1. Seventy-seven cases of tropical ulcer were studied in the General Hospital, Johore.
2. Age was found to be an important factor in the incidence and duration of the disease.
3. One or more debilitating factors could always be established. After removal of these factors, the ulcer in many cases tended to heal.
4. The course of the ulcer is divided into three stages. Stage I is the spreading stage. In Stage II, a mild sloughing occurs within the original boundaries of the ulcer. This is a chronic stage. In stage III, there is either a stationary or a healing ulcer.
5. Treatment for the first stage is mainly directed towards the general condition of the patient. In the second stage the associated debilitating factors are treated. In cases which do not respond to these measures we tried many forms of treatment. Of these, the most rational seems to be application of strong antiseptics to the sloughs themselves. We have used quinine, as recommended by Innes for this purpose, and we have obtained very satisfactory results in a small series of obstinate cases. Stage III is treated by the application of elastic adhesive bandage.
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.
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.
In the behavioural conceptual model of health education, behavioural pattern is placed first in the chain of events which can lead from health to disease. If such a model is acceptable, it implies that primary health education must be directed at those behavioural patterns that pre-dispose to diseases. There are obviously numerous behavioural patterns that one is familiar with which would pre-dispose to diseases. The paper discussed some of the more important examples to illustrate the role of behavioural patterns in the causation of disease and the consequential need for health education directed at such behavioural patterns. In relation to nutritional diseases, behavioural patterns in many areas of the developing world are a major contributory factor to the prevalence of protein calorie malnutrition. Such dietary restrictions may even cause the sick individual to be denied the very food he requires. Examples of behavioural patterns in relation to communicable and non-communicable diseases and to medical care were also discussed.
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.
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.
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.