caregivers of children with ASD. The caregivers were recruited from ASD databases in four tertiary hospitals in Kelantan and a meeting was set up during the child’s follow-up in the clinic. Multiple linear regression analyses were applied to determine the predictors of perceived stress. Results: The mean total perceived stress score was 20.84 (4.72). This was considered higher than average. Higher perceived stress was significantly predicted among caregivers who live far from the health institution, caregivers who do not own transportation to bring the child to the treatment center, and caregivers who have an ASD child with a learning disability. Conclusion: Caregivers of an ASD child perceived significant stress while taking care of their children. Institutions should alleviate the factors that were predicted to increase the caregivers’ perceived stress to improve the quality of the lives of children and ASD families as a whole.

Background: Caregivers are the initial gatekeepers in the health care management of children with autism spectrum disorder (ASD). Methods: This cross-sectional study aimed to determine the factors associated with caregivers’ satisfaction with different levels of health care services in managing children with ASD in Kelantan. The satisfaction scores of 227 main caregivers of confirmed ASD children were assessed with a modified Parent Satisfaction Scale (PSS) questionnaire. Results: The analysis showed that caregivers who waited longer for a doctor’s consultation in primary care had a reduced PSS score, whereas caregivers who were satisfied with the waiting time in primary care had higher PSS scores. At the secondary care level, caregivers who possessed at least a diploma had reduced PSS scores, whereas caregivers who were satisfied with both doctors’ consultation times and occupational therapy appointments had higher PSS scores. At the tertiary care level, caregivers with an underlying medical problem and who had children undergoing occupational therapy for two months or more had reduced PSS scores. Nevertheless, the analysis showed that caregivers who were concerned with their children’s sleeping problems, who had been informed about parental support, who were satisfied with speech and occupational therapy appointments, who were satisfied with waiting times at tertiary care clinics, and who were satisfied with their doctor’s knowledge and experience had higher PSS scores. Conclusions: This study elucidated the importance of understanding caregivers’ satisfaction in attaining care for their ASD children and highlighted the need to promote factors that would increase caregivers’ satisfaction with current ASD services.

Background: A Malay version of Parent Satisfaction Scale (PSS-M) is needed to investigate the factors contributing to the Malay caregivers’ satisfaction with health care management for children with autism spectrum disorder (ASD). The aim of the study is to translate and validate the questionnaire to assess the caregivers’ satisfaction on health care services. Methods: A cross-sectional study was conducted among 110 caregivers of children with ASD aged between 2 and 17 years old that received treatment at two tertiary care centres in Kelantan. Permission to use the original version of the PSS questionnaire was obtained. The original English version of the PSS was translated into a Malay version following the 10 steps proposed by an established guideline. Pre-testing of the PSS was carried out with 30 caregivers before confirmatory factor analysis (CFA) was established using 110 caregivers. They were asked to assess their understanding of the questionnaire. The one-dimensional questionnaire consists of 11 items, including staff attitudes, availability of staff, supportiveness, and helpfulness. The 5-point Likert scale provided ratings from 1 (strongly disagree) to 5 (strongly agree). Confirmatory factor analysis was performed using a robust maximum likelihood estimator. Results: The analysis showed model fit data with good reliability. Conclusion: The PSS-M shows overall model fitness based on specific indices, with good construct validity and excellent absolute reliability to determine the satisfaction level of caregivers of children with ASD with respect to health care services.

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.