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Fulltext Intestinal parasitic infections amongst Orang Asli (indigenous) in Malaysia: has socioeconomic development alleviated the problem?

Lim YA, Romano N, Colin N, Chow SC, Smith HV

Trop Biomed, 2009 Aug;26(2):110-22.
PMID: 19901897 MyJurnal

Orang Asli are the indigenous minority peoples of peninsular Malaysia. Despite proactive socioeconomic development initiated by the Malaysian Government in upgrading the quality of life of the Orang Asli communities since 1978, they still remained poor with a current poverty rate of 76.9%. Poverty exacerbates the health problems faced by these communities which include malnourishment, high incidences of infectious diseases (eg. tuberculosis, leprosy, malaria) and the perpetual problem with intestinal parasitic infections. Studies reported that the mean infection rate of intestinal parasitic infections in Orang Asli communities has reduced from 91.1% in 1978, to 64.1% in the subsequent years. Although the results was encouraging, it has to be interpreted with caution because nearly 80% of studies carried out after 1978 still reported high prevalence (i.e. >50%) of soil-transmitted helminthiases (STH) among Orang Asli communities. Prior to 1978, hookworm infection is the most predominant STH but today, trichuriasis is the most common STH infections. The risk factors for intestinal parasitic infections remained unchanged and studies conducted in recent years suggested that severe STH infections contributed to malnutrition, iron deficiency anaemia and low serum retinol in Orang Asli communities. In addition, STH may also contribute to poor cognitive functions and learning ability. Improvements in socioeconomic status in Malaysia have shown positive impact on the reduction of intestinal parasitic infections in other communities however, this positive impact is less significant in the Orang Asli communities. In view of this, a national parasitic infections baseline data on morbidity and mortality in the 18 subgroups of Orang Asli, will assist in identifying intervention programmes required by these communities. It is hope that the adoption of strategies highlighted in the World Health Organisation- Healthy Village Initiatives (WHO-HVI) into Orang Asli communities will ensure the whole mechanism of delivery and empowerment by the government agencies become more efficient and productive in alleviating intestinal parasitic infections in these communities.

Matched MeSH terms: Malnutrition/complications
Hookworm infection and protein-energy malnutrition: transverse evidence from two Malaysian ecological groups

Foo LC

Trop Geogr Med, 1990 Jan;42(1):8-12.
PMID: 2124397

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.

Matched MeSH terms: Protein-Energy Malnutrition/etiology*; Protein-Energy Malnutrition/epidemiology; Protein-Energy Malnutrition/parasitology
Pneumonia and diarrhoeas: killers of toddlers in developing countries

Chen ST

Trop Geogr Med, 1975 Mar;27(1):103-8.
PMID: 806152

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.

Matched MeSH terms: Protein-Energy Malnutrition/complications*
Giardiasis as a predictor of childhood malnutrition in Orang Asli children in Malaysia

Al-Mekhlafi MS, Azlin M, Nor Aini U, Shaik A, Sa'iah A, Fatmah MS, et al.

Trans R Soc Trop Med Hyg, 2005 Sep;99(9):686-91.
PMID: 15992838

A cross-sectional study to examine the association of giardiasis with protein-energy malnutrition, vitamin A deficiency and iron deficiency anaemia was conducted among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2-15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and faecal samples. The results showed that 24.9% of the children were infected with Giardia duodenalis, while 56.5, 61.3 and 15.1% had significant underweight, stunting and wasting, respectively. Giardiasis was statistically identified as a strong predictor of significant wasting in this study population.

Matched MeSH terms: Protein-Energy Malnutrition/epidemiology*; Protein-Energy Malnutrition/parasitology
Nutritional ill health among Malay children in the Ipoh District of Perak, Malaya. A case described of severe malnutrition with enlarged liver

THOMSON FA

Trans R Soc Trop Med Hyg, 1950 Dec;44(3):339-46.
PMID: 14809758
Matched MeSH terms: Malnutrition*
Validation of screening tools to assess appetite among geriatric patients

Hanisah R, Suzana S, Lee FS

J Nutr Health Aging, 2012 Jul;16(7):660-5.
PMID: 22836710

Poor appetite is one of the main contributing factors of poor nutritional status among elderly individuals. Recognizing the importance of assessment of appetite, a cross sectional study was conducted to determine the validity of appetite screening tools namely, the Council on Nutrition Appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) against the appetite, hunger and sensory perception questionnaire (AHSPQ), measures of nutritional status and food intake among geriatric patients at the main general hospital in Malaysia. Nutritional status was assessed using the subjective global assessment (SGA) while food intake was measured using the dietary history questionnaire (DHQ). Anthropometric parameters included weight, height, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A total of 145 subjects aged 60 to 86 years (68.3 ± 5.8 years) with 31.7% men and 68.3% women were recruited from outpatients (35 subjects) and inpatients (110 subjects) of Kuala Lumpur Hospital of Malaysia. As assessed by SGA, most subjects were classified as mild to moderately malnourished (50.4%), followed by normal (38.6%) and severely malnourished (11.0%). A total of 79.3% and 57.2% subjects were classified as having poor appetite according to CNAQ and SNAQ, respectively. CNAQ (80.9%) had a higher sensitivity than SNAQ (69.7%) when validated against nutritional status as assessed using SGA. However, the specificity of SNAQ (62.5%) was higher than CNAQ (23.2%). Positive predictive value for CNAQ and SNAQ were 62.6% and 74.7%, respectively. Cronbach's alpha for CNAQ and SNAQ were 0.546 and 0.578, respectively. History of weight loss over the past one year (Adjusted odds ratio 2.49) (p < 0.01) and thiamine intake less than the recommended nutrient intake (RNI) (Adjusted odds ratio 3.04) (p < 0.05) were risk factors for poor appetite among subjects. In conclusion, malnutrition and poor appetite were prevalent among the geriatric outpatients and inpatients. SNAQ was more reliable and valid as an appetite screening tool among this special group of population. There is a need to regularly include nutritional and appetite assessment for early intervention measures in order to prevent consequences of malnutrition.

Matched MeSH terms: Malnutrition/diagnosis; Malnutrition/prevention & control
Current prevalence and predictors of protein-energy malnutrition among schoolchildren in rural Peninsular Malaysia

Al-Mekhlafi MS, Surin J, Atiya AS, Ariffin WA, Mahdy AK, Abdullah HC

Southeast Asian J. Trop. Med. Public Health, 2008 Sep;39(5):922-31.
PMID: 19058591

A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.

Matched MeSH terms: Protein-Energy Malnutrition/epidemiology*
The nutritional situation in metropolitan Kuala Lumpur, with focus on squatters

Khor GL

Southeast Asian J. Trop. Med. Public Health, 1992;23 Suppl 3:17-30.
PMID: 1342754

Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.

Matched MeSH terms: Protein-Energy Malnutrition/epidemiology
Protein calorie malnutrition: a major health problem of multiple causation in Malaysia

Chen ST

Southeast Asian J. Trop. Med. Public Health, 1974 Mar;5(1):85-9.
PMID: 4209141
Matched MeSH terms: Protein-Energy Malnutrition/etiology*; Protein-Energy Malnutrition/epidemiology; Protein-Energy Malnutrition/prevention & control
Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

Boettiger DC, Aurpibul L, Hudaya DM, Fong SM, Lumbiganon P, Saphonn V, et al.

Pediatr Infect Dis J, 2016 May;35(5):e144-51.
PMID: 26835972 DOI: 10.1097/INF.0000000000001074

BACKGROUND: Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population.
METHODS: Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or body mass index-for-age Z score less than -3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age Z score less than -3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification.
RESULTS: Three hundred fifty-five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age Z score increased from -5.6 at ART initiation to -2.3 after 36 months. Not using trimethoprim-sulfamethoxazole prophylaxis at baseline was associated with poor weight recovery [odds ratio: 2.49 vs. using; 95% confidence interval (CI): 1.66-3.74; P < 0.001]. Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (odds ratio: 1.78 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.08-2.92; P = 0.023) and mortality (hazard ratio: 2.57 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.24-5.33; P = 0.011). Twenty-two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years, and rates did not differ by malnutrition severity.
CONCLUSION: Trimethoprim-sulfamethoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability, but CD4% response is compromised in children with a very low weight-for-height/body mass index-for-age Z score, which may contribute to their high rate of mortality.

Matched MeSH terms: Malnutrition*
Unintentional weight loss is the most important indicator of malnutrition among surgical cancer patients

Loh KW, Vriens MR, Gerritsen A, Borel Rinkes IH, van Hillegersberg R, Schippers C, et al.

Neth J Med, 2012 Oct;70(8):365-9.
PMID: 23065984

Disease-related malnutrition is highly prevalent in hospital patients and varies from 25-40%. Early nutritional screening of patients at admission helps to improve recognition of malnourished patients to allow early interventions and enhance clinical outcomes.

Matched MeSH terms: Malnutrition/diagnosis; Malnutrition/etiology*; Malnutrition/epidemiology; Malnutrition/therapy
Fulltext Outcome of moderate to severe malnutrition following persistent diarrhoea--a hospital-based retrospective study

Lee WS, Gan CS, Chai PF, Harun F

Med J Malaysia, 2008 Aug;63(3):229-36.
PMID: 19248696

We aimed to determine the outcome of nutritional intervention in children with moderate to severe malnutrition following persistent diarrhoea (PD), referred to a tertiary referral unit in Malaysia. Thirty-one (44%) of the 71 children (median age 19 months) with PD had moderate to severe malnutrition on admission. Fifty-three (75%) required dietary modification and 15 (21%) needed parenteral nutrition (PN, median duration 96 days). Of the 70 patients in whom remission of diarrhoea could be ascertained, 64 (91%) achieved remission. Three required home PN. At three months after discharge, there was a significant improvement in the mean weight-for-height z-score as compared to the original score at initial presentation (from -1.83 +/- -1.77 to -0.80 +/- -1.17; p < 0.001), although 12 (22%) of the 55 patients in whom nutritional status could be ascertained still had moderate to severe malnutrition. In conclusion, moderate to severe malnutrition was a common complication following PD resulting from diverse causes. With appropriate therapy, remission can be achieved in majority of patients, although a small number of patients needed home PN because of persistence of diarrhoea.

Matched MeSH terms: Malnutrition/etiology; Malnutrition/therapy*
Fulltext Intestinal parasitic infections and micronutrient deficiency: a review

Hesham MS, Edariah AB, Norhayati M

Med J Malaysia, 2004 Jun;59(2):284-93.
PMID: 15559182

Malnutrition including vitamin A and iron deficiency and parasitic diseases have a strikingly similar geographical distribution with the same people experiencing both insults together for much of their lives. Parasitic infections are thought to contribute to child malnutrition and micronutrient deficiency through subtle reduction in digestion and absorption, chronic inflammation and loss of nutrients. Parasites may affect the intake of food; it's subsequent digestion and absorption, metabolism and the maintenance of nutrient pools. The most important parasites related to nutritional status are intestinal parasites especially soil transmitted helminthes, Giardia duodenalis, Entamoeba histolytica, followed by other parasites such as the coccidia, Schistosoma sp. and malarial parasites.

Matched MeSH terms: Protein-Energy Malnutrition/etiology*
Fulltext The use of mid-arm circumference for screening malnutrition in preschool children

Ng TKW

Med J Malaysia, 1984 Mar;39(1):28-34.
PMID: 6439983

Correlation analysis of mid-arm circumference (MAC), weight-for-age and weight-for-height obtained from 807 Malay preschool children aged 12-71 months show that MAC had a relatively low correlation with weight-for-age (r = 0.59, P <0.001) and weight-for-height (r = 0.63, P<0.001). MAC percentiles and sensitivity-specificity analysis indicate that when weight-for-age and weight-for-height were used separately to define 'true' malnutrition, MAC was not sensitive enough to detect Malaysian children with only mild to moderate protein-energy malnutrition (PEM). The value of MAC as a screening measure in malnutrition is only limited to identifying the more severe forms of PEM in young children and the present study indicates that a MAC of 13.0-13.7 cm may be used for identifying moderate to severe PEM and under 13.0 cm for severe PEM.

Matched MeSH terms: Protein-Energy Malnutrition/diagnosis*
Fulltext Population & social indicators of food and nutrition in Peninsular Malaysia

Chong YH

Med J Malaysia, 1982 Jun;37(2):134-40.
PMID: 6813659

Health, including nuirition is not independent but is closely associated with the social and economic environment. Malnutrition itself can cause death, but more commonly, it can cause considerable ill-health, physical retardation, impaired mental performance, loss in productivity and a decline in the quality of life. The effects of malnutrition as obstacles to socio-economic development are now well recognised. In a rapidly developing country like Malaysia, the nutritional and nutritionally-related problems present themselves with contrasting features. While population indicators such as toddler mortality, incidence of low birthweight and food balance sheet studies suggest an improving nutritional situation, methods of direct assessment have shown that chronic protein-energy malnutrition and anaemia are sWI common amongst pre-school children in both the rural and urban disadvantaged sectors. Moderate anaemia also affects a significant proportion of older children and women of childbearing age. Intestinal parasites, another indicator of under development at the local level, are ubiquitous in the rural setting and urban slums owing to unsatisfactory waste disposal. In striking contrast, diseases associated with dietary excesses and increasing affluence have now emerged as the major killers. This changing pattern of mortality and morbidity along the lines encountered by the industrialised societies is now dramatised by the fact that road accidents are now claiming a large number of victims. It is clear that while continued efforts should be given to the improvement of the nutritional health of both rural and urban poverty communities, little time should be wasted in considering the adoption of public health measures aimed at stemming the rising number of deaths associated with our increasing affluence, particularly those diseases that are nutritionally linked, such as coronary heart disease, hypertension and diabetes mellitus, not forgetting the increasing road toll afflicted by the motor vehicle.

Matched MeSH terms: Protein-Energy Malnutrition/epidemiology
Prevalence of protein-calorie malnutrition in a group of Malaysian school children

Chen ST

Med J Malaysia, 1977 Jun;31(4):266-9.
PMID: 412037
Matched MeSH terms: Protein-Energy Malnutrition/epidemiology*
Nutritional status in a rural estate community

Kandiah N, Boo LJ

Med J Malaysia, 1977 Jun;31(4):270-6.
PMID: 412038
Matched MeSH terms: Protein-Energy Malnutrition/epidemiology
Changes in body fluid distribution in experimental protein malnutrition

Chandrasekharan N, Ho CL

Med J Malaysia, 1976 Jun;30(4):266-72.
PMID: 824533
Matched MeSH terms: Protein-Energy Malnutrition/metabolism*
Some aspects of malnutrition in Malaya

Burgess RC

Med J Malaya, 1948;2:239-246.

Malnutrition is one of the most important causes of ill-health in Malaya. The incidence of deficiency diseases was extremely high during the Japanese occupation, but there has been satisfactory improvement since 1945, though in some respects, particularly in the case of beriberi, this improvement can only be regarded as due to artificial and transitory circumstances, mainly the importation of Australian wheat. Surveys have recently been undertaken of nutritional status in rural areas in Malaya, embracing clinical, dietary, sociological and economic aspects of the problem. Data derived from clinical examinations, height and weight data and vital statistics indicate deficiency in almost all nutrients, and these are confirmed by dietary survey. Poverty is the main cause of the poor dietary intake. Investigations have shown that protein and calorie intakes are directly related to the money available in the family for expenditure on food. Vitamin A and riboflavin intakes are, on the other hand, largely uninfluenced by economic factors and their deficiency in the diet is mainly a matter of ignorance, prejudice and the unavailability of foodstuffs rich in these nutrients. As the economic side of the survey showed that the money spent on food, in most families, is over 80 per cent. of the total expenditure, the problem is clearly an economic one, and can only be solved by country-wide measures of increased and better food production, education and economic betterment. Dean A. Smith.

Matched MeSH terms: Malnutrition
Fulltext Current trends in the management of oral mucositis related to cancer treatment

Biswal BM

Malays J Med Sci, 2008 Jul;15(3):4-13.
PMID: 22570584 MyJurnal

Oral mucositis is one of the most common toxicities observed during radiotherapy and chemotherapy treatment for cancers. Mucositis results in sore mouth, altered taste sensation, pain and dysphagia leading to malnutrition. Left untreated, oral mucositis leads to ulceration, orodental infection, bleeding and discontinuation of effective radiotherapy or chemotherapy. Frequent hospitalization, enteral or parenteral nutrition, increased demand for analgesics ultimately account for increased cost of healthcare. Quantification of oral mucositis using standardized grading system is important for appropriate evaluation, reporting and management. In the recent past there is a paradigm shift in the pathobiology of cancer therapy related mucositis. Clear understanding of its pathogenesis is essential for the formulation of effective mucositis care. Numerous drug therapies, radiation techniques and oral care protocols have been tried in the past to reduce oral mucositis, None have proven to be consistently effective. Current trends for the prevention and treatment of oral mucositis is multi-targeted treatment supplemented by aggressive oral hygiene, reactive oxygen species (ROS) inhibitors, growth factors and use of specific topical agents to improve treatment of oral mucositis in future.

Matched MeSH terms: Malnutrition

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