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The prevalence of malnutrition and geo-helminth infections among primary schoolchildren in rural Kelantan

Zulkifli A, Anuar AK, Atiya AS, Yano A

Southeast Asian J. Trop. Med. Public Health, 2000 Jun;31(2):339-45.
PMID: 11127336

A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.

Matched MeSH terms: Rural Health
Fulltext The prevalence and intensity of soil-transmitted helminthiasis among pre-school children in Orang Asli resettlement villages in Kelantan

Zulkifli A, Khairul AA, Atiya AS, Abdullah B, Yano A

Med J Malaysia, 1999 Dec;54(4):453-8.
PMID: 11072462

A study of the prevalence and intensity of soil-transmitted helminthiasis among pre-school children aged 0 to 7 years from an Orang Asli village resettlement scheme in Gua Musang, Kelantan was undertaken. The overall prevalence of soil transmitted helminthic (STH) infections was 56.0%. The predominant helminth found was Ascaris lumbricoides while the commonest type of infection was a mixed infection with Ascaris lumbricoides and Trichuris trichiura. The prevalence rates of Ascaris, Trichuris and hookworm infections were 47.5%, 33.9% and 6.2% respectively. The intensity of Ascaris infections were 64.5% light, 27.3% moderate and 8.3% heavy whilst the intensity of Trichuris infections were 80.5% light, 18.3% moderate and 1.2% heavy. However, the intensity of hookworm infections were 86.7% light, 13.3% moderate and no heavy infection. The prevalence of helminthiasis (STH) shows an-age dependent relationship, with the lowest prevalence in 0-< 1 year age group and highest in the 6-< 7 year age group.

Matched MeSH terms: Rural Health*
Fulltext Human Plasmodium knowlesi infections in South-East Asian countries

Zaw MT, Lin Z

J Microbiol Immunol Infect, 2019 Oct;52(5):679-684.
PMID: 31320238 DOI: 10.1016/j.jmii.2019.05.012

Plasmodium knowlesi is now regarded as the fifth malaria parasite causing human malaria as it is widely distributed in South-East Asian countries especially east Malaysia where two Malaysian states namely Sabah and Sarawak are situated. In 2004, Polymerase Chain Reaction (PCR) was applied for diagnosing knowlesi malaria in the Kapit Division of Sarawak, Malaysia, so that human P. knowlesi infections could be detected correctly while blood film microscopy diagnosed incorrectly as Plasmodium malariae. This parasite is transmitted from simian hosts to humans via Anopheles vectors. Indonesia is the another country in South East Asia where knowlesi malaria is moderately prevalent. In the last decade, Sarawak and Sabah, the two states of east Malaysia became the target of P. knowlesi research due to prevalence of cases with occasional fatal infections. The host species of P. knowlesi are three macaque species namely Macaca fascicularis, Macaca nemestrina and Macaca leonina while the vector species are the Leucosphyrus Complex and the Dirus Complex of the Leucophyrus Group of Anopheles mosquitoes. Rapid diagnostic tests (RDT) are non-existent for knowlesi malaria although timely treatment is necessary for preventing complications, fatality and drug resistance. Development of RDT is essential in dealing with P. knowlesi infections in poor rural healthcare services. Genetic studies of the parasite on possibility of human-to-human transmission of P. knowlesi were recommended for further studies.

Matched MeSH terms: Rural Health
Fulltext Estimates and distribution of body mass index in a sample of Malaysian adolescents

Zalilah MS, Mirnalini K, Khor GL, Merlin A, Bahaman AS, Norimah K

Med J Malaysia, 2006 Mar;61(1):48-58.
PMID: 16708734 MyJurnal

The purpose of this study was to report on the estimates and distribution of body mass index in a sample of Malaysian adolescents. The study utilized a cross-sectional design and multi-stage random sampling of secondary schools to select 5 urban and 9 rural schools in Kedah and Penang. A total of 6555 male and female adolescents (11-15 years old) of Malay, Chinese and Indian ethnic groups were measured for weights and heights for body mass index calculation. Information on household demographic and socioeconomic were obtained from parents through self-administered questionnaires. Analyses of body mass index distribution by location, ethnicity, gender and age were conducted using Chi-square test of SPSS 11.5. More of the rural (12.1%) and urban (19.4%) adolescents were underweight and overweight, respectively. While in all ethnic, gender and age groups, rural adolescents were more likely to be underweight, more of the urban adolescents were overweight. The prevalence of underweight was highest among the Indians (19.2%) and lowest in Chinese (7.2%). The prevalence of overweight in the three ethnic groups was in the range of 18-19%. More male than female adolescents were underweight (15% vs 7.8%) and overweight (19.5% vs 16.7%). Consistent patterns were also observed across location, ethnic and age groups. As age increased, the prevalence of overweight decreased across the ethnic and gender groups. The reported findings can serve as current reference on body mass index distribution of Malaysian adolescents and a basis for future efforts in health and nutrition interventions for Malaysian children and adolescents.

Matched MeSH terms: Rural Health
Fulltext Cardiovascular risk and events in 17 low-, middle-, and high-income countries

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al.

N Engl J Med, 2014 08 28;371(9):818-27.
PMID: 25162888 DOI: 10.1056/NEJMoa1311890

BACKGROUND: More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown.
METHODS: We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years.
RESULTS: The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001).
CONCLUSIONS: Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.).
Note: Malaysia is a study site (Author: Yusoff K)

Matched MeSH terms: Rural Health
Maternal mortality amongst the rural Malays

Yusof K

Med J Malaysia, 1974 Mar;28(3):149-53.
PMID: 4278186
Matched MeSH terms: Rural Health
Fulltext Antimicrobial stewardship in rural and remote primary health care: a narrative review

Yau JW, Thor SM, Tsai D, Speare T, Rissel C

Antimicrob Resist Infect Control, 2021 07 13;10(1):105.
PMID: 34256853 DOI: 10.1186/s13756-021-00964-1

BACKGROUND: Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies.
METHODS: The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools.
RESULTS: Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing.
CONCLUSIONS: Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

Matched MeSH terms: Rural Health Services*
Fulltext Health characteristics of rural elderly Malay females in selected villages in Negeri Sembilan

Yassin Z, Terry RD

Med J Malaysia, 1990 Dec;45(4):310-8.
PMID: 2152052

Health indices of 317 healthy elderly Malay females 55 years and older from two rural subdistricts in Negeri Sembilan were collected through personal interviews. About 33% of the respondents perceived their health condition as good to excellent, 63.4% rated their health status compared to a year earlier as about the same, 48.3% had no worry about their health, and 49.2% perceived themselves as physically active as their peers. Arthritis was the major ailment which affected the daily activities of about 64% of the respondents. The classical age-related problems of poor hearing, poor sight and difficulty in chewing were also prevalent among these elderly.

Matched MeSH terms: Rural Health*
Distribution of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse) in small towns and villages of Penang Island, Malaysia--an ovitrap survey

Yap HH

Southeast Asian J. Trop. Med. Public Health, 1975 Dec;6(4):519-24.
PMID: 1226538

An ovitrap survey was carried out in April and May of 1975 at twenty-one locations scattered throughout Penang Island excluding the City of Georgetown. The results showed the ubiquitous presence of Ae. albopictus. Ae. aegypti was recorded only in Tanjung Tokong Lama, an area adjacent to the City of Georgetown. In the survey, Ae. albopictus females were found to prefer the outdoor ovitraps than indoor ones. The effectiveness of ovitrap in Aedes survey was discussed.

Matched MeSH terms: Rural Health
Community Residency Programme (CRP)--a tool for research and rural health training for medical students

Yadav H

Med J Malaysia, 2002 Dec;57 Suppl E:94-8.
PMID: 12733201

Rural health training is an important element in the training of medical students in the University of Malaya. There is a need for the undergraduates to be familiar with the rural health infrastructure and to understand the social and economic aspects of the rural poor. The objective of the training is to make the students understand the problems faced by the poor in the rural areas so that when they practice in rural health areas, after graduation, they will understand the problems of the rural poor. They will have the knowledge of the diseases in the rural areas and also understand the community and the environmental factors that contribute to the disease. The training lasts' for 4 weeks, one week for lectures on health survey, two weeks for the field trip and one week of data analysis and presentation of their findings to an expert panel. During the field trip the students are divided into groups and they go to different parts of the country. Each group will do a field survey to find out the socio-demography, environmental, economic, nutritional and health problems in the village. In addition to the survey they also do a research project on any topic. The students also do social work, visit places of public health interest like the water treatment plant, sewage disposal, factory visits and others. Apart from technical skills in statistics and epidemiology, various other managerial skills like leadership, teamwork, communications and public relations are also learnt during the training. In conclusion this rural health training is an important aspect of the medical students training as it imparts several skills to them that are needed as a doctor.

Matched MeSH terms: Rural Health*
Fulltext Teleprimary care in Malaysia: a tool for teleconsultation and distance learning in health care

Yadav H, Lin WY

Asia Pac J Public Health, 2001;13 Suppl:S58-61.
PMID: 12109251

Malaysia enjoys a comprehensive range of health services, the government being committed to the principles of universal access to high quality health care, which the Ministry of Health provides through a wide variety of nation wide network of clinics and hospitals. One of the major problems is the availability of comprehensiveness and quality of health care in remote health centres. When patients are transferred from the health centres to the hospitals for further treatment, this not only incurs inconvenience to the patients and their family but also increases the cost to the health care system. Teleprimary care is one of the tools to overcome this problem. The doctors in the remote clinics are able to discuss the problem cases through teleconsultation with the doctors and specialist in the hospitals using an audiovisual system to provide better care in the health centers without transferring the patients to the hospitals. Only the essential and needy patients are referred to the hospitals. This has not only reduced the number of patients referred to the hospitals but it has reduced the cost to the health care system. It has also provided a more comprehensive care to the patients in the health centres. The doctors in the health centers are also provided training and are also updated on the latest in medicine. This method of training has made doctors in the health centers more efficient and satisfied.

Matched MeSH terms: Rural Health Services/manpower; Rural Health Services/standards
Fulltext A review of maternal mortality in Malaysia

Yadav H

International e-Journal of Science, Medicine & Education, 2012;6(10):0-0.
MyJurnal

There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.

Matched MeSH terms: Rural Health
The changing role of primary health care in Malaysia - The past and the future

Yadav H, Sirajoon NG

JUMMEC, 2001;6:36-39.

The concept of primary health care (PHC) according to WHO has been implemented in Malaysia since 1978. The rural health centres which provide the primary health care have developed from about 47 in 1970 to about 772 in 1998. Since the implementation of the health centres there has been significant reduction in morbidity and mortality rates. However due to the emerging issues like changing demographic 'patterns, changing pattern of disease, and increasing demand from the public, the delivery of PHC is being reviewed. Newer programmes and review of the older programmes are being done to address the provision of PHC in the 21st century. The functions and roles of the existing staff in the health centres are being reviewed. This new concept is known as expanded scope of primary health care. The purpose of this paper is to explain the achievements in primary health care and the components of primary health care in the expanded scope.

Matched MeSH terms: Rural Health
Fulltext Utilization of traditional birth attendants in MCH care in rural Malaysia

Yadav H

Singapore Med J, 1987 Dec;28(6):520-5.
PMID: 3441793

The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.

Matched MeSH terms: Rural Health*
Fulltext Self-reliance in health among village women

Wong ML, Chen PCY

World Health Forum, 1991;12(1):43-8.
PMID: 1859597
Matched MeSH terms: Rural Health*
The life of a malay child

Willliams CH

Journal of the Malaya Branch of the British Medical Association, 1938;2:73-84.

Matched MeSH terms: Rural Health
The delivery of a total tuberculosis service in a scattered rural community with poor communications

Webb AH

N Z Med J, 1973 Nov 14;78(502):412-4.
PMID: 4129253
Matched MeSH terms: Rural Health*
Supervisors' experiences of workplace supervision of nursing and paramedic students in rural settings: a scoping review

Trede F, McEwen C, Kenny A, O'Meara P

Nurse Educ Today, 2014 May;34(5):783-8.
PMID: 24698307 DOI: 10.1016/j.nedt.2013.10.003

We present our findings from a scoping review that sought to identify what is known about nursing and paramedic clinical supervisors' experiences of their supervision practices in rural settings. Our interest in these two groups is based on the central role that nurses and paramedics play in rural health care.

Matched MeSH terms: Rural Health Services*
Fulltext Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban women in six provinces of the Democratic People's Republic of Korea

Tran NT, Choe SI, Taylor R, Ko WS, Pyo HS, So HC

Asian Pac J Cancer Prev, 2011;12(11):3029-33.
PMID: 22393985

BACKGROUND: This study assessed women from the Democratic People's Republic of Korea for: (i) their level of knowledge of cervical cancer and attitudes and practices concerning cervical screening (KAP); and (ii) differences in KAP between rural and urban groups.

METHODS: In a descriptive cross-sectional study, a purposive sample of 200 women in 6 provinces of DPRK (rural: n=99, urban: n=101) were interviewed using a standardized questionnaire. Differences between proportions were assessed using the χ2 test. Significance was defined as p<0.05.

RESULTS: 63% of rural and 60% of urban participants had heard of cervical cancer (p>0.05). 42% knew that it is the most common cancer of the female reproductive tract, 55% knew that all women are at risk, but only 36% were aware of cervical cancer's preventability. Some 13% of rural and 29% of urban respondents had heard of cervical cytology testing (p<0.001). Only 6% of participants had ever received a cervical cytology smear. Among the reasons for not screening, 48% mentioned a lack of awareness of cervical cytology; 47% their dislike of pelvic examinations; 17% of rural and 31% of urban interviewees reported the absence of symptoms (p<0.05); and 62% of rural and 0% of urban women mentioned travelling long distances to service delivery points (p<0.001).

CONCLUSIONS: There is a reasonable level of knowledge of cervical cancer among North Korean women; however, there are major gaps regarding awareness of its preventability and actual uptake of cytology screening services. There are no significant differences between rural and urban women with regard to their KAP. Large scale health promotion campaigns are needed to educate women and the community about cervical cancer and its preventability through screening. The national health care system needs to ensure that screening services are effective, accessible, feasible and acceptable to women.

Matched MeSH terms: Rural Health
Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban female healthcare practitioners in the Democratic People's Republic of Korea

Tran NT, Taylor R, Choe SI, Pyo HS, Kim OS, So HC

Asian Pac J Cancer Prev, 2011;12(11):3023-8.
PMID: 22393984

BACKGROUND AND OBJECTIVE: Little is known about cervical cancer (CC) in the Democratic People's Republic of Korea (DPRK). This study examines the knowledge, attitudes and practices (KAP) concerning CC and screening among female health care practitioners (HCPs), and whether differences exist between rural and urban HCPs.

METHOD: In a descriptive cross-sectional study, a purposive sample of 200 women HCPs from 128 health care centers in 6 provinces of DPRK was interviewed using a standardized questionnaire.

RESULTS: 98% of HCPs were aware of CC. Awareness of the national CC policy was significantly lower in rural (44%) than urban (62%) respondents (p<0.05). Fewer rural (71%) than urban (89%) HCPs knew of cervical cytology (p<0.05). Around 30% of HCPs were aware of the association between CC and human papillomavirus infection. Only 13% of HCPs had ever had a cervical cytology smear. Only 4% of rural and 21% of urban practitioners (p<0.05) provided cytology; all used unaided visual inspection of the cervix without staining to determine whether cytology testing was indicated. For all, screening intervals depended on presence of symptoms.

CONCLUSION: Misconceptions and ineffective clinical practices regarding screening need to be urgently addressed among both rural and urban HCPs. There are no major differences between rural and urban HCPs regarding their KAP.

Matched MeSH terms: Rural Health

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