Citation: Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, de Silva A, et al. Investing in Maternal Health: Learning from Malaysia and Sri Lanka. Washington, DC: World Bank Publications; 2003.
The difference between maternal mortality in the industrialized and developing world is greater than any other development indicator. The apparent lack of progress in this area has generated a sense of hopelessness. Malaysia and Sri Lanka are two of the very few developing countries that have succeeded in reducing maternal mortality to levels comparable to many industrialized countries. This study provides the first comprehensive, in-depth analysis of the factors that contributed to maternal mortality decline in Malaysia and Sri Lanka over the last 50-60 years. It considers policy issues, health system developments, health system expenditures in maternal health, and the use in both countries, of professionally trained midwives.
Maxillae and mandibles of males of 44 species of 12 mosquito genera and females of three autogenous genera and two partially autogenous species were examined under light microscopy and scanning electron microscopy. The maxillae and mandibles of male mosquitoes are delicate, tape-like structures with lengths characterizing genera or higher level classification units. Five patterns are recognized: (A) long maxillae and mandibles with mandibles longer than maxillae in Anopheles; (B) long maxillae and mandibles with maxillae longer than mandibles in Toxorhynchites; (C) short or intermediate lengths of maxillae with short mandibles in Aedes, Armigeres, Culex, Ochlerotatus, Orthopodomyia, and Uranotaenia; (D) short or intermediate length of maxillae with no mandibles in Mimomyia and Tripteroides; and (E) no maxillae and mandibles in Malaya and Topomyia. Maxillary and mandibular lengths of male mosquitoes show a positive correlation. Length of maxillae and mandibles of autogenous females are reduced to the same level as conspecific males. In contrast, females of partially autogenous species have complete maxillae and mandibles as in females of anautogenous species.
Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.
MeSH terms: Colposcopy; Contraception; Epilepsy; Folic Acid; Infant, Newborn; Malaysia; Mothers; Pregnancy; Primary Health Care; Preconception Care
The morbidity patterns of elderly patients presenting to a family physician clinic was studied by the attending physician completing a questionnaire on all elderly patients aged 60 and above attending the clinic between 1st January to 31st March 2000. 612 elderly patients registered during the study period. The most common presentations included upper respiratory tract infections (21.6%), hypertension and diabetes mellitus (18%), gastritis/dyspepsia (5.0%) and injuries (5.0%), Musculoskeletal complaints (backache, gout, osteoarthritis) and anxiety were also among the top 10 most common presenting complaints. Injuries were mainly soft tissue injuries and sprains sustained at home. Some were preventable.
MeSH terms: Aged; Ambulatory Care Facilities; Anxiety; Back Pain; Cross-Sectional Studies; Diabetes Mellitus; Family Practice; Gout; Humans; Hypertension; Malaysia; Morbidity; Osteoarthritis; Primary Health Care; Private Practice
The need to deliver teaching material in medical education using the internet is compelling in view of the many advantages that the internet provides. The internet has enabled organizations, in particular institutions of higher education to conduct various courses entirely electronically and without regard to physical geographical boundaries. The term CAL is used to denote the employment of the Internet for the delivery of teaching material, conduct of discussion, as;sessment of performance and interaction between students and teachers. This study reviews reports of the use and evaluation of Computer-Aided-Learning (CAL) in teaching various major disciplines in medicine.
Introduction: Depression is an important problem in primary care practice and is the commonest psychiatric disorder among the elderly.
Aim: To assess the prevalence of depression among the elderly patients attending a rural primary health care clinic in Malaysia and to identify its associated factors.
Method: The Geriatric Depression Scale (GDS) questionnaire was used as a screening instrument. Patients with positive GDS scores for depression were further assessed for Major Depression.
Results: 14% of the patients were found to have depression. The associated factors identified were gender, marital status, educational level, total family monthly income, living arrangement and if they had someone to confide in. Further clinical evaluation using the DSM IV Criteria for major depression revealed that two-thirds of the patients with depression were suffering from major depression.
Conclusion: The prevalence of depression among the elderly patients at a rural primary health care clinic was high. Primary health care doctors and staff should take extra care to detect depression when managing elderly patients.
MeSH terms: Aged; Ambulatory Care Facilities; Mental Disorders; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Humans; Malaysia; Mass Screening; Primary Health Care; Prevalence; Marital Status; Sex Distribution
1) A variety of surgical lesions can occur in infants and children. 2) The first step in the management is to arrive at an accurate diagnosis. Most lesions can be diagnosed or suspected through "pattern recognition" 3) Some lesions can be treated by the general practitioners / family physicians for e.g. umbilical granuloma. 4) Lesions that can be observed over time for spontaneous resolutions are umbilical hernia, congenital hydrocele and haemangioma. 5) Lesions or conditions that require prompt referral are undescended testis, inguinal hernia, neonatal jaundice and large cystic hygJ1Qmas 6) Thyroglossal cyst, hypospadias and small cystic hygromas can be referred to a specialist at a time convenient for the family. 7) Phimosis may require an expert consultation 8) Expert consultation should be sought when in doubt; for example when difficulty is encountered in differentiating a retractile testis from an undescended testis. 9) As a general rule, all skin and subcutaneous swellings, except a hemangioma should be referred to a specialist, as soft tissue malignancy is a possibility even in infants. 10) Family physicians should be aware of the potential long-term problems of some conditions such as undescended testis and biliary atresia.
Caring for an elderly person is not an easy job and it requires understanding, patience, tolerance, full attention and dedication on the part of the caregiver. The effects on the caregiver in terms of his mental, emotional, physical and financial aspects are tremendous. Due to all these stresses, the caregiver's mental health would possibly be affected. This study explored the relationship between the mental and physical health of the elderly person and the caregiver, in forty-three elderly persons and their caregivers. Analyses of the results indicated that the caregivers' burden was related to their mental health status. In addition, the elderly persons' depressive symptoms, memory and behavior problems were the two main causes of these caregivers' burden.
In the light of present HIV worldwide epidemic. there is a need to teach the busy general practitioners how to recognise HIV & AIDS. Due to the deadly nature of this infection and its manifold presentations from opportunistic diseases. the busy general practitioners in primary care may be misled in making the correct diagnosis. In Malaysia. the doctors in the primary care level constitute 70 to 75% of the doctors' population. The rest are specialists in secondary and tertiary care institutions. Family Physicians from the Font liners to recognise and detect early cases of HlV in all its early manifestalions on the various systems. Any doctors in primary medicine whether from private or public sector, amy be confronted by patients who present with trivial complaints. These patients may be fee-paying, or particularly those doctors involved with welfare and health of factory workers and the other forms of the main work force should well arm themselves with updates in HIV and AIDS.
MeSH terms: Acquired Immunodeficiency Syndrome; Malaysia; Physicians, Family; Primary Health Care; HIV Infections