Breast feeding has been actively encouraged in Malaysia in the last few years in all public hospitals. This study proposes to find out the prevalence of breast feeding in three villages in a rural community in Kedah, Malaysia. This was a cross sectional study on breastfeeding practices in Kubang Pasu, a district of Kedah. Majority of the mothers initiated breast feeding but exclusive breastfeeding was only 21% for four months and predominant breastfeeding was about 12.6%. The breastfeeding practice was more prevalent among women from the higher educational strata and higher income than those from the lower strata and lower income (p
Rural health training is an important element in the training of medical students in the University of Malaya. There is a need for the undergraduates to be familiar with the rural health infrastructure and to understand the social and economic aspects of the rural poor. The objective of the training is to make the students understand the problems faced by the poor in the rural areas so that when they practice in rural health areas, after graduation, they will understand the problems of the rural poor. They will have the knowledge of the diseases in the rural areas and also understand the community and the environmental factors that contribute to the disease. The training lasts' for 4 weeks, one week for lectures on health survey, two weeks for the field trip and one week of data analysis and presentation of their findings to an expert panel. During the field trip the students are divided into groups and they go to different parts of the country. Each group will do a field survey to find out the socio-demography, environmental, economic, nutritional and health problems in the village. In addition to the survey they also do a research project on any topic. The students also do social work, visit places of public health interest like the water treatment plant, sewage disposal, factory visits and others. Apart from technical skills in statistics and epidemiology, various other managerial skills like leadership, teamwork, communications and public relations are also learnt during the training. In conclusion this rural health training is an important aspect of the medical students training as it imparts several skills to them that are needed as a doctor.
The overall mean birth weight of the total deliveries (1986-1988) in Lundu Hospital was 2.96 kg. The mean birth weight for the male babies was 2.94 kg. The Chinese babies had a significantly higher mean birth weight (3.12 kg) than the other ethnic groups (p < 0.05). The overall incidence of low birth weight (LBW) in this study was 11.84 per cent. The Chinese again had a lower incidence of LBW of 6.73 per cent compared to Ibans who had the highest incidence of LBW, 13.59 per cent, with the Bidayuhs 12.97 per cent and Malays, 12.45 per cent. It was also noticed that of the 14.9 per cent preterm deliveries, 37.5 per cent were LBW. The very young mothers (15-19 years) and older mothers (> 40 years) seem to have a higher incidence of LBW. Mothers who had medical conditions like anaemia, hypertension, pre-eclampsia also had a higher incidence of LBW when compared to mothers who did not have a medical condition. Special emphasis should be given to mothers who have medical conditions, and to very young and very old mothers during antenatal care, to prevent incidence of LBW.
Comment in: Chia CP. Low birth weight babies. Med J Malaysia. 1995 Mar;50(1):120
Author reply to: Chia CP. Low birth weight babies. Med J Malaysia. 1995 Mar;50(1):120.
Comment on: Yadav H. Low birth weight incidence in Lundu, Sarawak. Med J Malaysia. 1994 Jun;49(2):164-8.
Maternal deaths in Kerian district during a 5 year period (1976-1980) is described. There were 35 maternal deaths in all and Malays constituted the majority 32 (91.4 percent). Most of the women were of low socio-economic status and only 20 percent had some formal education. The women were mainly multigravida and majority of them 20 (57.2 percent) were between 31-40 years of age. The main cause of death being PPH and PPH with retained placenta. Most of them died at home and were attended to by TBAs. The need to identify, train and utilise TBAs has been realised as they delivered about 41.4 percent of the deliveries in Kerian in 1976.
The findings of a cholera epidemic in Krian district is reported. There were 77 cases and 92 carriers in the epidemic. Although the three main ethnic groups of Malays, Chinese and Indians were involved in the epidemic, the Malays constituted majority of the cases and carriers. The overall infection rate and case attack rate was higher among the younger population. The case: carrier ratio was also higher among the younger population especially among Indians. Various reasons and probable causes of the epidemic have been described briefly.
The birth weight distribution, mean birth weight and incidence of LBW amongst the various ethnic groups in Malaysia is described briefly. The data collected and analysed is hospital data where all deliveries in 1980 were analysed. The mean birth weight showed that the Chinese had the highest Mean Birth Weight amongst the three ethnic groups and the Indians had the lowest mean birth weights. The overall incidence of LBW was 11.8% and the Malay and Indian babies constituted the high
incidence of LBW whereas the Chinese had a low incidence of LBW babies in the study. Amongst the various ethnic groups the Indians had a higher incidence of LBW compared to the Chinese and Malays.
The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.
The International Medical University has a Community and Family Case Study (CFCS) programme as part of the training for medical students. The aim of the programme is to emphasize the family and community perspective of patient care in the home environment. A cross-sectional descriptive study was done among 66 final year medical students using a questionnaire. The students were in the 10th Semester and had completed their Community and Family Case Studies (CFCS) programme. Majority (54.5%) of the students who were interviewed were Malays, 34.8% Chinese and 9.1% Indians. Majority of the students (87.9%) liked the programme because it was a good opportunity to understand the patient in their home environment; it improved their commination skills and made them understand the patient better in the community setting. The perceived problem in this programme by the students were mainly choosing an index patient initially (32.8%), patient cooperation (19.0%) and transportation to the patients' house (13.8%). They said that this programme was useful because they learnt more about the disease (45%) and understood the patient management better (15%). The programme also provided the students a wider exposure to medicine (37.9%) and the opportunity to practice clinical skills. Overall the CFCS programme in IMU was well liked by the students as it gave them an opportunity to practice some of the clinical skills in the patients' home environment and it provided an opportunity to manage the patient better. The major problem the students faced was in selecting the index patient.
There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
This is a cohort study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to determine whether reassessment on the development of children with disability under rehabilitation should be done at three months interval or six months interval. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study was carried out for seven months from 1st August 2004 until 28th February 2005. A total of 168 disabled children followed up for six months were selected in this study. Schedule of Growing Scale (SGS) II was the tool used for analysis. Results showed a statistically significant difference in the mean total SGS score at six months interval but not at three months interval. The result suggests that reassessment on children with Down Syndrome, Autism, Cerebral Palsy, mental retardation and delayed speech under rehabilitation should be carried out every six months while children with gross developmental delay and slow learner might need a longer interval for reassessment.
This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.
Questionnaire: Denver Developmental Assessment Test II chart; DSST; Schedule of Growing Scale II; SGS
This study examines the association between maternal factors and low birth weight among newborns at a tertiary hospital in Malaysia. This was a cross-sectional study where mothers were followed through from first booking till delivery. There were 666 mothers who delivered from May 2007 to March 2008. Infants' birth weight were compared with maternal age, pre-pregnancy BMI, fathers BMI, parity, ethnicity, per capita monthly income, and maternal blood pressure during pregnancy. A multiple logistic regressions was used to determine the relationship of maternal factors and low birth weight, while the ROC curve was constructed to assess the sensitivity and specificity of the predictive model. Among the significant risk factors of low birth weight were older age (35 years and above), low pre-pregnancy BMI (<20 kg/m2), parity of 4 and above, Indian origin, economically under privileged, and low and high blood pressure. Blood pressure during pregnancy was an important risk factor for LBW, by using this parameter alone the risk of LBW could be predicted with a sensitivity rate of 70% and a specificity rate of 70%. The sensitivity and specificity was further improved to 80% and 75% percent respectively when other factors like maternal factors such as maternal age, pre-pregnancy BMI, ethnicity, and per capita monthly income were included in the analysis.