In developing countries, the family persists as a key institution, the centre of the emotional, spiritual and economic life of the individual and the context of the individual's interactions with the community. The majority of the population still live in rural areas where the family-community interaction is close, indeed intense. This remains true too of peasants migrating to urban slums to exist in a new culture of poverty. The family in developing countries represents a more closely shared, psychological, sociological and economic destiny than is perhaps represented by the family in the wealthy nations of the West.
'Health for all by the year 2000' is the promise of the Declaration of Alma-Ata to which all our governments have put their signatures. It is a noble ambition which is impossible to achieve unless the issues of poverty and maldistribution of wealth are seriously addressed. Nevertheless, much progress can be made during a campaign to achieve 'Health 2000' because an opportunity presents to discuss the prerequisites to achieving 'Health for all' and there is pressure to make some progress towards this.
An important opportunity now presents itself to put into effect the new concepts of family practice on a global scale. Hitherto the World Health Organization, (of which WONCA has just become a non-governmental organization affiliate) has not found it necessary to turn to family physicians for advice or expertise whilst organizations of family physicians for their part have shown little interest in the primary health care movement. Family physicians have practised under constraints that have favoured chargeable procedures as against the preventive approach, episodic care as against continuing care, caring for the fee-paying individual as against caring for the family and large panels as against small populations. This practice falls short of our ideals. In developing countries, there is a need for a community-oriented, family-based practice in which the physician and the health care team accept responsibility to work with their community to achieve health for all. We must now give attention to develop this atrophied wing of family practice.
This is truly a historic opportunity that we must seize to make available the concepts and skills of family practice and to universalize the relevance of our way of delivering primary health care. All of us in a great co-operative endeavour can do much for the health of the people of this small globe that we share.
'There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyages of their life
Is found in shallows and miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our venture.'
[Notes added by TCL: Full text of article. The quoted phrase was uttered by Brutus in William Shakespear's Julius Caesar Act 4, scene 3]
Most of the population in certain areas of Melanesia have one alpha-globin gene deletion (alpha thal2). It is thought that the high frequencies of alpha thal2 in this population is due to a selective advantage given by malaria infection to carriers of alpha thal2. We are interested in neighboring Polynesia which, although adjacent to Melanesia, has always been free of malaria due to the absence of the vector anopheles. We studied 60 Polynesian Samoans and 150 Malaysians by restriction endonuclease gene mapping using Eco RI, Bam HI, and Bgl II and hybridization to 32P-labeled alpha-globin gene probe. Seven among the 60 (11.7%) Samoans had triplicated alpha-globin loci type 1, while none had alpha thal2. On digestion with Bgl II the third alpha-globin gene was found in an additional 3.7 kb fragment in all seven Samoans with triplicated alpha-globin loci, while digestion with Bam HI produced an abnormal elongated 18.2 kb fragment carrying alpha-globin genes in addition to the normal 14.5 kb fragment. None of the Polynesian Samoans had alpha thal2 or alpha thal1. Only two of the Malaysians had triplicated alpha-globin loci.
MeSH terms: Adult; Chromosome Mapping*; DNA Restriction Enzymes; Electrophoresis, Agar Gel; Ethnic Groups*; Gene Frequency; Globins/genetics*; Humans; Malaysia; Thalassemia/genetics*; Thalassemia/epidemiology; Trisomy*; Independent State of Samoa
During a 6 yr period, 105 (69%) of 153 patients in whom a histological diagnosis of minimal change glomerular disease was made had renal biopsy tissue suitable for immunofluorescence examination. Thirty seven (35%) patients showed glomerular mesangial deposits of IgM. All the patients presented with the nephrotic syndrome. We found no significant difference in age and sex prevalence, presentation, response to therapy and glomerular morphology between IgM positive and IgM negative groups. This study suggests that there is no necessity to categorize IgM positive minimal change glomerular disease as a separate entity.
Seven villages in Banggi Island, Sabah, Malaysia, were surveyed four times to evaluate the roles of local mosquitoes as vectors of malaria and Bancroftian filariasis. 11 species of Anopheles were found biting man. 53.9% of the anophelines caught were An. flavirostris, 27.1% An. balabacensis, 6% An. donaldi and 4.2% An. subpictus. Infective malaria sporozoites, probably of human origin, were found in two of 336 An. flavirostris and 12 of 308 An. balabacensis. Sporozoites, probably of a non-human Plasmodium, were found in An. umbrosus. Nine of 1001 An. flavirostris and four of 365 An. balabacensis harboured L2 or L3 filarial larvae identified as those of Wuchereria bancrofti. This is the first record of An. flavirostris as a natural vector of malaria and W. bancrofti in Sabah.
The problem of dental decay was studied in a sample of 495 Chinese preschool children in Petaling Jaya. The children; 253 males and 242 females ranged in age from 3-6 years. 18.6% of the children was observed to suffer from rampant caries. Only 18.8% were caries free. The dft values ranged from 2.9 +/- 3.12 at 3 years to 5.85 +/- 3.41 at 6 years. The overall mean dft for this group was 4.99 +/- 3.81. Dental treatment was very inadequate. The decayed filled tooth ratio was 6.5:1.
Modern dentistry is a relatively young profession in Malaysia. The development of dentistry in Britain has a major influence on dentistry in Malaysia. Not only does it offer a historical perspective, it serves as a crystal ball to provide an insight into what dentistry will be like in the future. A brief review of dentistry in Britain follows.
MeSH terms: Great Britain; History of Dentistry*; History, 19th Century; History, 20th Century
In 3 urban areas in Selangor, Peninsular Malaysia between 1973 and 1981, blood from 4084 dogs was examined for haematozoa. The following frequencies were found: Babesia gibsoni 17.7%; microfilariae of Dirofilaria immitis 9.6%; Hepatozoon canis 1.2%; B. canis 1.1%; Ehrlichia canis 0.2%; Trypanosoma evansi 0.1%. A detailed examination of B. gibsoni infections and microfilariasis due to D. immitis with regards to monthly distribution, breed frequency, sex and age, revealed that pedigree and non-pedigree dogs were equally susceptible to Babesia and microfilariae infections.
MeSH terms: Age Factors; Animals; Babesiosis/epidemiology*; Dirofilariasis/epidemiology; Dog Diseases/epidemiology*; Dogs; Ehrlichia; Female; Malaysia; Male; Protozoan Infections/epidemiology; Protozoan Infections, Animal*; Rickettsiaceae Infections/epidemiology; Rickettsiaceae Infections/veterinary; Sex Factors; Species Specificity; Trypanosomiasis/epidemiology; Trypanosomiasis/veterinary; Apicomplexa
The plasmid profiles of 160 strains of Neisseria gonorrhoeae isolated in Peninsular Malaysia, comprising 80 penicillinase-producing (PPNG) and 80 non-penicillinase-producing (non-PPNG) isolates, were determined. The 80 PPNG isolates were divided into two plasmid groups. All of them harbored two common plasmid species, a 4.4 megadalton (Md) R plasmid previously associated with beta-lactamase production in PPNG strains from the Far East and a 2.6 Md multicopy plasmid of unknown function. In addition to these two plasmids, 60 (75%) PPNG isolates also carried a large 24.5 Md conjugative plasmid. In contrast, the 80 non-PPNG strains were divided into three plasmid groups. All of them possessed the 2.6 Md cryptic plasmid, and 35 (44%) isolates also harbored the 24.5 Md transfer plasmid. Besides these two plasmids, one non-PPNG isolate carried an additional 7.8 Md cryptic plasmid.
The decade of the 1980s is declared as a time to solve global domestic water supply problems. By 1990 international goals include the provision of adequate quantities of clean water to every person on earth. Such goals are justified on the basis of human health, economic well being, political development and equity and public safety. Drawing upon observations from Ethiopia, Malaysia and Liberia, cases where attempts to provide domestic water to villagers and rural town dwellers are presented. In all cited cases attempts to provide safe water have failed or are in jeopardy. Conclusions drawn from these cases include acknowledgement that global goals will best be achieved by approaching local problems one-by-one and recognizing the technical, environmental and human constraints upon safe water provision interact differently from one site to another. To properly plan, implement and maintain safe water systems the current technical solutions must be combined with the contributions of social and environmental scientists on a case-by-case basis.
MeSH terms: Communicable Disease Control/trends; Developing Countries*; Ethiopia; Humans; Liberia; Malaysia; Rural Health/trends*; Sanitation/trends; Water Microbiology; Water Pollution/prevention & control*; Water Supply/standards*
We examined the gross and microscopic anatomy of placental tissues and umbilical cords from six species representing the three living families of the Suina. These species included, of the Suidae, the wart hog (Phacochoerus aethiopicus), the giant forest hog (Hylochoerus meinertzhageni), the domestic pig (Sus scrofa), and the banded pig of Malaysia (Sus scrofa vittatus); of the Tayassuidae, the white-lipped peccary (Tayassu pecari); of the Hippopotamidae, the hippopotamus (Hippopotamus amphibius) and the pigmy hippopotamus (Choeropsis liberiensis). All these species have a diffuse epitheliochorial placenta. The chorion is folded, and has on its surface rows of shallow ripples or villi, interrupted by round, oval or irregularly shaped areolae. Placental capillaries indent the epithelial layer covering the tops and sides of the interareolar villi, but not the columnar cell layer lying in the troughs between these villi or covering the areolae. Cuboidal cells cover the crests of the villi in the Suidae and Hippopotamidae, whereas in the Tayassuidae the epithelium is syncytial in appearance. The similarities in placental structure between the six species are more apparent than the differences. Suidae and Tayassuidae have smooth umbilical cords containing two arteries and one vein; those of the Hippopotamidae are pustule-encrusted and contain two arteries and two veins.
The Reason for Encounter Classification (RFEC) was designed by a WHO Working Party to classify the reasons why patients seek care at the primary care level. It is designed along two axes: Chapters and Components. Each chapter carries an alpha-code which is the first character of the basic 3-character alphanumeric code. Each chapter is subdivided into seven "components" carrying 2-digit numeric codes. The field trial was undertaken by family physicians and nurses in: Australia, Barbados, Brazil, Hungary, Malaysia, the Netherlands, Norway and the US. 90497 RFE's were analysed. Their distribution over the chapters and components characterize the content of international primary care. Listings with the most common RFE's in the participating countries reflect the cultural differences. It is concluded that the RFEC is not only feasible to classify reasons why patients seek care but also to classify the diagnosis and the process of primary care. As a result of this, the International Classification of Primary Care (ICPC) succeeds the RFEC.
MeSH terms: Diagnosis; Disease/classification*; Humans; International Cooperation; Morbidity; Primary Health Care
The concentrations of non-haem iron, ferritin and ferritin-iron were measured in the livers of 137 adults and children collected at necropsy. The concentrations of non-haem and ferritin iron were found to be 146.6 +/- 95.2 micrograms/g and 61.6 +/- 32.4 micrograms/g, respectively, in males and 108.0 +/- 61.7 micrograms/g and 60.6 +/- 26.4 micrograms/g, respectively, in females. The values for males in Singapore were lower than those reported in developed Western countries. No correlation was observed between storage iron and age, or ferritin concentration and age. Concentrations of non-haem iron and ferritin were similar for persons dying from accident and coronary heart disease. The non-haem iron concentration in Chinese (187.9 +/- 101.0 micrograms/g) was significantly greater than that in Indians (103.1 +/- 65.8 micrograms/g), while the ferritin concentration in Chinese (6.18 +/- 2.37 mg/g) was significantly greater than either Malays (3.81 +/- 1.8 mg/g) or Indians (3.52 +/- 1.6 mg/g). A significant positive correlation was observed between the non-haem iron and ferritin and also ferritin-iron in Chinese males (r values of 0.678 and 0.598, respectively) and Indian males (r values of 0.576 and 0.612, respectively). However, the correlation between these indices was not significant in the case of Malay males. In premenopausal women the non-haem iron correlated well with ferritin (r = 0.737) and ferritin iron (r = 0.826) while the correlation was lacking in postmenopausal women.
A questionnaire on smoking habits was administered to 4106 Form IV school children in Kuala Lumpur. The period of survey was from 9 to 20 April 1984. 2099 boys and 2007 girls were studied and their mean age was 16.1 years. 32.8% of the students had been initiated to smoking and the mean age of initiation was 13.3 years. The prevalence of smoking was found to be 9.8% and the mean duration of smoking was 2.5 years. Most of the smokers and occasional smokers were boys. About 42% of the smokers wished to stop smoking and only 1% of the non-smokers intended to smoke in the future. The study recommended that health education programmes should be started earlier in school.
MeSH terms: Adolescent; Age Factors; Female; Humans; Malaysia; Male; Motivation; Sex Factors; Smoking*; Social Environment; Urban Population*
This paper examines four drug rehabilitation systems in Malaysia from an organizational perspective. It focuses on authority structures in rehabilitation centres and their impact on rehabilitees' identities. The findings show that there are important differences between government-run and private centres in terms of administration and approach to therapy. Some policy implications are derived from a comparison of these systems.
MeSH terms: Combined Modality Therapy; Community Mental Health Services/organization & administration; Heroin Dependence/rehabilitation*; Humans; Malaysia; Medicine, Traditional; Social Environment; Social Support