Despite the debates of the benefits of continuing mammography screening among elderly women, studies in Malaysia have shown that the prevalence of breast examination declines after age 45 years and for mammogram per se, the prevalence of examination increases until age of 64. This study aims to determine the prevalence of mammogram screening among elderly women in Hulu Langat, Selangor and its relationship with factors such as demographic factors, family history of breast cancer, perceived health status, perceived general psychological factor and lifestyle factors. Data used were from a cross sectional study of health status among community in Hulu Langat area by the Department of Community Health, Universiti Kebangsaan Malaysia carried out from the year 1998 till 2002. However this paper focused on the database involving elderly women age 60 and above. The sample population was 652. The mean (standard deviation) age was 67.17 (5.995). Only 8.3% of the elderly women claimed to ever had mammogram screening done. Hence, the prevalence of mammogram screening is still low among elderly women in Hulu Langat. Having family history of breast cancer (p < 0.001) and perceived positive psychological status (p=0.003) had shown significant associations with mammogram screening among them. It is therefore important for researcher to further look into the reasons behind this and qualitative exploration is highly recommended.
MeSH terms: Aged; Breast Neoplasms; Cross-Sectional Studies; Female; Health Status; Humans; Life Style; Malaysia; Mammography; Mass Screening; Prevalence
The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.
Study site: Physiotherapy department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and University Malaya Medical Centre (UMMC)
The paucity of published literature on periodontal treatment needs and services in developing countries has undermined the significance of periodontal disease burden on healthcare systems. This study analyses periodontal status and population treatment needs of Malaysians, and patterns of periodontal services provided at public sector dental clinics. A retrospective approach to secondary data analysis was employed. Data for population treatment needs were extracted from three decennial national oral health surveys for adults (1990, 2000 and 2010). Annual reports from the dental subsystem of the government Health Information Management System (HIMS) provided information on oral health care delivery for years 2006-2010. They were based on summaries of aggregated data; analyses were limited to reporting absolute numbers and frequency distributions. Periodontal disease prevalence declined between 1990 (92.8%) to 2000 (87.2%) but a sharp rise was observed in the 2010 survey (94.0%). The proportion of participants demonstrating periodontal pockets of 6 mm and more increased in 2010 survey after showing improvements in 2000. Individuals not requiring periodontal treatment (TN0) increased in proportion from 1990 to 2000, only to drop in 2010. An increase in utilisation was observed alongside a growing uptake of periodontal procedures (62.2% in 2006 to 73.6% in 2010). Only about 10% of treatment was surgeries. While the clinical burden of periodontal disease is observed to be substantial, the types of treatment provided did not reflect the increasing needs for complex periodontal treatment. Emphasis on downstream and multi-collaborative efforts of oral health care is deemed fit to contain the burden of periodontal disease.
MeSH terms: Adult; Delivery of Health Care; Dental Care; Dental Clinics; Developing Countries; Gingival Diseases; Government; Health Surveys; Humans; Male; Oral Health; Periodontal Diseases; Periodontal Pocket; Surveys and Questionnaires; Retrospective Studies; Prevalence; Public Sector; Health Information Management
Food borne diseases like cholera, typhoid fever, hepatitis A, dysentery and food poisoning occur as the results of ingestion of foodstuffs contaminated with microorganisms or chemical. The true incidence of food borne disease in Malaysia is unknown, however the incidence is low ranging from 1.56 to 0.14 cases per 100,000 population and the food poisoning cases is on the rise as the evident by the incident rate of 62.47 cases per 100,000 population in 2008 and 36.17 in 2009. The rapid population growth and demographic shift toward ageing population, changing eating habit such as consumption of raw or lightly cooked food, long storage of such food, lack of education on basic rules of hygienic food preparation and food trading without appropriate microbiological safety procedure become contributing factors for food borne diseases. Food borne disease in Malaysia is in the rise and the direct and indirect cost management of FBD will become one of the most common issues to face by the government. The world is spending millions and millions in cost of treatment due to food borne diseases. The information on this paper was collected via findings of previous journals, data and statistics from the MOH of Malaysia and WHO websites. As a result, authors found that the prevention and management of the food borne disease outbreak needs to be addressed seriously.
A cross-sectional study was carried out in July-October 2012 in UKM to remeasure, evaluate and compare the changes in health services utilization level among women staff in UKM with a previous study done in 2001 and its influencing factors. The services studied were blood pressure (BP) measurement and Pap smear test. A total of 234 respondents aged between 18 and 55 were selected using stratified random sampling from Bangi, Kuala Lumpur and UKMMC, Malaysia. Data was collected via self-administered questionnaire and was analyzed by using SPSS version 17.0. Majority 85.9% of the respondents were found to have utilized at least one BP measurement which is higher compared to previous study. The Pap smear test, 64.5% of women have had a Pap smear test done also higher compared to previous study. Multivariate analysis shows the factors associated with BP measurement are age (OR 2.7, CI 95% 1.2, 6.3), family history of general health problems (OR 3.4, CI 95% 1.5, 7.6), and health staff influence (OR 5.2, CI 95% 1.1, 25.5). The factors associated with Pap smear test are marital status (OR 62.8, CI 95% 7.2, 546.4), general health problems (OR 2.3, CI 95% 1.2, 4.5), family planning (OR 6.9, CI 95% 3.0, 16.5) and self-interest (OR 3.3, CI 95%, 1.3, 8.6). The level of health services utilization on BP measurement and Pap smear test in 2012 is higher than 2001. For both BP measurement and Pap smear test the determinant factors are differed in the aforesaid years.
MeSH terms: Blood Pressure; Cross-Sectional Studies; Family Planning Services; Female; Health Status; Humans; Malaysia; Patient Acceptance of Health Care; Surveys and Questionnaires; Vaginal Smears; Multivariate Analysis; Marital Status; Papanicolaou Test
Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people's perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire's reliability were calculated by Cronbach's alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett's test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people's perspective.
MeSH terms: Family Characteristics; Language; Surveys and Questionnaires; Rotation; Students; Translating; Turkey; Reproducibility of Results; Health Care Reform; Principal Component Analysis
Asthma is one of the most common chronic diseases in the world. It is estimated that around 300 million people in the world currently have asthma. The prevalence of asthma is increasing in most of countries, especially among children. The burden of severe asthma is considerable high in the Middle East courtiers including Iran. This study to investigate the effect of patients' knowledge about Inhaled Corticosteroids (ICS), attitude and health beliefs toward ICS, and behavioral intention to adhere to prescribed ICS in adult asthmatic patients in Yazd city, Iran. A cross sectional study was conducted from August 2008 to January 2009 in three private allergy and asthma clinics, located in Yazd city of Iran, using Structured face to face interviews using a questionnaire by the researcher. The results showed that the majority of patients (55.5%) were not adherent to their prescribed ICS. Patients’ knowledge toward ICS did not have effect on medication adherence behavior, while patients with positive attitude toward ICS were better adherent with their medication. Linear regression model identifies intention to comply with treatment and positive attitude toward ICS as predictors for adherence behavior. This study shows the relationship between medications beliefs, attitude, behavioral intention, and medication adherence. A better understanding of patient's medication beliefs, and attitude and their effect on compliance may help health care system to promote adherence.
MeSH terms: Adrenal Cortex Hormones; Adult; Asthma; Child; Chronic Disease; Cross-Sectional Studies; Humans; Hypersensitivity; Iran; Middle East; Surveys and Questionnaires; Research Personnel; Prevalence; Linear Models; Intention; Medication Adherence; Private Facilities
There is high expectation from the population on part of the healthcare providers. These include; skilful and timely medication administration; and knowledge, honesty, listening skills, availability and professional attitude. The aim of this paper is to evaluate the expectation of population with regards to the healthcare providers in Turkey. A cross- sectional study was conducted in Turkey, including both rural and urban population, carried out from October 2011 till January 2012. A total of 540 household heads were selected using multistage random sampling technique. Data was collected using modified self-administered 16-items QUOTE (Quality of Care Through the Patients’ Eyes) questionnaire. The questionnaire measures communication/ accessibility, organizational skills and professional skills. The response rate was (77.1%) and data was analyzed by using SPSS version 16.0. All the aspects measured using QUOTE questionnaire were found to be important by the majority of respondents, but with varying degrees of priority. The quality aspects related to the professional skills of physicians was ranked first followed by communication/ accessibility and last but not the least is the organizational skills of health care providers. This study explored the Turkish people priorities and expectations regarding healthcare providers. The public priorities and expectation were different across population. This may reflect the need to understand people's expectations before providing the services to avoid complaints that may occur after the services have been rendered.
MeSH terms: Communication; Cross-Sectional Studies; Health Personnel; Humans; Surveys and Questionnaires; Turkey; Urban Population
With economic growth and significant technological advances in the health sector, many countries have developed aggregate outcomes in terms of both health services and individual well-being. Life expectancy has seen a remarkable increase of more than fifty per cent between 1950 and 2009. Achievement is uneven, however, and some groups are better able to access health services than others. In our review, we explore the need and how to maximize health equity, efficiency and effectiveness. Methodology is the review and web surfing on public health, social science, humanity and development literature. The increasing gap in health inequality, however, calls for further reform of the health system to achieve both equity and efficiency. Health is essential for survival and human capability. Good health enables people to participate in society. A new approach to efficient and cost-effective health service provision is community participation in health development. Participation can increase the skills and knowledge of local people, thus providing opportunities to improve their lives (empowerment). Analysis suggests four functional changes to achieve equity and efficiency in maximizing health outputs: reforms targeting universal coverage to achieve universal access to health; people-centred service delivery through concentrating on health services based on need; public policy change targeting integrated and multi-system health planning; and collective health system and community response to achieve health for all.
MeSH terms: Health Equity; Achievement; Consumer Participation; Health Planning; Humans; Life Expectancy; Public Health; Public Policy; Social Sciences; Socioeconomic Factors; United States; Universal Coverage; Health Status Disparities; Economic Development
Worldwide maternal mortality rate had reduced tremendously including Malaysia. At the 2000 Millenium Summit, eight Millenium Development Goals (MDGs) were established with target for the year 2015. Three years remained until the deadline to achieve MDG5, which comprised of two targets and one being reducing the maternal mortality ratio by 75%.This review compared the trend of maternal mortality and its causes in our centre to the national data. The national data had shown a reduction from 44 to 27.6 in 100,000 live births in1991 and 2008 respectively. The subsequent rate had stabilized for the past seven years. In contrast the UKM Medical Centre (UKMMC) data in the past 15 years had not been stable. The target of MDG5 seemed to be achievable by our country but may require longer time as we have yet to find ways to overcome medical care inadequacy in remote areas.
MeSH terms: Female; Goals; Hospitals, Military; Humans; Malaysia; Maternal Mortality; Pregnancy; United States; Live Birth
Surprisingly little was known about the importance of touch in life which was placed at a lower emphasis than the rest-namely visual, auditory, olfactory sense and etc. This writing aimed to decipher the significances of interpersonal touch, its culture, practices, barriers and challenges, which were then conveyed to the public as a form of health promotion. Methodology includes narrative review where the suitable literatures used were searched using ScienceDirect database under the keywords of “Interpersonal Touch”, “Oxytocin” and “Touch”. In this review, we have highlighted some of the most critical points which should have been promoted to the public. For example, touch satisfies individual psychosomatic and psychosocial needs. It forms a non-verbal communication culture which interacts about emotions, trust, compliance and more. Furthermore, it has been linked to the secretion of multifunctional bioactive chemical-oxytocin which was well-known in its therapeutic advantages for a wide range of commonest chronic diseases and social ills. Although some dysfunctional consequences may be resulted, incorporating genuine interpersonal touch into today’s efforts is undeniably viewed as a good option in solving many social problems.
The population with normal body mass index (BMI) but with abdominal obesity are most of the time the ‘neglected’ population in terms of health interventions. The aim of this study is to study the prevalence of abdominal obesity and to explore the factors causing abdominal obesity by using waist circumference (WC) measurement. A cross sectional study was conducted among a group of respondents in Tanjung Karang, Selangor, Malaysia from January until June 2010, among those aged 18 years old and above, to explore the demographic (gender and ethnics), lifestyle factors (physical activity, carbohydrate intake and smoking status) and measurement of body weight, height and waist circumference. A total of 629 subjects with normal BMI were studied. The prevalence of abdominal obesity was 36.1% based on WC (40.0% males and 70.0% females). The predictor model revealed that being non-Malay (aOR = 2.1; 95% CI: 1.35-3.20) and being female (aOR = 3.6; 95% CI: 2.51-5.06) were the associated factors of having abdominal obesity in normal BMI population. In conclusion, females and non-Malay were factors that were found to be associated with abdominal obesity in normal BMI population. This is important in targeting this vulnerable population with risk factors that can develop non communicable diseases for early interventions.
MeSH terms: Adult; Body Weight; Carbohydrates; Cross-Sectional Studies; Female; Humans; Life Style; Malaysia; Male; Motor Activity; Surveys and Questionnaires; Risk Factors; Smoking; Body Mass Index; Prevalence; Early Intervention (Education); Vulnerable Populations; Waist Circumference; Obesity, Abdominal
The leading cause of mortality in Malaysia is coronary heart disease (CHD). Several cardiovascular (CVD) risk factors contribute to this problem and smoking is one of the main modifiable risk factor. Most of the patients started smoking early during youth period. This study aimed to determine the association and to predict the cigarette smoking and cardiovascular risk factors among the male youth. A cross sectional study was conducted by self-administered data sheets, physical examinations: blood pressure measurement and body mass index calculation, blood taking procedure for blood glucose, total cholesterol and HDL-C levels. The results showed that the glycemic status was significantly associated with smoking status (p=0.048) however, there was no significant association for smokers and risk of developing diabetes mellitus compared to non smokers although smokers had higher odd ratio (OR: 4.33; 95%CI: 0.900-20.811) (p=0.068). Interestingly, for daily exposure of smoking, those who smoke 5 cigarette and less was significantly associated with high systolic blood pressure (p = 0.036) and smoking showed protective trend against systolic hypertension (OR: 0.57; 95% CI: 0.266-1.230), however, it was not significant (p=0.152). In conclusion, smoking among youth and its association with the cardiovascular risk factor should be addressed tactfully and early screening should be promptly done among the smoking youth for early prevention.
MeSH terms: Adolescent; Blood Glucose; Blood Pressure; Cardiovascular Diseases; Cholesterol; Coronary Disease; Cross-Sectional Studies; Diabetes Mellitus; Humans; Hypertension; Malaysia; Male; Risk Factors; Smoke; Smoking; Body Mass Index; Odds Ratio
This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean
section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.
MeSH terms: Breech Presentation; Cesarean Section; Female; Humans; Obesity; Pilot Projects; Placentation; Pregnancy; Risk; Version, Fetal; Body Mass Index; Gravidity
The Use of Complementary and alternative medicine (CAM) is a common phenomenon among women with breast cancer in Malaysia. This study examines the prevalence, types, influencing factors and source of information regarding CAM among women with breast cancer, using a cross sectional research design. A purposive sampling was used to recruit 103 women with breast cancer who were attending follow up care at the Radiotherapy and Oncology unit of Universiti Kebangsaan Malaysia Medical Centre. Data was gathered through the use of self–administered questionnaires. Ninety one women identified themselves as CAM users while twelve were non users. Among the CAM users, 57(62.6%) were Malays, 27(29.7%) Chinese and 7(7.7%) Indians. The common types of CAM used were vitamins, nutritional supplements and traditional medicines (TM). CAM was used more frequently upon diagnosis (63.7%) and after completion of conventional treatment (97.8%). With regard to decision-making, most of the women (62.6%) did not make the decision to use CAM and were mostly influenced by their husband and mother (67%). Mother (71.4%), husband (67%), and relatives (56%) were the main sources of information and all values showed significant association with CAM use (p
MeSH terms: Complementary Therapies; Breast Neoplasms; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Malaysia; Medicine, Traditional; Mothers; Surveys and Questionnaires; Research Design; Vitamin A; Vitamin K; Vitamins; Prevalence; Spouses; Dietary Supplements
Maternal Home-based Record (MHR) is a concise medical record that can be kept by the pregnant women for regular documentation throughout pregnancy stages. This study was done to assess the usage of the MHR among the pregnant women and its associated factors. A good MHR usage was assigned using mean value as cut-off point that has been agreed by an expert group from scoring system which incorporates usage elements in term of follow-up, information documentation, knowledge seeking, continuity of care and self-monitoring of pregnancy. A cross-sectional survey was conducted in University Kebangsaan Malaysia Medical Centre (UKMMC) and a total of 79 pregnant women who attended the antenatal clinic were recruited. A validated self-administered questionnaire was used. The questionnaire was newly developed in Bahasa Malaysia. Content validity and reliability test for internal consistency for the knowledge, satisfaction and usage scale was performed. The Cronbach’s Alpha value for each domain was 0.764, 0.716 and 0.877 respectively. The results showed that the prevalence of good MHR usage was 51.3%. There were significant association found between level of education (Adj OR=0.32, 95% CI 0.12, 0.85, p=0.023) and doctor as birth attendant in previous pregnancies (Adj OR= 2.54, 95% CI 1.97, 6.59, p=0.045) with good usage of MHR. There was a positive significant relationship between satisfaction level among the respondent and the level of the usage (p=0.01, r=0.377), whereby with every increase in 1 score in satisfaction level will increase the usage score by 0.4 (95% CI 0.2 to 0.7) units, p<0.01. Therefore, MHR is still relevant as antenatal care monitoring instruments and it is important to make an effort to improve patient satisfaction in using MHR. Health care providers can use this validated self-administered questionnaire to assess function of MHR to remain relevant to the pregnant women population in their locality.
Key words: Antenatal care, home-based maternal record, usage, satisfaction
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
MeSH terms: Continuity of Patient Care; Cross-Sectional Studies; Documentation; Female; Follow-Up Studies; Hospitals, University; Humans; Malaysia; Medical Records; Outpatient Clinics, Hospital; Personal Satisfaction; Pregnancy; Surveys and Questionnaires; Universities; Reproducibility of Results; Prevalence; Gravidity; Parturition
Ewing sarcoma (ES)/ primitive neuroectodermal tumour (PNET) is an aggressive malignant neoplasm affecting mainly children and young adults. The tumour is included with other primitive neoplasms under the category of small round cell tumour. Cytokeratin expression in ES/PNET has been described in sporadic case reports as well as a few systemic series. We studied this feature in Malaysian patients diagnosed in University Malaya Medical Centre on the basis of typical morphology and immunohistochemical assays. Immunohistochemical staining for AE1/AE3 and MNF116 were performed in 43 cases. Cytokeratin was expressed in 17 cases (39.5%) in focal, intermediate or diffuse patterns. There was no significant association between cytokeratin immunoreactivity and the following parameters: patient age, sex, skeletal and extraskeletal primary location as well as primary, metastastic or recurrent tumours or chemotherapy treatment. A significant association between cytokeratin and neuron specific enolase (NSE) expression was demonstrated. Our study supports evidence of epithelial differentiation in ES/PNET and emphasizes that the expression of cytokeratin does not exclude ES/PNET in the differential diagnosis of small round cell tumours.
Malaysia is currently poised to introduce its Science, Technology and Innovation (STI) Policy and Act to bolster the nation's efforts at economic and social transformation. In championing this initiative, the Academy of Sciences Malaysia, while continuing to advise the Government on STI issues of the day, has made major strides in taking stock of the country's STI strengths in the various sectors of the economy as well as weaknesses that need to be addressed in terms of human capital development. In this article, the author examines the level of research expertise presently in the country in the field of chemistry, and elaborates on the four key areas of energy, catalysis and chemical synthesis, materials science and biological chemistry which will be researched globally in the next few decades that we would also need to be engaged upon to remain competitive. Intended for a wider audience than chemists alone, the descriptive sections in the article by and large belie an interdisciplinary flavour. The article also advocates the need for a more thorough road mapping exercise of the STI efforts in chemistry across the spectrum of academia and industry and makes some recommendations towards forging strong collaborations in research between the universities, public research institutes and the industry which are seen as vital in providing cross-cutting chemical solutions throughout the value chains and to the success of technologies identified as critical to the nation.
The unsustainable harvesting of sea cucumbers in the Straits of Malacca poses a danger of collapsing population of this marine resource. Recent survey revealed the absence of commercially important sea cucumber species like Stichopus horrens was alarming since there were a lot of taxonomical complications in identifying species from this genus. The knowledge of taxonomy and ecology is an integral part in determining resource management strategies and conservation of marine resources like sea cucumber.
MeSH terms: Animals; Ecology; Health Resources; Surveys and Questionnaires; Sea Cucumbers; Knowledge; Disease Management; Stichopus
Systems perspectives are fundamental in driving technological improvements and yield-enhancing strategies that improve agricultural productivity. These can resolve farmerʼs problems and are important pathways for sustaining food and nutritional security for human welfare in Asia. The essential determinants of this objective are the capacity to efficiently manage the natural resource base (land, crops, animals, and water) to resolve constraints to farming systems, and notably the integration of multiple research and development (R&D) issues through all levels of formal and non-formal learning systems. Both formal and informal education systems are important, with the former relating more to universities and colleges, and the latter to the intermediate level. Graduates from this level have the primary responsibility of introducing improved technologies and change to farmers, mainly along production and disciplinary pathways.The traditional research–extension–farmer model for technology delivery is no longer acceptable, due to “top down” extension functions and prescriptions, ineffectiveness to cope with the dynamics of production systems, complex interactions within the natural resources, effects of climate change and globalisation. There are also reservations on the technical capacity and skills of extension agents, constraints identification, methods for technology diffusion and dissemination, and innovative use of beneficial technological improvements that can directly respond to the needs of small farmers, and impact on subsistence agriculture. Agricultural education and systems perspectives are therefore an overriding compelling necessity which transcends prevailing limitations to waning agriculture and rural growth. Their wider recognition and applications provides an important means to maximise efficiency in the potential use; of the natural resources, increase engagement and investments in agriculture, promote ways to become more self-reliant in the development of crucial new technologies and intensification. These together can meet the challenges of the future and overcome the legacy of continuing poverty, food and nutritional insecurity. Asian farming systems, with their diversity of crops and animals, traditional methods, multiple crop-animal interactions, numerous problems of farmers present increasingly complex issues of natural resource management (NRM) and the environment. Many if not all of these can only be resolved by interdisciplinary R&D, which overcomes a major weakness of many R&D programmes presently and in the past. Improved education and training is a powerful and important driver of community-based participation aimed at enhancing sustainable food security, poverty reduction and social equity in which the empowerment of women in activities that support organising themselves is also an important pathway to enhance self-reliance and their contribution to agriculture. A vision for the future in which improved agricultural education in a systems context can provide the pathway to directly benefit the revitalisation of agriculture and agricultural development is proposed with a three-pronged strategy as follows:
Define policy for the development of appropriate curricular for formal agricultural education that provides strong multi-disciplinary orientation and improved understanding of the natural resources (land, crops, animals and water) and their interactions
Organise formal degree education and specialisation at the university level that reflects strong training in understanding of agricultural systems; systems perspectives, methodologies and their application, and
Define non-formal education and training needs that can be intensified at different levels, including the trainin of trainers as agents of change.