Ninety-six cases of severe malnutrition and associated nutritional disorders were encountered in children in the department of paediatrics for the year 1971. The predominant age group was in children under the age of two years. Malay and Indian children were affected more than the Chinese children with malnutrition. Protein caloric malnutrition had already affected the growth pattern of these children as the majority were below the 50th percentile in height and weight comparing them with Hong Kong childrens’ height and weight standards. Seventy-five per cent of the children presented with infection. Fifty-four per cent of the families with malnutrition had three to six children and in two thirds of the families the income was from $100/- to $249/- per month. Forty per cent of the children lived in the kampong type of houses with no proper sanitation. Worm infestation was common in this group. The mean haemoglobin, serum iron levels, and serum folic acid levels were lower in the Indians and Malays. Protein caloric malnutrition must be treated early because of its irreversible effects on brain and bone growth. It is recommended that some form of allowance either in the form of food or money be given to these children from poor social-economic background.
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.
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.
PIP: It is generally believed that extended families encourage high fertility, but a review of the theoretical discussions and empirical research examining the relationship between family type and fertility fails to show any support for the customary belief. Nuclear families consist of husband, wife, and their immediate children. The extended family is broadly defined as any group of related persons living together which includes but is larger than the nuclear family. The main theoretical discussions of extended family and fertility are by Davis (1957); Davis and Blake (1956); Lorimer (1954); and Goode (1963; 1964). In the patrilocal extended family, the wife wants to have offspring as early as possible to strengthen the family line and her own status in the household. In a truly joint household the authority of the elders continues after marriage; the reproductive behavior of a couple is subject to their influence. Less intimate or less intense interspousal communication precludes the possibility of discussion on fertility-related problems and family planning. Younger age at marriage and lack of privacy contributes to higher fertility. According to Goode extended family behavior is characterized by more rules for behavior, while nuclear families emphasize the conjugal bond. Since most affinal and consanguineal kin are excluded from day-to-day decisions in the nuclear family there are weaker reciprocal controls.
PIP: The nature of the family in Southeast Asia is examined by reviewing the work of Koichi Mizuno on multi-household compounds in Northeast Thailand in comparison with groupings among Kedah Malays. The authors conclude that the family among Thais and Malays is a flexible, social circle of interwoven dyadic relations and that it can take a variety of grouping pattterns according to circumstances
The design of family studies to estimate the value of an intraclass correlation coefficient p is considered when ni individuals are to be selected from each of k families, i = 1, 2, ..., k. In particular, the accuracy of a balance design (ni = n, i = 1, 2, ..., k) for estimating p is compared with the accuracy of an unbalanced "natural" design, in which the ni are sampled at random from family size distributions that tend to occur in practice. It is found for two different estimators of p that the balanced design is usually preferable, but only to a small degree if the number of families sampled is greater than 50.
PIP: A model of the determinants of child quality and of the value of a woman's time is developed and tested using data from the Malaysian Family Life Survey of 1976-1977. Child quality is measured by educational attainment; factors influencing the value of the mother's time include size and age composition of household, family income, education, and hours worked. The results indicate that size and age composition of household affect a woman's asking wage. However, more data are needed before the effects of family structure on schooling can be measured with confidence.
"The commitment to population programs is now widespread," says Rafael Salas, Executive Director of the UNFPA, in its report "State of World Population." About 80% of the total population of the developing world live in countries which consider their fertility levels too high and would like them reduced. An important impetus came from the World Conference of 1974. The Plan of Action from the conference projected population growth rates in developing countries of 2.0% by 1985. Today it looks as though this projection will be realized. While in 1969, for example, only 26 developing countries had programs aimed at lowering or maintaining fertility levels, by 1980 there were 59. The International Population Conference, recently announced by the UN for 1984, will, it is hoped, help sustain that momentum. Cuba is the country which has shown the greatest decline in birth rate so far. The birth rate fell 47% between 1965-1970 and 1975-1980. Next came China with a 34% decline in the same period. After these came a group of countries--each with populations of over 10 million--with declines of between 15 and 25%: Chile, Colombia, India, Indonesia, the Republic of Korea, Malaysia and Thailand. Though birth rates have been dropping significantly the decline in mortality rates over recent years has been less than was hoped for. The 1974 conference set 74 years as the target for the world's average expectation of life, to be reached by the year 2000. But the UN now predicts that the developing countries will have only reached 63 or 64 years by then. High infant and child mortality rates, particularly in Africa, are among the major causes. The report identifies the status of women as an important determinant of family size. Evidence from the UNFPA-sponsored World Fertility Survey shows that in general the fertility of women decreases as their income increases. It also indicates that women who have been educated and who work outside the home are likely to have smaller families. Access to contraceptives is, of course, a major influence on fertility decline. According to UNFPA some of the Latin American countries have the highest contraceptive use among developing countries. The countries of Asia come next and contraceptives are least used in sub-Saharan Africa where birth rates of 45/1000 are still common. The money for population programs, says the report, has come largely from developing countries themselves. A survey of 15 countries showed them to have contributed 67% out of their own budgets--the rest having come from external aid. And in programs aided by UNFPA the local input has been even higher. During 1979-1981 the developing countries themselves budgeted $4.6 for each dollar budgeted by UNFPA. The report also highlights some of the emerging problems for the next 2 decades--and which will be high on the agenda of the 1984 conference. These include "uncontrolled urban growth" in developing countries as well as an important change in overall population age structure as more and more old people survive. Aging populations are of particular concern to the developed countries but, as the report points out, even countries like China--which has achieved a steep drop in fertility and mortality--will face the problems of an aging population by the year 2000.
A survey of 4.112 primary school children living in and around Kuala Lumpur, Malaysia, revealed that 12.9% of the children were infested with Pediculus humanus capitis. Indians (28.3%) and Malays (18.9%) have a higher prevalence than Chinese (4.6%). The higher prevalence among Indians and Malays correlates well with their lower socio-economic status in the community; long hair also contributes to the higher rates of pediculosis among them. The prevalence rate was found to be related to socio-economic status, length of hair, family size, age, crowding and personal hygiene. Treatment with 0.2% and 0.5% malathion in coconut oil gave cure rates of 93% and 100%. Treatment with gammexane and actellic at 0.5% concentration gave a cure rate of 100% against adults and nymphs of Pediculus humanus capitis.
Child mortality may affect spacing through biological and behavioral channels. The death of a child may elicit a desire to have another one soon; further, it may interrupt breastfeeding and shorten the sterile period following childbirth. The hypothesis that the child mortality-spacing linkage varies across parities, being strongest in the middle parities, is examined using microdata from Malaysia and the Cox-regression technique. The empirical results lend support to the hypothesis.