This study presents clinical observations in pregnancy made on aborigines of the deep jungle and "outside" populations. Migration out of the jungle results in lowered nutritional status as a result of low socio-economic status in the "outside" aborigine. This, together with food habits, increased family size and higher incidence of helminthic infestations, results in lower mean values of Hb, PVC and MCHC and a higher prevalence of anaemia in pregnancy in the migrant aborigine. A higher population density in the "outside" population resulting in frequent intermingling and increased chances of cross-contamination probably explains the increased vaginal bacterial growth in the "outside" Aborigine women. A higher prevalence of vaginal candidiasis in the "outside" aborigine woman is probably related to exposure to oral contraceptives and broad-spectrum antibiotics. On the other hand, better medical and obstetrical services become more readily available to the "outside" aborigine and this results in a favourable influence on perinatal health.
A retrospective study of birthweights, the incidence, and possible aetiology of low birthweight in 31,490 Nigerian children, delivered in two hospitals at Ibadan, is reported. The important findings were: (a) mean birthweights for males (3,000 gm), and for females (2,880 gm) in a non-teaching hospital were significantly higher than 2,980 gm and 2,860 gm for males and females respectively in the teaching hospital; (b) the mean birthweights for boys were significantly higher than those for girls in both hospitals; (c) these mean birthweights, though generally higher than previous reports from Nigeria, were significantly lower than those for North American Caucasian and Negro babies, and of babies of three different racial groups in Malaysia. Other interesting, though expected findings were: (a) a high incidence of low birthweight (15.5 per cent) and (b) a high incidence of small for dates babies (60 per cent). It is suggested that since birthweights, the incidence of low birthweight and its aetiology are vital in the planning of health care in any country, a prospective study involving many urban and rural areas of the country and including factors known to influence birthweight should be undertaken.
The characteristics of normal labour in 977 Malay, Chinese and Indian parturients were established from a retrospective study. Indian babies were found to be significantly smaller than Malay babies which were significantly smaller than Chinese babies (P less than 0-05, P less than 0-05). The mean duration of the first stage of labour taken from the time of admission to the labour ward was 3-4 hours in primiparae and 2-7 hours in multiparae. The mean durations of the second stage of labour were 23-7 minutes and 13-1 minutes respectively. Curves of mean dilatation of cervix and probit analysis at 80% revealed significant differences in the progress of normal labour in primiparae among the three racial groups. The Indian primiparae not only had a slower rate of cervical dilatation but seemed to reach the accelerated phase of dilatation later. No significant differences were noticed in the labours of multiparae.
The birthweights of 13,614 singleton infants comprising 5376 Malays, 5352 Chinese and 2886 Indians born at the Maternity Hospital Kuala Lumpur, during 1973, 1975 and 1977 have been extracted and analysed. Male Chinese infants (3.16 ± 0.37 kg) were significantly heavier than Malay and Indian infants while the male Malay infants (3.12 ± 0.41 kg) were significantly heavier than the Indian (2.97 ± 0.41 kg). Both female Chinese (3.04 ± 0.38 kg) and Malay infants (3.05 ± 0.38 kg) were heavier than the female Indian (2.89 ± 0.39 kg) but there was no difference in birthweight between Chinese and Malay female infants. The mean gestational period and the proportion of full-term births were similar for all 3 races with averages of 39.9 weeks and 77.8 percent respectively. Maternal age at first birth was also closely similar for the three communities with an average of 22.9 years. Significant correlations were found between birthweight and length of neonates, birthweight and gravida, birthweight and maternal age. Indians have a higher incidence of low birthweight or small-for-gestational age infants (14.5 percent) compared to the Chinese (5.6 percent) and the Malays (7.6 percent); the incidence of low birthweights being higher in girls than in boys. Present-day Malay and Indian full-term male and female infants are significantly heavier than their counterparts born at the same Hospital two decades ago, but no difference in birthweight was observed for Chinese infants during this time interval. The gap between the incidence of low birthweight found in Malaysia and those in the developed countries seems to be narrowing and this may be taken to reflect the overall effects of socioeconomic development, including the greater availability of general health and ante-natal care throughout the country since its Independence in 1957.
A review of recent data available on the nutritional health of Indian children seems to suggest that malnutrition is a major problem among poor Indian preschool and school children. Examination of indirect indicators of malnutrition reveals that for Indians, the annual percentage decrease in TMR is the lowest and incidence of low birth weight and perinatal mortality rate the highest. While there is very little documentation in the extent and severity of protein-malnutrition among Indian children, hospital admission returns for severe PEM show a predominance of Indian preschool children. This suggest that moderate forms of malnutrition may even be more widely prevalent amongst this group of the population thus posing a great problem from the public health point of view. The prevalence of moderate PEM as represented by acute ("wasting") and chronic forms ("stunting") was found to be the highest among Indian urban and rural children. Biochemical studies indicate widespread prevalence of anemia, vitamin A and B deficiencies especially among Indian preschool children. The presence of high parasitic infections may exacerbate such deficiencies. The causes of malnutrition are multiple and complex. Low family income as a consequence of high unemployment rate (8%) and low wages, lack of basic sanitation and adequate housing, large family size, alcoholism and apathy among parents, ignorance of good nutrition and disturbed conditions in the home environment have been identified as some of the factors that may contribute towards malnutrition in this community. Thus the viscous cycle of malnutrition appears to have gained a foothold in the poor Indian community. As has been well documented, the social implications of malnutrition are many, the most important being its effect on education. It is now well known that malnutrition hinders intellectual development; it interferes with a child's motivation, ability to concentrate, and ability to learn and cope with the school situation. Malnutrition thus could be one of the contributory factors to the generally poor performance in studies, to the low aspiration for higher education and to the alarming drop-out rate (60%) found among Indian school children. While this review attempts to highlight some of the nutritional problems confronting the Indian poor, it is clearly essential from a national view-point that community level surveys should be further undertaken to assess the nutritional health of this group. The problem of malnutrition among poor Indian children is real and needs urgent recognition and remedial measures from both public and political sectors alike.