Screening by culture of endocervical specimens revealed four cases of gonorrhea among 744 pregnant women attending the prenatal clinic at the University Hospital in Kuala Lumpur, Malaysia. The observed prevalence of gonorrhea (0.54%) in pregnant women is similar to that in Great Britain (0.2-0.7%), but lower than the prevalences reported for North America (2.5-7.5%) and Thailand (11.9%). The results indicate that routine screening of pregnant women attending prenatal clinics in Malaysia would aid in the control of gonorrhea in that country.
Citation: National Health Morbidity Survey 1986. Kuala Lumpur: Ministry of Health, Malaysia, 1987
Study name: National Health and Morbidity Survey (NHMS-1986)
National Health and Morbidity Survey (NHMS) was first initiated in 1986. Its objectives were to supplement existing data on the pattern of health problems, health needs and expenditure on health in the community to enable the Ministry of Health to review priorities and activities of programmes, plan future allocation of resources and evaluate the impact of strategies.
The scopes covered in the survey were morbidity rates, health service utilizations and their barriers, health expenditure and their sources, immunization coverage, acute respiratory illness, hypertension, angina, smoking, diabetes, astma and injuries. The survey only focused in Peninsular Malaysia with response rate in different modules ranging from 92 to 100%. The survey was spearheaded by the Institute for Public Health (IPH) and partially supported by the World Health Organisation (WHO) Grant.
The scopes covered in this survey were load of illness, health seeking behaviour, health care consumption cost, health related behaviours (exercise, breast-feeding practices, pap-smear examination, breast examination, smoking, alcohol consumption, obesity, adolescent risky behaviour: smoking, alcohol consumption, drug abuse, sexual practices), specific health problems (hypertension, ischaemic heart disease, diabetes mellitus, medically diagnosed cancer, injury, physical impairments, astman and acuter respiratory inflections), and blood cholesterol level. The response rate at Living Quarters (LQ) level was 86.9%.
One hundred years ago cervical cancer was rapidly fatal, regardless of therapy rendered. Today with cytological screening, early diagnosis is possible and ablative therapy can be instituted in appropriate cases. The advent of coloscopy has helped reduce unnecessary cone biopsy for diagnosis. However, the same cannot be said of the use of cytology for screening endometrial cancer, and often endometrial tissue biopsy is necessary. Ovarian cancer is notoriously silent in its early stages and symptoms if present are generally non-specific. To date there is no other useful and reliable method for its early detection than routine pelvic examination. An annual cytological screening test for cervical cancer will give an opportunity for examination of the breasts, abdomen and pelvis. Screening techniques for female genital tract malignancies are discussed.
A monoclonal antibody raised against Haemophilus ducreyi was tested for its sensitivity and specificity as an immunofluorescence (IF) reagent using simulated vaginal smears containing H. ducreyi, smears taken from skin lesions of mice infected with H. ducreyi and patients from South Africa, Thailand and Malaysia with clinically diagnosed chancroid. The IF test was more sensitive than culture or Gram staining in the simulated smears, theoretically detecting less than 4 organisms/sample. It detected H. ducreyi in 95% of the animal lesions compared with 14% detected by culture. Immunofluorescence testing identified over 90% of culture-positive cases of chancroid but also detected organisms in some culture-negative cases where clinical evidence for the diagnosis was strong. These results suggest that this antibody may provide a simple, rapid and sensitive means of detecting H. ducreyi in cases of chancroid.
Seventy-seven patients who had PAP smear cytology and colposcopic examination in a 2-year period between 1988 and 1989 were reviewed. Those with findings indicative or suspicious of malignancy were subjected to biopsy. All 50 patients thus biopsied were confirmed to have preclinical cancer on histological examination. Compared against histology, PAP smear cytology gave an accuracy rate of 90% (5 false negatives) and colposcopy gave an accuracy rate of 94% (3 false negatives). These results demonstrate that the two techniques are useful as screening tests for preclinical cervical cancer. The results are improved if they are used complementarily. However, there was poor specificity in the categorisation of cervical cancer by both methods. This was probably due to the subjectiveness of the two procedures. The study also raised the possibility of a higher incidence of preclinical cervical cancer in the Chinese ethnic group.
Cytohormonal evaluation was done on the vaginal smears of 480 normal, asymptomatic, post-menopausal women whose ages ranged from 36 to 74 years. About 50% showed atrophic smears consistent with total oestrogen lack. 41% had mild to moderately proliferative smears compatible with sub-optimal oestrogen stimulus. 9% showed a highly proliferative pattern typical of unopposed oestrogen effect and in this group two women had atypical endometrial cells in their smears, which subsequently were found to come from an atypical endometrial hyperplasia and an endometrial adenocarcinoma-in-situ. The clinical relevance of cytohormonal studies in post-menopausal women is briefly discussed.
Cervico-vaginal smears from 350 IUCD users were analysed to ascertain the range of abnormalities induced in the genital tract of these women. Alteration of the microbial environment, inflammatory, degenerative, reparative and proplastic epithelial changes were the salient cytological findings. The clinical implications of these are briefly discussed.
A cross-sectional survey of 568 married women aged 21-65 years in the Pasir Panjang Constituency was conducted to determine the prevalence of cervical cancer screening in the community and the factors affecting acceptance of this screening test. Results show that 309 (54.4%) of the respondents had ever had a Pap smear. The women who reported having had a smear were more likely to be below 45 years of age (prevalence ratio 1.47, 95% confidence interval 1.15 to 1.88), Chinese and of a higher socioeconomic status (1.68, 1.33 to 2.12). They were also more likely to have married at a later age (1.68, 1.21 to 2.31) than women who had not had a smear. Age and socioeconomic status remained independent predictors on multivariate analysis. The findings suggest that an important task of public health practitioners is to increase the uptake of screening among older and socially disadvantaged women who are known to be at the highest risk of cervical cancer. In addition, strategies to encourage younger women to continue regular attendance at screening clinics beyond their childbearing years will be important for the future.
The study was conducted to determine the pick-up rate of abnormal cervical smears and the prevalence rate of cervical cancer in women aged 60 years and above and the demographic characteristics of the women screened. The pick-up rate of abnormal cervical smears was 1.65%. The prevalence rate for cervical intraepithelial neoplasia and frank carcinoma was 6.4 and 5.0 per thousand women screened respectively. The study group comprised 89.7% Chinese, 4.7% Malays, 3.6% Indians and 2.0% Others. The pick-up rate of abnormal smears was 1.9% in the Chinese and 1.3% in the Indians. There were no abnormal smears in the Malays and Others. The results demonstrate the importance of a routine cervical cancer screening programme among elderly women aged 60 years and above in Singapore.
The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.
Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital
Citation: National Health Morbidity Survey 1996. Kuala Lumpur: Ministry of Health, Malaysia, 1997
Study name: National Health and Morbidity Survey (NHMS-1996)
The Second National Health and Morbidity Study (NHMS 2) was conducted in 1996 and funded by R&D Funding under the Intensification of Research in Priority Areas Programme, Government of Malaysia and Ministry of Health. The need for this survey was identified during a discussion on research priority areas for the Seventh Malaysia Plan. NHMS 2 was aimed to provide community based data and information for the MOH to review health priorities, programme strategies and activities and planning for allocation of resources.
The scopes covered in this survey were load of illness, health seeking behaviour, healthcare consumption cost, health related behaviours (exercise, breast-feeding practices, pap-smear behaviour: smoking alcohol consumption, drug abuse, sexual practices), specific health problems (hypertension, ischaemic heart disease, diabetes mellitus, medically diagnosed cancer, injury, physical impairments, astmna and acute respiratory infections), and blood choleterol level. The NHMS 2 covered whole Malaysia including Sabah and Sarawak. The response rate at Living Quarters (LQ) level was 86.9%.