Despite great development in socioeconomic status throughout 50 years of independence, Malaysia is still plagued with soil-transmitted helminthiases (STH). STH continue to have a significant impact on public health particularly in rural communities. In order to determine the prevalence of STH among rural Orang Asli children and to investigate the possible risk factors affecting the pattern of this prevalence, fecal samples were collected from 292 Orang Asli primary schoolchildren (145 males and 147 females) age 7-12 years, from Pos Betau, Kuala Lipis, Pahang. The samples were examined by Kato-Katz and Harada Mori techniques. Socioeconomic data were collected using pre-tested questionnaires. The overall prevalence of ascariasis, trichuriasis, and hookworm infections were 67.8, 95.5 and 13.4%, respectively. Twenty-nine point eight percent of the children had heavy trichuriasis, while 22.3% had heavy ascariasis. Sixty-seven point seven percent of the children had mixed infections. Age > 10 years (p = 0.016), no toilet in the house (p = 0.012), working mother (p = 0.040), low household income (p = 0.033), and large family size (p = 0.028) were identified as risk factors for ascariasis. Logistic regression confirmed low income, no toilet in the house and working mother as significant risk factors for ascariasis. The prevalence of STH is still very high in rural Malaysian communities. STH may also contribute to other health problems such as micronutrient deficiencies, protein-energy malnutrition and poor educational achievement. Public health personnel need to reassess current control measures and identify innovative and integrated ways in order to reduce STH significantly in rural communities.
Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.
A cross-sectional survey covering 976 households in 41 rural villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the type of latrines they have and their usage of pourflush latrines. The survey was carried out by inspection and interview. Fifty-six percent of the households had pourflush latrines and upon inspection 91.3% of them showed signs of recent use. Based on the interview, ninety percent of the women responded that they always use the latrine for defecation. It was also reported that 86.5% of the husbands and 47.6% of the children below five years, always used the latrine for defecation. The most common reason for not using the latrine among adults was the lack of water to flush the latrines as well as not being home when the need arises. The reason for using the latrines were to keep the compound clean, convenience and health reasons. It is recommended that building latrines continue to be a prerequisite for getting water supply under the program and that non health-related reasons be emphasized in health education which aim to motivate people to build and use the latrines.
Idiopathic chronic anal fissure is believed to be a consequence of a traumatic acute anodermal tear followed by recurrent inflammation and poor healing due to relative tissue ischaemia secondary to internal sphincter spasm. This pilot trial compared the efficacy of a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec) to the standard procedure of lateral internal sphincterotomy (LIS) for chronic anal fissure.
This paper presents the socio-economic profile of households in the Family Dynamics Study (FDS) (1997-2001) and makes comparisons with the earlier Functional Groups Study (FGS) (1992-1996). For the current study, FGS villages with a high prevalence of child malnutrition were purposively selected. In each village selected, all households were included, and interviews with a structured questionnaire were conducted in April-May 1998. Incomes were generally low and incidence of poverty was high; 49.6% of the households were under the poverty line income, of which 37.2% were poor and 12.4% were hard core poor. Overall, only 23.2% of heads of households were in agricultural occupations, others being primarily waged workers and petty traders. Livestock rearing was widespread (57.8%), and most households (90.4%) owned at least one motorised vehicle, the most common being the motorcycle. The majority of households had refrigerators (73.6%), washing machines (58.8%), and televisions (91.1%); but telephones (42.2%), mobile phones (6.1%) and computers (2.3%) were less common. Although 99.7% of households had electricity supply and 95.1% had either a flush or pour flush latrine, only 57.4% had piped water supply. In comparison to the FGS, poverty in the current study is lower (49.6% of FDS households are poor compared to 55.2% of FGS households), the proportion of household heads in agricultural occupations is also lower (26.9% compared to 55.3%), while all other socioeconomic indicators were better, except for piped water supply, which remains inadequate for households in the current study.
The lower percentage of water, sanitation and hygiene are the root causes of diarrhoea and cholera. Cholera is a sudden onset of acute watery diarrhoea which can progress to severe dehydration and death if untreated. The current pandemic, Vibrio Cholera O1 started in 1961. This study explores water, sanitation, hygiene and cholera and diarrhoea in three affected villages of Beluran District, Sabah Malaysia to support effective and timely public health intervention. This cross sectional study uses purposive sampling. All (114) households were interviewed and household water samples collected. The study reported lower coverage improved sanitation facilities (35.3% to 52.3%), no latrine at home (37% to 63%), improved water supply (52% to 60%), and prevalence of hand washing after toilet (57% - 74%). For water quality, Ecoli was present in household water (32% to 37%) but Vibrio cholerae was not isolated in any of the water samples tested. Statistically significant associations were found for; 1) occupation−nonagriculture and unimproved sanitation facility and 2) house ownership and correct knowledge of ORS preparation. Predictors for household water quality were: latrine at home, and improved household toilet. Aggressive strategies to improve water supply, sanitation and hygiene−hand washing after toilet−were recommended for future prevention of cholera and diarrhoea in the affected area.
Background : Safe potable water is critical during and post flood. In the pre-flood period, Johore has an excellent, systematic and comprehensive water supply system. More than 98.6% of Johore population received treated water supply from the water treatment plants.
Methodology : Data collection was performed by conducting additional water sampling at routine sampling stations as well as the flood relief centres, water tankers (lorries) and static water tanks. Water treatment plant outlet and water tanker inlet shall have a minimum level of 2.0 mg/l of residual chlorine so that reticulation, water tanker outlets and static water tanks would have at least 0.5 mg/l as a measure to prevent the incidence of water borne diseases. Sampling was done everyday to monitor water quality at the flood relief centres as well as flood-hit areas. Inspections and surveillance on sanitation were also conducted on latrines, solid waste disposal systems and on the surrounding environment.
Results : A total of 6,283 water samples had been collected during and post flood. Violations on E. coli, turbidity and residual chlorine were 0.8%, 0.6% and 4.0% respectively with the Kluang district recorded the highest percentages for all the three parameters. A number of 621 wells had been inspected with 378 of them (60.9%) had been chlorinated. In order to ensure environmental cleanliness, 26,815 houses in 708 villages had been visited. Out of them, 2,011 houses (7.5%) were not satisfactory. Sanitation inspections found that 1,778 latrines, 2,719 domestic water sewerage systems and 2,955 solid waste disposal systems were under substandard conditions thus remedial actions had been taken immediately.
Conclusion : Although the flood disaster was massive with prolonged flooding period, however, an overall quality status on treated water supply was satisfactory whilst sanitary hygiene was under control. Hence, the incidence of communicable disease especially water borne diseases would not progress into serious outbreak, in fact, neither cholera nor typhoid was reported during the Johore flood disaster.
Malaysia is a rapidly developing country with a very young population, about 36% of which are below the age of 15 years. The standard of child health has improved greatly. However, there are great changes in the morbidity and mortality patterns of childhood diseases relating mainly to an improved standard of living; availability of safe water supply and adequate sanitary latrines; a higher literacy rate; rapid industrialisation and urban migration. The infant mortality rate has droppedfrom 50.1 per 1,000 livebirths in 1986 to 10.4 in 1995, and similar trends apply also to neonatal, perinatal and toddler mortality rates. Nevertheless, current major child health problems are those relating to events in the perinatal period and to infections. Despite improvements in the standard of neonatal care with the use ofhigh technology, the commonest cause of certified deaths still occur in the neonatal period. A rapid and inexpensive screening test for G6PD deficiency, a disease present in 2-3% of the population, is now widely available and, together with the use of phototherapy is largely responsible for the declining incidence of kernicterus in the country. Infections remain an important cause of morbidity and mortality although their patterns have changed. The very high (>95%) WHO-EPI-vaccines coverage rate is linked to the great reduction in the incidence of diphtheria, pertussis, tetanus, poliomyelitis and measles. Childhood tuberculosis is less common now, with about 250 - 300 reported cases per year and TB meningitis is rare with about 30-40 reported cases/year. The hepatitis B carrier rate is high (5%) and the introduction of routine newborn hepatitis B vaccination in 1989 is expected to have a positive impact as is the immunisation of young girls against rubella introduced in 1985 in reducing the incidence of congenital rubella syndrome. The incidence of malaria has declined but remains prevalent in the interiors of PeninsularMalaysia and in Sabah and Sarawak. Filariasis is largely under control. Unfortunately, despite great efforts at mosquito control, dengue virus infection remains a major problem with thousands of cases reported every year. Children are most susceptible to dengue haemorrhagic fever with many dying from the shock syndrome. The incidence of acute gastroenteritis has also dropped with most cases being due to a viral aetiology. Acute respiratory infections, mostly viral in origin, account for most attendances at paediatric outpatient services. Although staphylococcal and streptococcal impetigo and pneumonia are common, the incidence of streptococcal related diseases like rheumatic fever and acute glomendonephritis is rapidly declining. The nutritional status of children has improved in tandem with the rise in the standard of living, but subclinical malnutrition is prevalent, particularly among urban squatters and the rural poor. There is a disturbing decline in breastfeeding among urban working mothers. Poor weaning practices and food habits are responsible for the common occurrence of nutritional anaemia (5%) among infants and young children. Greater prosperity, rapid industrialisation and urbanisation have resulted in changes in the childhood disease pattern where non-communicable diseases assume greater importance as the problems of malnutrition and infection are gradually overcome. Road traffic accidents are a major killer and home accidents, largely preventable, are an important cause of morbidity and mortality. Childhood cancer, with about 550 new cases a year, is an important cause of death beyond infancy. Major congenital malformations, with a 1% prevalence rate, cause much ill-health. Thalassaemia is a particularly common genetic disease with fl thalassaemia gene frequency of about 5%. The prevalence of asthma is increasing, with a rate of 13.9% in the Kiang Valley but the prevalence of asthma-related symptoms is much higher. Physical, sexual child abuse and neglect, abandoned babies, substance abuse are but signs of stress of modern city living and peoples inability to cope with it. Although the general standard of child health has greatly improved, there are several states where it is still not satisfactory. In Sabah where there is a large illegal immigrant population, the infant mortality and infection rates are relatively high. In Kelantan and Trengganu, it is common for parents to refuse permission for a lumbar puncture required to treat meningitis. Other still deeply entrenched, culturally-related adverse health practices include : a fatalistic attitude to illness; a preference for traditional practitioners of medicine resulting in late treatment; and 'doctor-hopping' with unrealistic expectations of 'instant cure'. Childhood illnesses that are uncommon in Malaysia include: cystic fibrosis, coeliac disease, ulcerative colitis, Crohns disease, Sudden Infant Death Syndrome, Encopresis, enuresis and epiglottitis due to Haemophilus Influen:ae.
Access to improved water and sanitation is essential. We describe these practices in Malaysia using data from a nationwide community survey and used logistic regression to assess the determinants. Of the 7978 living quarters (LQs), 58.3% were in urban areas. About 2.4%, 0.5% and 27.4% of LQs had non-improved water sources, non-improved toilet types and improper domestic waste disposal, respectively. Open burning was practiced by 26.1%. Water source was a problem for long houses (10.5%), squatters (8.5%) and shared houses (4.0%). Non-improved toilet types were 11.9% for squatters and 4.8% for shared houses. Improper domestic waste disposal practices were higher for occupants of village houses (64.2%), long houses (54.4%), single houses (45.8%) and squatters (35.6%). An increase in education or income level was associated with a decrease in improper domestic waste disposal methods. House type significantly affected water and sanitation after adjusting for the effects of other variables. Lower household income was associated with non-improved toilet types and improper domestic waste disposal. Lower education and rural location influenced domestic waste disposal. The water and toilet facilities in Malaysia were generally good, while domestic waste management practices could be improved. There remain pockets of communities with environmental challenges for the nation.
An intensive health education programme geared towards increasing community's knowledge and inducing some changes in the attitude and behavioural factors towards the use of latrines.