A survey of smoking habits among the students attending the Student Health Clinic for various ailments showed:
1. Smoking in women is very uncommon.
2. About 30% of men smoke.
3. The majority of these had commenced smoking before they entered the university.
4. The majority smoked filter tipped brands.
5. Where the mothers in the family smoked, the sons seem to take to smoking more readily.
6. Knowledge of the effects of smoking on health was poor, but equal in all three groups viz in women and in both smoking and non-smoking men.
The immunisation-rate of infants in Malaysia is low, and diphtheria and tetanus are common. If a satisfactory level of population immunity is to be achieved, many more infants must attend clinics more often, or other forms of immunisation must be offered. However, a mathematical model shows that the immunisation-rate can be improved immediately, without the need for additional staff or increased attendance of infants at clinics, by giving some immunisations in the immediate postnatal period and the remainder soon afterwards. Many of the infants who came to the clinics had minor infections. The model shows that the immunisation-rate would increase further still if immunisations were given in the presence of these infections. It is possible that earlier immunisation may give lower levels of immunity in individuals, but the increased numbers immunised would more than compensate for this.
The pattern and incidence of cardiovascular disease was studied in a general practice in an urban-rural area in the west coast of West Malaysia. Hypertension, rheumatic heart disease and congenital heart disease accounted for 85% of the 476 patients with evidence of cardiovascular disease. Ischaemic heart disease, arteriosclerotic heart disease and other conditions accounted for the rest. Emphasis is laid on the salient features of incidence in general practice. Comparison is made with previous clinical and pathological studies from this region.
The Municipal Maternal and Child Health Clinics at Kuala Lumpur were faced with a declining but continuing problem of diphtheria. The arrangements for immunization were such that a low coverage was obtained for triple vaccination, but a high one for smallpox, a disease they had not experienced for many years. By reversing the schedule, so that triple vaccine injections were administered first, and ensuring that fewer children were not immunized because of concurrent minor ailments, the diphtheria immunization coverage was greatly improved. There was some loss of smallpox cover.
The revision commenced in 1970 and the diphtheria incidence rate, which had been falling since 1965, continued to fall but at a lower rate. The author does not discuss possible explanations for this. The article illustrates a dramatic improvement in immunization cover by a simple re-arrangement better suited to the needs of the town
One hundred and ninety-nine children brought by 181 adults to a child health clinic based in a rural health sub-centre in Peninsular Malaysia are studied. It is noted that the families from which they come are relatively poor, with a large number of children, and that they are fairly highly motivated. Forty-four per cent of children attending the clinic at the time of the study are symptomatic indicating the need to organise the child health clinic on a "preventive-curative" basis. It is also noted that the young child is initially seen in early infancy but is lost to the clinic when he is older making it judicious to formulate immunization schedules that take this into account.
Stool samples from healthy children mainly of the low income group aged 0 to 7 years of age from five Maternal and Child Health Centres in Kuala Lumpur were obtained for isolation of enteroviruses. The specimens were collected before and after the mass vaccination given in the face of polio type 1 epidemic which started in October, 1971. The prevelance rate of enteroviruses was 11.9% (3.0% polioviruses, 8.9% non-polio enteroviruses) before the vaccination and essentially the same after. Coxsackie A viruses predominated over the other enteroviruses in the pre- and post-vaccination phases. The highest isolation rate of enteroviruses was observed in children 0 to 2 years age. No significant differences in distribution by sex, race and month were noted. A sharp fall in the prevalence rates of total enteroviruses and polioviruses was noted shortly after the mass vaccination campaign However, the rates reverted to the pre-vaccination state during the next successive years.
Disease patterns among outpatients seen at static and travelling dispensaries, as well as among hospital admissions and hospital deaths are compared between 1959 and 1974. While disease patterns of patients seen by travelling dispensaries show no change, patients seen by static dispensaries and hospital admissions in 1974 show a marked relative decline in infective and parasitic diseases and an increase in accidents, poisonings and violence. Causes of death in hospitals in 1974 were different, there being relative increases in diseases of early infancy, diseases of circulatory system, neoplasms, and accidents, poisonings, violence while infective and parasitic diseases, and diseases of the digestive system declined.
Concerned by the alarming decline in breast feeding in the urban and rural areas of Malaysia, we conducted a critical review of infant feeding practices among nursing personnel from representative centres using questionnaires. It was found that although 75% of mothers breast-fed their babies at birth only 19% did so at 2 months and 5% at 6 months respectively. Chinese mothers initiated breast feeding less frequently compared with Indian or Malay mothers. The prevalence of breast feeding was higher among lower category nurses, lower income groups and those from health centres. Decision for breast feeding was based in most instances on conviction derived from reading, lectures or advice from relatives. The vast majority of mothers listed "work' as the main reason for termination of breast feeding followed by "insufficient breast milk' and satisfactory past experience with bottle feeding. The ramifications of these findings and measures to improve the prevalence and duration of breast feeding are discussed.
Study site: University Malaya Medical Centre (UMMC), Hospital Kuala Lumpur, Hospital Kota Bharu, Kelantan, Hospital Kajang, Klinik Kesihatan Ulu Langat, Selangor, Malaysia
In a survey of 5233 patients seen in the clinics of three general practitioners, 339 patients were found to be doctor hoppers (6.48 per cent). Respiratory symptoms and fever were the commonest presentation affecting mainly the paediatric age group. No improvement in the symptoms was quoted as the most common reason for switching to another doctor. Many factors contributed to doctor hopping and these were best considered in relation to the illness, the patient and the doctor: From the point of prevention, the doctor himself has a significant role to play, particularly in improving the doctor-patient relationship and patient compliance.
Study site: Johor (Johor Bahru, Batu Pahat, Muar)
Results are presented of research undertaken in the Republic of Korea and Malaysia to determine how far integration affects the performance of family planning and allied programs and to identify organizational determinants of clinic level interactive linkages. The report discusses the background of the research, provides overviews of the country programs, outlines research methodologies and procedures, and presents findings. 41 clinics with high, medium, and low performance ratings in Korea and 17 main health centers, 31 sub-health centers, and 49 midwife stations in Malaysia, (some of them intensive input demonstration areas) were assessed on performance, interaction measures, and organizational determinants. The overall finding was that integration affects program performance, but the direction of the impact depends on how the integrated programs are organized. In Malaysia, where the program is specifically organized to integrate family planning with maternal and child health, the integration appears to have increased service delivery and resulted in larger numbers of family planning acceptors. No spill-over was found from the inputs of the 2 components to each other. The overall positive impact and lack of service reduction due to integration appears to result from specific planning for a limited degree of integration. In Korea, a mild negative relationship was found between clinic level performance in the family planning and community development, or Saemaul Undong (SU) components. In the field SU was observed to be more favored and powerful, and was not fully integrated with family planning. The major conclusion of the study was that integration works best when family planning is linked to similar services, and does not work as well with services that are different in character or in degree of government support.
312 diabetics were seen in a multiracial urban general practice in Peninsular Malaysia during a five-year period. Of these, 210 (67%) were Indians, confirming the higher prevalence of diabetes among Indians reported in other studies. 67 were newly found diabetics. The sex, age, family history, of the diabetics, duration and complications of diabetes, are reviewed and compared with similar studies. The larger number of diabetics may partly be attributed to the presence in the community of a large number of Indians born in India. Stress also may contribute to the high prevalence of the disease in Indians, who are prone to diabetes by virtue of heredity.
The study reported served 2 purposes: 1) to assess the amount of sexual information posessed by a sample of staff nurses working for the National Family Planning Board and the Public Health Dept., and 2) to gather local normative data on the Information Subtest of the Derogatis Sexual Functioning Inventory (DSFI). The subjects for the this study were 2 groups of staff nurses. 10 were employees of the National Family Planning Board currently working in 1 of its clinics and 25 were public health nurses who were at a 1 week training at the clinic. The research was a questionnaire type study. Each subject was given the DSFI. On the Information Subtest of the DSFI the subjects obtained a mean score of 12.7 with a standard deviation of 4.2. This score is much lower than the normative mean (American population) and the sexually dysfunctional women mean. The nurses had inadequate and inaccurate knowledge about anatomy, physiology and psychology of sexual relations. Error analysis revealed that as a group they had poor understanding about male sexuality, the effect of aging on sexuality fertility and menopause, and difficulty in accepting oral-genital sex and sexual fantasies. This study recommends that these nurses, in order to more effective in their work, should be trained in the area of human sexuality. This training must include not only the physiology of sex but also the human aspects of sexual union.