Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, et al.
ISBN: 0-7326-0959-3
Citation: Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, Rosenblatt R, Rourke J, Strasser R, Wainer J. WONCA Policy on Rural Practice and Rural Health. Traralgon, Victoria, Australia: Monash University School of Rural Health; World Organisation of Family Doctors (WONCA), 2001
Citation: Abu Bakar, Suleiman
Keynote Address. Bengkel “Program Perubatan Keluarga: Posting Pusat Kesihatan”. Pusat Kesihatan Padang Serai, Kulim, Kedah, Malaysia, 27 Mac 1995
Matched MeSH terms: Rural Health; Rural Health Services
BACKGROUND: Measures of central adiposity are better predictors of adverse health events than BMI. Nonetheless, BMI is more widely used in health research. One reason for this may be the limited research supporting the self-measurement of waist and hip circumference. The lack of validity studies is particularly acute in Asia. The main objective was to establish the validity of self-measurement of waist and hip circumference in a community setting and the correlation of those measures with BMI, blood pressure, and blood glucose levels.
METHODS: A community based, cross-sectional survey. A "healthy living expo" at a shopping mall in a rural town on peninsular Malaysia One hundred and thirty six (136) individuals volunteered to participate in the study, 125 of whom met the inclusion criteria. The ethnic distribution of the participants was 80% Chinese, 17% Malay and 3% Indian. Most participants were female (60%), with participants' ages ranging from 18 to 78 years (mean, 47.2). Self and assisted measurements of waist and hip were taken. Blood pressure, non-fasting blood glucose, height, and weight were also measured. Bland Altman plots and Lin's concordance coefficient were used to measure agreement between self and assisted measures. Pearson's correlation was used to examine the association of self and assisted measures with blood pressure, blood glucose, and BMI.
RESULTS: There was a downwards bias in self measured waist (-0.81 cm) and hip (-1 cm) circumferences compared with assisted measures. The concordance for the self and assisted measures of waist, hip and the ratio of the two were, respectively, .96, .93 , and .84. The correlation between measures of central adiposity and BMI, blood pressure and blood glucose were similar for self and assisted measures.
CONCLUSION: The results provide additional support for the use of self-measurement of waist and hip circumference studies of central adiposity, but is limited by the specificity of the setting.
Food insecurity occurs whenever people are not able to access enough food at all times for an active and healthy life or when adequate and safe food acquired by socially acceptable ways is not available.
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.
Oral health care services are often sparse and inconsistent in India therefore it is often difficult for poor people to get access to the oral health care services. The approach by dental institutions with the help of community outreach programs is a step ahead in overcoming this situation.
Matched MeSH terms: Rural Health Services/organization & administration*
OBJECTIVE:This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria.
DESIGN: An exploratory descriptive design.
SETTING: Small rural hospitals in Gippsland, Victoria.
PARTICIPANTS: Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia).
RESULTS AND CONCLUSION: Recruitment of married overseas trained nurses is more sustainable than that of single registered nurses, however, the process of recruitment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommodation and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospitals. Overall both the registered nurses and the employees believe the experience to be beneficial rather than detrimental.
Matched MeSH terms: Rural Health Services/manpower*
In this review, our aim was to examine the influence of geographic variations on asthma prevalence and morbidity among adults, which is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity. Asthma is a complex inflammatory disease of multifactorial origin, and is influenced by both environmental and genetic factors. The disparities in asthma prevalence and morbidity among the world's geographic locations are more likely to be associated with environmental exposures than genetic differences. In writing this article, we found that the indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke in both urban and rural areas. Asthma and asthma-related symptoms occurred more frequently in urban than in rural areas, and that difference correlated with environmental risk exposures, SES, and healthcare access. Environmental risk factors to which urban adults were more frequently exposed than rural adults were dust mites,high levels of vehicle emissions, and a westernized lifestyle.Exposure to indoor biological contaminants in the urban environment is common.The main risk factors for developing asthma in urban areas are atopy and allergy to house dust mites, followed by allergens from animal dander. House dust mite exposure may potentially explain differences in diagnosis of asthma prevalence and morbidity among adults in urban vs. rural areas. In addition, the prevalence of asthma morbidity increases with urbanization. High levels of vehicle emissions,Western lifestyles and degree of urbanization itself, may affect outdoor and thereby indoor air quality. In urban areas, biomass fuels have been widely replaced by cleaner energy sources at home, such as gas and electricity, but in most developing countries, coal is still a major source of fuel for cooking and heating, particularly in winter. Moreover, exposure to ETS is common at home or at work in urban areas.There is evidence that asthma prevalence and morbidity is less common in rural than in urban areas. The possible reasons are that rural residents are exposed early in life to stables and to farm milk production, and such exposures are protective against developing asthma morbidity. Even so, asthma morbidity is disproportionately high among poor inner-city residents and in rural populations. A higher proportion of adult residents of nonmetropolitan areas were characterized as follows:aged 55 years or older, no previous college admission, low household income, no health insurance coverage, and could not see a doctor due to healthcare service availability, etc. In rural areas, biomass fuels meet more than 70% of the rural energy needs. Progress in adopting modern energy sources in rural areas has been slow. The most direct health impact comes from household energy use among the poor, who depend almost entirely on burning biomass fuels in simple cooking devices that are placed in inadequately ventilated spaces. Prospective studies are needed to assess the long-term effects of biomass smoke on lung health among adults in rural areas.Geographic differences in asthma susceptibility exist around the world. The reason for the differences in asthma prevalence in rural and urban areas may be due to the fact that populations have different lifestyles and cultures, as well as different environmental exposures and different genetic backgrounds. Identifying geographic disparities in asthma hospitalizations is critical to implementing prevention strategies,reducing morbidity, and improving healthcare financing for clinical asthma treatment. Although evidence shows that differences in the prevalence of asthma do exist between urban and rural dwellers in many parts of the world, including in developed countries, data are inadequate to evaluate the extent to which different pollutant exposures contribute to asthma morbidity and severity of asthma between urban and rural areas.
A survey was carried out in a Malay-speaking Muslim community in southern Thailand to obtain baseline data for planning of long term multidisciplinary research and development. By using a 30-cluster sampling technique, 210 households of 1,308 subjects were studied in the post-Ramadan period. It was found that the community was in a social transition. The crude birth rate was 4% and 37.6% of the households had at least one migrant. About half of these migrants had been to Malaysia and mainly worked in rubber plantations. Ninety-five per cent of the households had electricity whereas only 23.8% had a latrine. Boiled or rain water was regularly drunk in only 13.3 per cent of the households. Home-grown agricultural products were not sufficient to provide adequate food. Twenty-six per cent of the adults were unemployed and 24.6% were illiterate. Of the pregnancies 26.7% had no antenatal care and complete tetanus toxoid was given to only 27.8%. Traditional birth attendants conducted 81.1% of the deliveries and only 28.9 and 24.4% of the umbilical cords were correctly cut and correctly dressed, respectively. Breast feeding was still a common (87.8%) practice. However, complete immunization was given to only 10.8%, and 37.8% of the infants had at least one diarrheal episode in the previous month. It was concluded that high birth rate, high migration, low education, low income and bad health of infants are major problems. These problems were interlinked and needed a special multidisciplinary approach. In addition to common obstacles for routine health delivery, migration may create international complications, particularly related to maternal and child care.
Strasser R, Rourke J, Anwar I, Naidoo N, Rabinowitz H, McLeod J, et al.
ISBN: 0 7326 0961 5
Citation: Strasser R, Rourke J, Anwar I, Naidoo N, Rabinowitz H, McLeod J, Newbery P, Aziz T, Rosenblatt R, Lee SH, Wynn-Jones J, Rajakumar MK, Yuan G, Chater B, Doolan T, Cowley J, Simpson C. Training for rural general practice. Traralgon , Victoria, Australia: Monash University School of Rural Health; World Organization of Family Doctors (WONCA), 1995
To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia.
Matched MeSH terms: Rural Health/statistics & numerical data
A cross sectional study was conducted among 1007 children aged 1-2 years, from padi farming area. The percentage of male children was 51.4%. The prevalence of at least one of the chronic respiratory symptoms was 12.81%, and the prevalence of chronic cough, chronic sputum, wheezing and bronchial asthma as diagnosed by doctors were 9.33%, 3.87% 5.36% and 3.38% respectively. The overall prevalence of bronchial asthma was 6.26%. The prevalence of asthma was highest among children aged 11-12 years (8.9%) and higher among males (6.95%). No significant relationship was found between the prevalence of either chronic respiratory disease symptoms of bronchial asthma, and selected environmental factors, namely exposure to cigarette smoke, use of mosquito coil and wood stove. However there was a significant relationship between prevalence of asthma in children and history of asthma among parents and grandparents.
Study site: Two villages in Tg. Karang (Kg. Sawah Sempadan and Kg Sri Tiram Jaya), Selangor, Malaysia
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.
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.
This article examines the numerous problems faced by primary health care in Malaysia, care that traditionally has been a private sector activity. While general practitioners have adapted, and are continually adapting, to the needs of a multiracial society with diverse cultural patterns, it is hoped that with the emergence of a dynamic discipline of family practice, family doctors will be able to provide a sophisticated form of primary health care that will serve the needs of the people.