Three species of commonly eaten shellfish found in Malaysian coastal waters were examined for the presence of common bacterial enteropathogens. Vibrio parahaemolyticus, non-agglutinating vibrios, and various serotypes of enteropathogenic E. coli were isolated from a large proportion of them. Salmonella were isolated in two instances. High colony counts with evidence of faecal contamination indicated the strong possibility of pulltion being the cause for the presence of these enteropathogens. Methods of cooking and eating these shellfish enhance their likelihood of acting as vehicles of diarrhoeal disease.
An epidemiological survey of filariasis and malaria in Banggi Island and Upper Kinabatangan, Sabah, revealed microfilarial rates of 7.2% and 8.6% respectively and malaria prevalence of 9.7% and 16.9% respectively. Wuchereria bancrofti was a rural nocturnally periodic type with a periodicity index of 137.2 and average peak hour at 01.32 hrs; 9.2% of microfilaremic carriers as compared to 2.4% amicrofilaremic subjects had clinical filariasis. The Plasmodium falciparum: P. vivax: P. malariae ratios were 1:1:0.17 and 1.4:1:0.12 for Banggi and Upper Kinabatangan respectively. Anopheles flavirostris was incriminated as a new malaria vector in Banggi where the well-known primary malaria vector is An. balabacensis. The latter was also found for the first time to be a vector of rural W. bancrofti in Upper Kinabatangan. Experimental feeding also showed that L3 larvae of W. bancrofti were recovered at low rates from An. balabacensis. Aedes togoi appeared to be a suitable laboratory vector for W. bancrofti.
A case of pharyngeal tuberculosis is reported in a 54-year-old Chinese man. This is an uncommon condition and is often associated with pulmonary tuberculosis as in our patient.
Domiciliary deliveries have always been the responsibility of traditional birth attendants. Since Independence, acquired in 1957, educated young women have been trained as auxiliary midwives and sent to serve in rural communities where they usually are met with resistance by the established traditional birth attendants. To counter this and to incorporate the traditional birth attendants into the health team, new roles were developed for each so that the two would be able to cooperate and support each other rather than rival and antagonise each other. A specific experience in one area of Malaysia is examined as an example.
Since Independence, gained in 1957, major changes have occurred in the rural areas of Malaysia not least amongst which has been the provision of maternal and child care services to hitherto neglected areas. In the first part of this paper, the demographic and disease patterns are described. The second part outlines the general development efforts and describes in greater detail the rural health services that have been organized in Malaysia. In the concluding section, changes in mortality and morbidity are examined.
Three indigenous Malay surgical procedures, namely circumcision by the mudim, bone-setting by the bomoh patah and cupping, are described. It is noted that complications are associated with both circumcision and bone-setting, and suggestions are made of possible health measures to cope with the situation.
Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.
Based on the prevalence of antibody, an estimated 3% of the population of rural Malaysia is infected with Rickettsia tsutsugamushi each year, resulting in positive antibody rates in focal areas of 6 to 69%. Most of these infections do not appear to produce clinical scrub typhus. A wide range of seropositivity rates was found in areas otherwise resembling each other in predominant occupation, terrain, and nearby habitat. The prevalence rates however were significantly higher in people who worked in forested areas and significantly lower in people with urban occupations.
Four cases of Hb S were seen between Jan. 1976 and June 1976; three of them were newly discovered while the fourth was previously diagnosed. Out of the four cases, two were Malays and the other Indians. The family members of one Malay case were investigated. Six members had Hb S and three had Hb CoSp. Association of Hb CoSp and Hb S was seen in two of the members. Clinically they were healthy.
Anthropometric and parasitological data from cross-sectional studies of two groups of primary school children (Group I of Indian origin, 325 boys and 259 girls, age = 7 years; Group II of Malay origin, 284 boys and 335 girls, age = 7-9 years) from two different ecological settings in Peninsular Malaysia were examined for epidemiological evidence of an association between hookworm infection and protein-energy malnutrition. In both ecological groups, significant weight, height and haemoglobin deficits were observed in children with hookworm infection after adjustment for covariables including Ascaris and Trichuris infection intensities and other child and family characteristics. The deficits were related to the intensity of infection based on egg counts. These findings suggest that hookworm may be an important determinant of chronic protein-energy malnutrition, as well as anaemia, in areas where diets are generally inadequate in protein, energy, and iron. Well-controlled intervention studies are needed to confirm these observations.