Preliminary findings of a survey on the influences of institutional facilities on mothers in the post-partum period in hospital that affect breast-feeding were reported. It was observed that although advice on breast-feeding is now given, there is a conflict between advice and practice so that the advice has been ritualistic. There is a lack of follow-up on advice, and the mother is not helped and encouraged to breast-feed and to overcome her initial disappointment and difficulties. It was also pointed out that the artificial milk-food industry exercises a negative influence through maternity ward staff by provision of milk samples to maternity units and by visits of their sales staff to the mothers. It was emphasised that the hospital factor could be an important cause of failure of the mother to breast-feed.
Some of the factors that could contribute towards influencing a mother's decision on breast-feeding and its success were discussed. One of the most important of such factors is the information and encouragement a mother receives, or fails to receive, when she needs it most. Such information, which is mostly non-medical, includes the technique of breast-feeding. Some of the negative influences on breast-feeding discussed include old wives' tales about diet and elements secreted through the mother's milk, the fear of losing one's figure, the fear by working mothers that breast-feeding is impossible to manage, the hospital practice of separating the mother and new-born for the first 24 hours, the shyness of breast-feeding babies in front of others, the lack of confidence in their own efficiency in breast-feeding, and the belief that breast-feeding is inconvenient. Some of the positive influences which can help towards successful preast-feeding are assistance and support from Breast-feeding Associations, a supportive husband and family, and the physician who makes a point of spending a few minutes to encourage his patient to breast-feed her forthcoming infant. The author called for combined efforts towards the restoration of breast-feeding as every infant's basic right.
The effect of toilets, piped water, and maternal literacy on infant mortality was analyzed using data from the Malaysian Family Life Survey collected in 1976-1977. The effect of toilets and piped water on infant mortality was dependent on whether or not mothers were literate. The impact of having toilets was greater among the illiterate than among the literate, but the impact of piped water was greater among the literate than among the illiterate. The effect on the infant mortality rate for toilets decreased from 130.7 +/- 17.2 deaths in the absence of literate mothers to 76.2 +/- 25.9 deaths in the presence of literate mothers. The reduction in the mortality rate for maternal literacy dropped from 44.4 +/- 14.1 deaths without toilets to -10.1 +/- 23.9 deaths with toilets. Reductions in mortality rates for piped water increased from 16.7 +/- 12.7 deaths without literate mothers to 36.8 +/- 21.0 deaths with literate mothers. Similarly, reductions in the mortality rate for maternal literacy rose from 44.4 +/- 14.1 deaths in the absence of piped water to 64.5 +/- 19.5 deaths in the presence of piped water. The results from a logistic model provided inferences similar to those from ordinary least squares. The authors infer that literate mothers protect their infants especially in unsanitary environments lacking toilets, and that when piped water is introduced, they use it more effectively to practice better hygiene for their infants.
This study compares the knowledge, attitudes and practice of mothers in two ethnic groups with regard to acute respiratory infections (ARI) in their child. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Most mothers were aware of the effect of frequent attacks of ARI on the health status of their child and of the importance of early treatment. Reasons for their becoming worried during an episode of ARI in their child indicated that problems of distance, transportation and arrangements for care of their other children predominate. A large proportion of the respondents felt that their present knowledge of ARI was inadequate and were thus interested in obtaining more information.
A study was conducted in an urban slum area of Kuala Lumpur, the capital of Malaysia, to determine the health status of the children under 6 years old and the knowledge and practice associated with diarrhoeal diseases and use of oral rehydration salts (ORS) among mothers in the area. It was seen that the health status of the children was poor with one fifth of them born underweight, 33% experiencing more than 6 spells of illness per year and a high percentage of them suffering from diarrhoeal diseases (4.3%). Child care practice was associated with urban lifestyles with early weaning, short term breast-feeding and early introduction of solid and bottle feeding. Knowledge and practice of mothers concerning child care was inadequate to support healthy living. Knowledge of diarrhoeal diseases and the effectivenss of oral rehydration salts was poor. Only 47.7% of mothers knew about ORS and 27.8% ever used it when their chidlren suffered from diarrhoea. Health care system dependence was shown by the high percentage of mothers immediately bringing to a doctor's attention (75.6%).
To verify the actual immunisation coverage in Kuala Lumpur, City Hall Health Department and the Malaysian Paediatric Association (NGO ) carried out a survey. The survey revealed that the immunisation coverage determined at the child's first birthday for BCG was 95%, DPT 3 94%, OPV 3 94%, and measles = 27% (59% at 2 years). These figures correspond closer to City Hall's estimated coverage rather than the rates projected by the Ministry of Health. The main reasons for immunisation failure were, child ill 31.8% (not brought = 20.1%, brought but not given vaccine 11.7%), lack of information 28.6%, lack of motivation 9.1%, mother too busy 9.1%. Measles immunisation coverage at 1 year was low because of wrong information on schedules. Tetanus toxoid immunisation coverage of pregnant women was low. Only 27% of children were protected against neonatal tetanus although 97% of pregnant women received antenatal care and 50% had attended other health facilities as well during pregnancy. Private medical practitioners were responsible for more than 40% of all immunisations but were not submitting returns to the Health Department. Recommendations to improve immunisation coverage include education and motivation of the public and also doctors and health personnel on prevention of missed opportunities, contraindictions to immunisation and correct schedules. (Copied from article).
Mass vaccination of all newborns against hepatitis B virus infection has been implemented in Malaysia since January 1989. The significance of perinatal transmission of hepatitis B virus and the prevention of the disease are discussed. Routine screening of 6443 mothers in the University Hospital showed an overall carrier rate of 1.9%; whilst this was high amongst the Chinese (4.7%), a significant number of Malays were also infected (1.6%). The mechanism of perinatal transmission of hepatitis B and the important role of routine screening of antenatal mothers in eradicating the disease are discussed.
This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.
Cross-sectional studies on infant feeding practices in Malaysia have shown that even though there is a high percentage of initial breastfeeding, there is also a very rapid fall-off of full breastfeeding to be replaced by mixed feeding or full formula feeding. This paper gives the findings of a study conducted on 148 mothers who had just delivered their babies at the Maternity Hospital, Kuala Lumpur. 56 of these mothers were followed up to identify the feeding practices up to 6 months of the infant's life. Just after delivery, 83 .1% of the 148 motftrs had indicated interest to breasffeed either fully or partially. However, in the 56 mothers followed up later, 15 (26.7%) babies were not breasffed or breasffed for less than 1 week and only 15 (26.5%) were breasffed at least 6 months. Several factors affect breastfeeding rate amongst these mothers. Breastfeeding rate was significantly higher and longer amongst the Malays and least and shortest amongst the Chinese. The number of Malay mothers breastfeeding less than 1 week was 2 out of 24 (8.3%) whereas the number of Chinese mothers was 10 out of 19 (52.6%). Similarly, the number of Malay mothers breastfeeding beyond 3 months was 16 out of 24 (67.7%) and Chinese mothers only 4 out of 19 (21.0%). Other important factors are the type of initial feeding and the onset of initial formula feeding. Out of 26 babies initiated on breastmilk as the first feed, 12 were breasffed for at least 6 months whereas 8 of the 18 started on formulas were not breasffed at all or for less than 7 days and only one breastfed for at least 6 months. Similarly, out of 27 babies given formula feeding in the first 2 days, 15 were not breasffed at all or for less than 1 week and only 3 breasffed at least 6 months. This suggests the importance of early mixed feeding in the rapid decline of breastfeeding. The employment status of the mother and the family income do not seem to affect the breastfeeding rate and its duration for the baby.
The neonatal Intensive Care Unit (NICU) in the Maternity Hospital Kuala Lumpur (MHKL) was frequently understaffed and overcrowded. A separate special care nursery (called K5) was set up in July 1991 for the purpose of providing non-intensive neonatal care for infants. Mothers were simultaneously admitted and they provided a major bulk of feeding and nursing care. Case records for 2 months prior to and 2 months after opening of the ward were studied. The average duration of hospital stay per neonate was shorter in the later period (9.18 days vs 11.05 days, p < 0.05). Also the very low birth weight infants (VLBW) gained weight faster (28 grams a day) compared to similar infants in the earlier period (22 grams a day, p < 0.05).
This study was conducted to investigate the nutritional status of the rural population in Malaysia, especially women and children. A total of 262 women aged 18 and over and 183 children aged 2-6 years were selected using multistage cluster sampling from four locations in rural areas. It was found that the prevalence of malnutrition among children 2-6 years old ranged between 25.5% in the Malays Felda settlement scheme to 80% in the Orang Asli settlement. Malnutrition was associated with worm infestations, bottle feeding and early weaning. More than 30% of Orang Asli women were malnourished compared to less than 15% of Malay Felda settlement women. On the other hand, Malay women in the land settlement scheme had a higher risk of developing overweight and diabetes. Goitre was found among 11.5% of children; however, no cretinism was found. Breast feeding was still a common practice among rural mothers, but inadequate health education tended to reduce the duration of breast feeding and increased early weaning. Upgrading women's status in the rural areas will ultimately improve the nutritional and health status of the children and community as a whole.
The effect of the oil-spill dispersant Corexit 9527 on egg-hatching rate of Macrobrachium rosenbergii (de Man) was studied by using an innovated flow-through bioassay technique. This bioassay method relies on the fact that M. rosenbergii fertilized eggs when detached from the mother prawn were able to hatch artificially. The flow-through system generated a stable and good water quality environment for hatching the eggs successfully. The Corexit 9527 had a pronounced effect on hatching rate of the M. rosenbergii eggs. In the control, the hatching rate of the eggs was 95.55% +/- 1.74%. However, it was reduced drastically with increasing concentrations of Corexit 9527. A 100% inhibition of egg hatchability was found when the level of Corexit 9527 was higher than 250 mg litre(-1). The EC(50) and the EC(95) values estimated by the probit method were 80.4 +/- 5.5 mg litre(-1) and 193.5 +/- 39.9 mg litre(-1) respectively (P = 0.05). The recommended safety level of Corexit 9527 for M. rosenbergii in Malaysian estuarine waters is below 40 mg litre(-1).
The objective of this study was to assess the nutritional status of children in FELDA Sungai Koyan, Pahang. Anthropometric measurements were taken from 105 children comprising of 62 boys and 43 girls aged 12 to 72 months. Food intake records from 84 of these children aged 4-6.9 years were obtained. Socio-economic factors which may influence nutritional status were also studied. The anthropometric assessment showed that 14.3% (n=15) of the children were underweight, 10.5% (n=11) stunted and 2.9% (n=3) wasted when compared with the NCHS Reference. It was also found that 28.6% (n=30) of the children had low mid arm circumference for age according to the Frisancho reference, indicating a low protein calorie reserve. The result of the dietary study showed that the intake of calories, calcium, niacin and thiamine were below the recommended daily allowances (RDA) for Malaysia. However, the intake of protein, iron, vitamin A, riboflavin and vitamin C were above the RDA levels. Foods most frequently taken were rice, fish, milk and meat. Vegetables and fruits were also often consumed by the children. Based on the Pearson correlation test, a significant relationship was shown between the nutritional status of the children (weight for age and height for age) with the mother’s educational level, and the number of children in the family. There was also a significant relationship between mother’s nutrition knowledge and the nutritional status of the children (weight for age). Inadequate calorie intake is one of the important factors involved in the causation of protein energy malnutrition. This problem is influenced by socio-economic factor such as low educational level and nutrition knowledge of mothers and large family size. Parents should be encouraged to participate in activities that enhance nutrition knowledge and promote good nutritional practices. FELDA is encouraged to organize more such activities.
Anaemia still constitutes a public health problem in the world, especially in the developing countries (1). Nutritional deficiency remains a major causative factor (2). During pregnancy, growth of the foetus, placenta and the larger amount of circulating blood in the expectant mother will lead to an increase in the demand for nutrients, especially iron and folic acid. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies. In pregnancy, anaemia has been shown to be associated with an increased risk of maternal and fetal morbidity and mortality (3,4,5). Iron and folic acid supplementation is routinely given to pregnant mothers in Malaysia. It is anticipated that pregnant mothers who comply strictly with the prescribed iron supplement will maintain adequate iron stores at parturition. However, the compliance rate among rural mothers in Kelantan is often poor (6). Kelantan is also one of the most socio-economically underdeveloped
A survey of infant-feeding and weaning practices of 566 mothers, systematically sampled from 15 rural villages, randomly selected in the district of Tumpat, Kelantan was carried out. Almost all mothers (97.3%) breastfed their children, reinforcing the previously reported high incidence of breast-feeding among rural Malaysian mothers. One hundred and seventeen (21.3%) of the 551 children breastfed were also given mixed feeding with infant fomulae as well. Weaning started before 4 months of age in 28.3% of the children and after 6 months of age in 12.8% of the children. The 3 most common type of food used in weaning were Nestum (45.0%), rice porridge or paste (42.6%) and wheat porridge or cakes (11.5%). Forty eight children (12.1%) discontinued breastfeeding once weaning was initiated. The main reasons for initiating weaning was mothers' perception that there was insufficient milk and that the child was always hungry (55.7%). Most mothers were also given advice by the health clinic staff on weaning, including the timing and the suitable weaning foods to give. All of the mothers were able to name at least one commercial weaning food product available in their community.