Displaying publications 1 - 20 of 83 in total

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  1. Hyder AA, Merritt M, Ali J, Tran NT, Subramaniam K, Akhtar T
    Bull World Health Organ, 2008 Aug;86(8):606-11.
    PMID: 18797618
    Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.
  2. Wickersham JA, Marcus R, Kamarulzaman A, Zahari MM, Altice FL
    Bull World Health Organ, 2013 Feb 01;91(2):124-9.
    PMID: 23554524 DOI: 10.2471/BLT.12.109132
    PROBLEM: In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed.

    APPROACH: After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release.

    LOCAL SETTING: Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy.

    RELEVANT CHANGES: STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners.

    LESSONS LEARNT: Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.

  3. Gordon Smith CE, Turner LH, Armitage P
    Bull World Health Organ, 1962;27:717-27.
    PMID: 13993152
    Because of the risk of introduction of yellow fever to South-East Asia, comparative studies were made of yellow fever vaccination in Malayans who had a high prevalence of antibody to related viruses and in volunteers without related antibody. The proportions of positive neutralizing antibody responses to subcutaneous vaccination with 17D vaccine were not significantly different between volunteers with and without heterologous antibody but the degree of antibody response was greater in those without. The ID(50) of 17D in both groups was about 5 mouse intracerebral LD(50). Multiple puncture vaccination with 17D gave a much lower response rate than subcutaneous vaccination in volunteers with heterologous antibody. In both groups subcutaneous doses of about 50 mouse intracerebral LD(50) gave larger antibody responses than higher doses. The neutralizing indices and analysis of results were calculated by a method based on the survival time of the mice. This method, which has advantages over that of Reed & Muench, is fully described in an annex to this paper.
  4. Desmarchelier PM, Apiwathnasorn C, Vilainerun D, Watson C, Johari MR, Ahmad Z, et al.
    Bull World Health Organ, 1994;72(6):877-84.
    PMID: 7867133
    Food-handling practices were studied in 119 and 158 households, respectively, in an urban and a rural community in Peninsular Malaysia. Hazard analyses, including microbiological analysis of foods, were carried out in two households in each community and in a house that prepared food for distribution in the urban area. Kitchen hygiene was generally acceptable, although rated "poor" in some instances in the rural area. Food prepared for lunch was usually sufficient for dinner also, the leftover items being stored at ambient temperature until required. In the house that prepared food for distribution, breakfast was prepared during the evening, stored at ambient temperature overnight, and reheated before sale the next morning. There was a local preference for cooking food at temperatures close to boiling point; this reduced the numbers of vegetative cells but not those of spores. In some stored foods the populations of Staphylococcus aureus, Bacillus cereus and mesophilic aerobic bacteria increased, the last-mentioned reaching spoilage levels. Reheating reduced the populations of proliferating bacteria in most foods to acceptable levels but would not have destroyed heat-resistant enterotoxins. Because of their importance in combating acute bacterial foodborne disease, the control of the temperature and time factors during the cooking and storage of food should receive special attention in education on health and food safety.
  5. Gordon Smith CE, Turner LH, Harrison JL, Broom JC
    Bull World Health Organ, 1961;24(6):807-16.
    PMID: 20604093
    In previous papers it has been demonstrated that ground-dwelling rats are the principal reservoir of leptospirosis in Malaya. The present paper considers the distribution of infection by sex and weight in the ten principal rat species. There appears to be a general tendency for females to be infected more frequently than males, but significant differences were demonstrated only in R. sabanus (more than three times as many females as males infected) and R. whiteheadi. In Malaya, where seasonal changes are minimal, weights can be used as a good index of age in rats. In rat species with a low incidence of infection the incidence appeared to rise steadily with age. In species with a medium incidence the infection rate rose at first with age, fell in the 6-8-month age-group, and then rose again. In high-incidence species the rate rose rapidly from the second month.There appear to be three types of enzootic infection; (1) intensive transmission of a single serogroup in a crowded population of rats of a single species (transmission probably being through urinary contamination of damp soil); (2) low-intensity transmission of several serogroups among ground-rats frequenting wet places (probably with urinary transmission); and (3) low-intensity transmission of several serogroups among ground-rats in dry places (the transmission may be venereal).
  6. Smith CE, Turner LH, Harrison JL, Broom JC
    Bull World Health Organ, 1961;24(1):5-21.
    PMID: 20604085
    In recent years leptospirosis has been shown to be an important cause of human febrile illness in Malaya. Studies were therefore undertaken to determine its animal reservoirs and the factors influencing spread of infection from them to man and domestic animals. This paper presents the board picture obtained. A wide range of animal species were trapped in forest localities, ricefield areas, areas of scrub and cultivation and in several towns and villages. The maintenance hosts of leptospirosis in Malaya appear to be mainly or entirely rats, although evidence of infection has been found throughout the animal kingdom. Some rat species have characteristics which suggest that they are better maintenance hosts than others. Evidence was found of practically every serogroup of leptospires infecting animals in Malaya. Altogether 104 strains were isolated and identified, and 155 animals were found to have serological evidence of infection. Of 1763 rodents examined, 194 had evidence of infection, and 41 of 1083 other animals. A serum survey of domestic animals showed the highest incidence of antibodies to be in goats and the lowest in oxen.
  7. Smith CE, Turner LH, Harrison JL, Broom JC
    Bull World Health Organ, 1961;24(1):23-34.
    PMID: 20604083
    In a previous paper the authors reported on the methods and zoogeographical background of a survey of animal leptospirosis in Malaya, giving a broad analysis of results. In the present paper the localities studied in towns and villages, in ricefields, in secondary forest and scrub and in primary forest are compared in detail. In towns and villages infection rates in rats were low, except in a seaport town where the invading R. norvegicus was heavily infected. In ricefields infection is maintained in R. argentiventer, alone or in association with R. exulans. In secondary forest and scrub there is overlap with forest species and the main hosts of leptospires appear to be R. exulans and R. jalorensis. In primary forest giant rats and, to a lesser degree, spiny rats are the main hosts.Ground-living rats appear to be better maintenance hosts than those scrambling on vegetation or arboreal rats. With some exceptions the incidence of infection of a rat species in an area was found to be in direct relation to the proportion that species formed of the total rat population. The critical number of rats for maintenance of leptospirosis in an area is estimated to be about two rats of the maintenance species per hectare.
  8. Inwang EE, Khan MA, Brown AW
    Bull World Health Organ, 1967;36(3):409-21.
    PMID: 5299673
    The yellow fever mosquito Aedes aegypti has developed resistance to DDT in the Caribbean region and in South-East Asia, but not in West Africa. Therefore West African strains were compared with South-East Asian strains for their response to laboratory selection with DDT. It was found that West African strains were much slower to respond initially, but eventually could build up a high degree of DDT-resistance. By crossing and backcrossing with a susceptible marker-gene strain, it was found that this resistance was due to a single gene linked with the gene y (yellow) on chromosome 2 at a cross-over distance of approximately 35 units in an Upper Volta strain as in a Bangkok strain; interstrain crosses indicated that the gene was the same as that in a Trinidad strain and in one from Penang. Dieldrin-resistance could be readily induced in the Upper Volta strain and proved to be due to a gene also linked with y but at a crossover distance of approximately 25 units, comparable to that in Caribbean strains previously studied. Material from Karachi, West Pakistan, developed a dieldrin-resistance also showing 25% crossing over with y, and a DDT-resistance also linked with this chromosome-2 marker gene.
  9. Warrener L, Slibinskas R, Chua KB, Nigatu W, Brown KE, Sasnauskas K, et al.
    Bull World Health Organ, 2011 Sep 01;89(9):675-82.
    PMID: 21897488 DOI: 10.2471/BLT.11.088427
    OBJECTIVE: To evaluate the performance of a newly developed point-of-care test (POCT) for the detection of measles-specific IgM antibodies in serum and oral fluid specimens and to assess if measles virus nucleic acid could be recovered from used POCT strips.

    METHODS: The POCT was used to test 170 serum specimens collected through measles surveillance or vaccination programmes in Ethiopia, Malaysia and the Russian Federation: 69 were positive for measles immunoglobulin M (IgM) antibodies, 74 were positive for rubella IgM antibodies and 7 were positive for both. Also tested were 282 oral fluid specimens from the measles, mumps and rubella (MMR) surveillance programme of the United Kingdom of Great Britain and Northern Ireland. The Microimmune measles IgM capture enzyme immunoassay was the gold standard for comparison. A panel of 24 oral fluids was used to investigate if measles virus haemagglutinin (H) and nucleocapsid (N) genes could be amplified by polymerase chain reaction directly from used POCT strips.

    FINDINGS: With serum POCT showed a sensitivity and specificity of 90.8% (69/76) and 93.6% (88/94), respectively; with oral fluids, sensitivity and specificity were 90.0% (63/70) and 96.2% (200/208), respectively. Both H and N genes were reliably detected in POCT strips and the N genes could be sequenced for genotyping. Measles virus genes could be recovered from POCT strips after storage for 5 weeks at 20-25 °C.

    CONCLUSION: The POCT has the sensitivity and specificity required of a field-based test for measles diagnosis. However, its role in global measles control programmes requires further evaluation.

  10. Chapple PJ
    Bull World Health Organ, 1966;34(2):243-8.
    PMID: 5296130
    Studies have recently been published of surveys of antibodies to common respiratory viruses in human sera from several parts of the world. The present article reports the findings of a survey of antibodies to two more viruses (adenovirus type 8 and coxsackievirus type A21) in human sera mainly collected from six widely separated geographical regions (Alaska, England, Marshall Islands, Sarawak, South-West Africa and Tunisia).A world-wide geographical distribution of infection with these two viruses was found. However, antibodies to individual viruses were not found with the same frequency in all countries; and, in marked contrast to the findings in the earlier surveys of antibodies to the common respiratory viruses, the frequency of antibodies was not the same for each virus in sera from the same country. It was not possible to draw any final conclusions as to the reasons for the observed differences.
  11. Cheng FY
    Bull World Health Organ, 1968;38(3):469-77.
    PMID: 5302337
    In certain areas of Sabah, East Malaysia, local houses are frequently built without walls or with incomplete walls. Also, the people in these areas often refuse permission for their houses to be sprayed inside with insecticide (DDT). These special conditions are the reason for the persistence of malaria transmission under a WHO malaria eradication programme.Field trials were conducted in specially constructed huts, similar to the local houses, in which all-night collections of mosquitos were made, both those biting human baits and those resting on walls, in order to determine (1) the effectiveness of spraying DDT in houses without, or with incomplete, walls; and (2) the best way to protect people against mosquito bites with DDT-spraying where the house-owners have refused indoor spraying.The results indicate that (1) as expected, DDT-spraying inside a hut with incomplete walls is less effective than in a hut with complete walls, especially 6 months or more after spraying; (2) external spraying of walls with DDT at double the normal dose (i.e., 4 g/m(2)) greatly reduced contacts between man and mosquito and thereby limited transmission of malaria.
  12. Savell E, Gilmore AB, Sims M, Mony PK, Koon T, Yusoff K, et al.
    Bull World Health Organ, 2015 Dec 01;93(12):851-61G.
    PMID: 26668437 DOI: 10.2471/BLT.15.155846
    OBJECTIVE: To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.

    METHODS: Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.

    FINDINGS: Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.

    CONCLUSION: Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

  13. Busvine JR, Coker WZ
    Bull World Health Organ, 1958;18(4):651-6.
    PMID: 13536807
    Colonies of three strains of Aëdes aegypti resistant to DDT were obtained from Trinidad, Haiti and Malaya and reared beside a normal colony. From their relative resistance to a series of compounds analogous to DDT, characteristic resistance "spectra" were obtained. The two colonies from the West Indies showed a similar type of resistance, rather different from the (smaller) resistance of the Malay strain. No resistance to methoxychlor or dieldrin was found.
  14. Cavalli-Sforza LT, Rosman A, de Boer AS, Darnton-Hill I
    Bull World Health Organ, 1996;74(3):307-18.
    PMID: 8789929
    One impact of socioeconomic progress on populations has been to reduce the number of cases due to diseases of undernutrition and microbial contamination of food, which affected mostly infants and young children, and to increase those due to diseases of excessive food consumption, which are affecting adults and a growing number of children. This article reviews the main dietary factors which have an influence on cardiovascular disease and cancer, and discusses the link between economic development and increased rates of chronic diseases. There is evidence that the noncommunicable diseases and their risk factors have risen rapidly in countries of the WHO Western Pacific Region. Data from 29 countries and areas in the region indicate that 70% of them show lifestyle diseases in three or more of the top five causes of death. While public health measures have been implemented by some countries to prevent and control nutrition-related chronic diseases, further action is needed.
  15. De Zulueta J
    Bull World Health Organ, 1956;15(3-5):651-71.
    PMID: 13404442
    A general malaria survey of Sarawak and Brunei, two of the territories of British Borneo, is described. Contrary to what was expected in view of the climate and the general conditions, the prevalence of malaria in Sarawak and Brunei proved, on the average, to be low. The coastal areas were found to be practically free from the disease, although epidemics have occurred there in recent years. Malaria was found to be endemic in the hilly and mountainous interior. In fact, topography proved to be an important factor in malaria prevalence, the spleen- and parasite-rates, generally speaking, being higher the more abrupt the country. Differences were also observed in the prevalence among the various racial groups, but these were considered to be due to different habits and customs rather than to race itself.Entomological studies showed that Anopheles leucosphyrus Dönitz was the main malaria vector in the interior of Sarawak, A. barbirostris playing a secondary role. A. leucosphyrus balabacensis had already been recognized as the malaria vector in Brunei.The favourable results of a first field trial of residual insecticides are mentioned and plans for a nation-wide malaria-control programme are briefly outlined.
  16. McKay DA, Lim RK, Notaney KH, Dugdale AE
    Bull World Health Organ, 1971;45(2):233-42.
    PMID: 5316620
    Measurements of child growth have become the most accepted means of assessing the protein-calorie nutritional status of economically developing populations. International reference standards have been suggested for a number of body measurements, but there has been little evaluation of their applicability in South-East Asia.In order to delineate the present range of nutritional standards in West Malaysia, and to aid in the development of guidelines for further nutritional work in this region, anthropometric tests were made on 3 groups of children below school age belonging to the Malay ethnic group and living under diverse conditions. Children of Malaysian Army personnel differed significantly in most measurements from rural village children in Trengganu and children from a small urban elite in Kuala Lumpur. Measurements for the latter group approximated to internationally used standards of height and weight. Parental height data suggest that these differences are not primarily genetic. Anaemia, malaria, and ascariasis were common among the Trengganu children.Weight and height emerge as the measurements that are most sensitive in differentiating between the groups; arm circumferences and skinfold measurements are also useful because they are relatively independent of age. Measurement of chest and head circumferences and of crown-rump lengths appeared to be of little value.
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