The objective of the study is to investigate the extent of preventive and promotive health care in the ambulatory management of paediatric gastroenteritis in an incompletely immunised child using the simulated patient methodology. Only 44% of doctors explained to the fathers the nature of their child's ailment. 75% of clinicians prescribed oral rehydration solution but only 4% met the Gold Standard. The questionnaire survey showed that doctors rated immunisation as a very important health message to disseminate to all parents. But only 3% of doctors in the study advised parents to complete each child's immunisation once he is well. The extent of preventive and promotive health care in ambulatory paediatric practice in the Klang Valley is very low. (Copied from article).
Food insecurity exists whenever people are not able to access sufficient food at all times for an active and healthy life. This study used the Radimer/Cornell hunger and food insecurity instrument to assess food insecurity and to determine the risk factors and consequences of food insecurity among low-income households in Kuala Lumpur. One hundred and thirty-seven Malay pre-school children (4-6 years old) from Taman Sang Kancil were measured for their weights and heights. Questionnaires were used to collect food security and socioeconomic information on the households. The findings indicated that 34.3% of the households were food secure, while 65.7% experienced some kind of food insecurity, (27.7% households were food insecure, 10.9% individuals were food insecure and 27.0% fell into the child hunger category). The prevalence of underweight, stunting and wasting were 44.5%, 36.5% and 30.7% respectively. The prevalence of high weight-for-height (overweight) was 13.1%. Based on multinomial logistic regression, larger household size (OR=1.418; p<0.01) and lower educational level of mothers (OR=0.749; p<0.01) and fathers (OR=0.802; p<0.05) were found to be significant risk factors for food insecurity. The study, however, did not find any significant difference in children's nutritional status according to household food security levels. It is recommended that for the Malaysian population, the Radimer/Cornell hunger and food insecurity instrument should be modified and further validated with various ethnic groups in a variety of settings. The validation should include the appropriateness of the statements to the target grounds and their different risk factors and outcomes of food insecurity.
A cross-sectional study to determine the prevalence of malnutrition and some associated factors among primary one schoolchildren, aged 7 years from rural areas of Tumpat and Bachok in Kelantan was carried out. A total of 922 chiMren from 18 primary schools were examined. The parents completed self-administered questionnaires eliciting demographic and socio-economic information. The weight and height of each child was taken. The nutritional status was assessed by the z-scores of weight-for-age (WAZ) , height- or-age (HAZ) and weight-for-height (WHZ). The prevalence of underweight was 25 .2% , stunting was 21 .1% and wasting was 6 .2%. Less than 1 .0% ofthe children were overweight. Risk factors of underweight were lueinga male (OR=l .4),
having an unemployed father (OR=2 .6) and a monthly family income of RM 251 -500 (OR=2 .0) . Being a male (OR=1 .6) was the only risk factor for stunning and working mother (OR=2 .0) was the only risk factor of wasting. In conclusion, there is still a high prevalence of undemutrition among primary one schoolchildren in rural areas of Tumpat and Bachok. This may be due to the poor socioeconomic status of the rural community and the lack of emphasis ofthe supplementary feeding program on the late preschool children. A comprehensive nutrition support program is essential, especially targeting the preschool children in these rural communities
Even though vaccines are effective for prevention of diseases, compliance with recommended schedules of immunisation in early childhood is not always complete. Identification of potential risk factors associated with under-immunisation may help increase vaccination uptake. The objectives of this study were to determine the prevalence and risk factors of under-immunisation in hospitalised preschool children in Universiti Sains Malaysia Hospital (HUSM). Children aged 1 month to 2 years admitted between December 1998 and December 2000 in medical paediatric wards at HUSM were studied. Parents/guardians were interviewed during admission regarding immunisation status and potential risk factors. Children who did not have home-based cards during admission were excluded. Among 401 children, 37.9% had complete immunisation, 43.4% had delayed immunisation and 34.9% had incomplete immunisation. The uptake of BCG, DPT/OPV 1, DPT/OPV2, Hepatitis B3, DPT/OPV3, and measles were 98.5%, 90.7%, 83.2%, 81.4%,79.2% and 72.9% respectively. Vaccines scheduled to be given at later ages were significantly less likely to be taken (p=0.002) compared with vaccines scheduled to be given at an earlier age. Significant independent risk factors for under-immunisation were elderly mothers (3 40 years old) (OR 3.0, 95% CI: 1.2-8.0), low birth weight £2.0 kg (OR 6.2; 95% CI: 1.8-21.4) and presence of chronic illness in the child (OR 4.5; 95% CI: 2.5-7.9). In children whose father's education was low (primary school or no education), low maternal education was significantly associated with lower rate of under-immunisation (p = 0.005, OR 0.11 95%CI 0.02-0.51).
In conclusion this study showed that a large proportion of hospitalised preschool children were under-immunised, and vaccines scheduled to be given at a later age had lower uptakes. The situation can be rectified if every opportunity is taken to immunise all children, who have lapsed in their immunisation schedule.
This is a cross-sectional study to determine the association between religious perception and smoking behavior of secondary male students in Kota Bharu, Kelantan. A self-administered questionnaire survey was conducted on 526 secondary four male students from eight randomly selected schools in Kota Bharu. There were 182 (34.6%) students who were current smokers, 12 (2.3%) were ex-smokers and 332 (63.1%) were non·smokers. More than half of the current smokers (53.4%) smoked regularly. Student’s perceptions on the religious opinion on smoking were signihcantly associated with smoking behavior. Other significant risk factors were having close friends who smoke, their perceptions on benefits and negative effects of smoking and the level of
y relationship with their fathers. These factors were also found to be good predictors of student's smoking status. Health education programs to control smoking should include the religious aspect of smoking to improve it’s effectiveness.
On December 26, 2004, an earthquake triggered a devastating tsunami that caused death and destruction in twelve countries including India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka and Thailand. One of the authors was a volunteer with FELDA WAJA AMAN MALAYSIA medical relief team that served the Aceh victims from 16th February to 24th February 2005 (8 weeks post tsunami). A study to determine the pattern of health ailments was conducted among children aged 18 years and below based at Seuneubok Camp, 30 km from Banda Aceh. All respondents were from Pulau Aceh and the total number of children seen and examined was 60. About 18% had lost their fathers, 10 % had lost their mothers and 27% had lost one or more of their siblings. 77% suffered some form of health ailments. The common health ailments were diarrhea (61%), respiratory complaints (59%) and fever (20%). About 38 % of preschoolers had loss of appetite and 28% had sleep disturbances. About 35% of the elementary school children suffered from sleep disturbances, 29% of the young adolescents suffered from headaches and 24% had sleep disturbances. Nearly a quarter (24%) of all the children felt fearful and anxious about the disaster. Nevertheless, 56% of the respondents wanted to return back to Pulau Aceh, although 14 % did not want to go back. Interestingly, 73% of the children voiced their gratitude to God for having been saved from death.
Psychoanalysts believed that early mother-child relationships form the prototype of all future relationships and the outcome of adolescents development depends on their ego-strength. Object relations theory believed that intrapsychic process mediates interpersonal interaction to develop a sense of secure self and adolescents must relinquish the internalized other in order to develop a more mature sense of self. Social-relation theory believed that mothers and fathers provide different socialization experiences. Self-esteem depends on the functioning of the whole family in which adolescent is intimately related to the dyadic relationship in a family. There is an association between interparental conflict and adolescent's self-esteem and problem behaviour.
Fragile X syndrome is a result of an unstable expansion of (CGG)n trinucleotide sequences in the FMR-1 (Fragile X Mental Retardation 1) gene site at Xq27. In a normal person, n ranges from 6 to 40 repeats with an average of 30 repeats, whereas in a mutated FMR1 gene the sequence is repeated several times over (stuttering gene). Full mutation occurs when n equals 200 repeats or more. Where n equals 50 to 200 repeats, it is a premutation. Fragile X occurs when the FMR-1 gene is unable to make normal amounts of usable Fragile X Mental Retardation Protein, or FMRP. The amount of FMRP in the body is one factor that determines the severity of the Fragile X syndrome. A person with nearly normal levels of FMRP usually has mild or no symptoms, while a person with very little or no normal FMRP has more severe symptoms. The mechanism for the role of the FMRP gene is still being researched upon. However, it has been observed that large numbers of repeats (more than 200) inactivates the gene through a process of methylation and when the gene is inactivated, the cell may make little or none of the needed FMRP. Inheritance is X-linked with reduced penetrance and the frequency of occurrence goes up through generations. The phenotypic manifestations of fragile-X syndrome vary and are largely dependent on the size of the mutation or premutation. The identification of the fragile site on G banded metaphases is a time consuming and delicate process requiring experience and skill, however, molecular diagnosis using DNA analysis and Southern blotting, even though expensive, is more specific in determining the presence or absence of the gene. This study was aimed to establish a rapid polymerase chain reaction (PCR) based - touch down PCR, as a screening method for fragile X syndrome. A total of six cases were analysed. Of these, one was a known case of Fragile X (T1) diagnosed by conventional cytogenetics, two were from the latter’s family members namely, his mother (T2) and father (T3), and the other two (T4 and T5) were randomly selected from patients presenting with dysmorphic features and delayed development respectively. One normal control (TC) was included. Cytogenetic analyses for detection of the fragile site was carried out in all cases. Two culture systems were used, namely the synchronised lymphocyte culture and the folate - thymidine deficient culture. Stained metaphases from the fragile X cultures were screened for the presence of the fragile site on the X chromosome. G-banded karyotyping was done using an image analyser to exclude presence of chromosomal abnormalities. DNA was extracted from these samples and amplified by touch-down PCR. Cytogenetic analysis revealed a folate-sensitive fragile site in the affected male, but none in the other five samples. G-banded karyotyping exhibited no additional chromosomal abnormalities. All extracted DNA samples were successfully amplified. Five of the samples showed presence of the product at the expected band at 552bp, excluding the presence of an expansion of CGG segment of the FMR-1 gene. The absence of a band in an affected individual, suggested a fully mutated allele of FRAXA (Folate Sensitive Fragile Site at Xq28). We succeeded in establishing a slightly modified touch-down PCR analysis. Our study indicates that PCR testing offers a rapid and specific method for screening of normal allele and full mutation of the fragile X gene. We suggest this technique to be applied as a complementary tool for cytogenetic analysis to detect the FRAXA gene.
Mr S is a 38 year old Indian man who has type 2 diabetes mellitus for 3 years. He is currently on metformin 500mg BD. His BMI is 24.9 kg/m2 (weight 72 kg, height 170 cm). His blood glucose is well controlled (HbA1c 6%). His fasting lipid levels are as follow: Total cholesterol 5.0 mmol/L, HDL-C 1.60 mmol/L, LDL-C 2.6 mmol/L and triglyceride 0.9 mmol/L. He has no family history of acute myocardial infarction. He is a smoker (14 sticks/day, 12 years) but non-hypertensive. He asks if he should take atorvastatin, a lipid-lowering drug that his father is taking. Should statins be started in type 2 diabetic patients without pre-existing coronary artery disease whose lipid level is not elevated?
In recent years, there has been concern that non-smokers may also be at risk from secondhand smoke exposure, especially children. This study was done to determine the prevalence of secondhand smoke exposure at home and the association between secondhand smoke exposure and respiratory symptoms among primary schoolchildren in Kota Bharu, Kelantan. This was a comparative cross-sectional study involving children, aged 10·12 years. A structured questionnaire was used to obtain the information on sociodemographic, respiratory symptoms and smokers in the house. A random sample of 10 from 95 primary schools in Kota Bharu was included. Six classes were randomly selected from each school, two classes each from each school year of primary 4·6. A total of 795 children completed the questionnaire during September 2003 till March 2004. 386 of children (48.6%) were boys and 409 children (51.4%) were girls. Most of the children were Malay (99.9%). A total of 442 (55.6%) children lived with at least 1 smoker in the house mainly from the smoking fathers. Significantly increased odds ratios due to secondhand smoke exposure were observed for most of the respiratory symptoms. The odds ratios (95% confidence interval) were 1.67 (1.18, 2.39) for cough in the morning, 1.59 (1.10, 2.30) for cough at night, 1.76 (1.16, 2.65) for cough most days for the previous 3 months, 1.57 (1.14, 2.17) for phlegm in the morning, 1.49 (1.08, Z.07) for phlegm during daytime or at night, 1.38 (1.03, 1.86) for nose problems in the morning, 1.40 (1.03, 1.90) for nose problems at night and 1.78 (1.14, 2.78) for throat problems at night, 1.55 (1.06, 2.26) for ever wheeze or diagnosed asthma by doctor, 1.57 (1.05, 2.36) for throat problems in the morning and 1.81 (1.15, 2.85) for throat problems during daytime. The odds ratios increased with increasing number of smokers at home for cough in the morning, cough most days for the previous 3 months, phlegm in the morning, ever wheeze or diagnosed asthma by doctor, throat problems in the morning, throat problems during daytime and throat problems at night. In view of the significant health risks posed to children by secondhand smoke, public health policies are needed to protect this vulnerable population. The aim of such policies Ls to ensure the right of every child to grow up in an environment free of tobacco smoke.
Generally, the karyotype profile of Down Syndrome has been reported to be full trisomy 21 in 92% of patients, mosaic trisomy 21 in 4% of patients and translocation involving chromosome 21 in 4% of patients in most of the population groups worldwide. But, karyotype analysis of 149 DS patients at the Human Genome Center, USM, during the past five years revealed that free trisomy accounted for 94.6%, mosaic trisomy 21 for 4.7% and translocation involving chromosome 21 in 0.7% of the Down Syndrome etiology in North East Malaysian population, indicating a low frequency of translocation DS in this region. Here, we report one case of translocation Down Syndrome encountered during karyotype analysis of 149 DS cases. Karyotype showed a robertsonian translocation where an entire extra chromosome 21 was attached to the centromere of one of the chromosome 14, resulting in a derivative chromosome 14 with attached chromosome 21. Karyotype analysis of the parents revealed a normal 46,XY pattern for father and 46,XX pattern for mother indicating that this robertsonian translocation had arisen de novo either prior to or at conception.
Interstitial deletions of the long arm of chromosome 4 are rare. The deletions may occur at the proximal or the distal portions of the chromosome and different breakpoints may be involved. We report an interstitial deletion of 4q: 46XY der 4 (q28;q35) in a six-year-old boy with dysmorphic features associated with moderate mental retardation. Parental chromosomal analysis showed a balanced paternal translocation.
We aimed to report the first case of anorexia nervosa in a young Malaysian Malay homosexual man with underlying borderline personality disorder and major depression. Patient and parents were interviewed. The Structured Clinical Interview for DSM IV was used to generate Axis-I diagnosis. The Hamilton Depressive Rating Scale was used to assess the severity of depression. His parents had marital discord. His father was overinvolved. Regarding anorexia nervosa, he had 163 cm height, 46kg weight and a body mass index (BMI) of 17 kg/m2. His four limbs had multiple scratch marks. Laboratory test results showed anemia, leukocytosis and hypoalbuminemia. Family pathology, borderline personality disorder and homosexuality could be the risk factors of anorexia nervosa in this patient.
This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented.
Sickle cell disease (SCD) is an inherited red cell disorder, characterized by the tendency of haemoglobin S or sickle haemoglobin to polymerize and assume a characteristic sickle shape. Molecular analysis has been the mainstay of detection method when confirmation is required. Previously a polymerase chain reaction (PCR)-based restriction enzyme analysis was used for this purpose. A simple bidirectional allele-specific amplification, recently described by Waterfall in 2001 was used to detect the GAG --> GTG mutation on codon 6 of the beta globin gene. Two sets of primers for the mutant and the wild type alleles were used in a single PCR reaction to amplify the regions of interest. The resultant PCR products will produce two fragments at 517 and 267 base pair (bp) respectively. This report highlights the investigations for SCD in the family of a 16-year old girl with recurrent painful crisis affecting the lower limbs whereby the family members are asymptomatic for the disease. Her haemoglobin electrophoresis at an alkaline pH showed dense bands at the HbS and HbF regions, while her father and two sisters had bands at HbS, HbF and HbA. The PCR analysis showed that she was homozygous for the mutation by the presence of only one band at 267 bp fragment, while the father and her sisters were heterozygotes, with the presence of two bands at 267 as well as 517 bp fragments. DNA sequencing of the sample confirmed the mutation. In conclusion, this case report highlighted the simple and cheap yet practical method for molecular confirmation of the presence of HbS gene in subjects with homozygous or heterozygous state of the condition.
This paper examines fatherhood among the Malay Muslims of Southern Thailand (representing a minority at the national level, but constituting the majority population in the region). Traditional practices related to birth and the postpartum period are upheld as a marker of ethnic and religious identity by such groups. Building on the concept of patrescence as 'becoming a father', proposed by Dana Raphael, the data presented show how the process of assuming fatherhood develops during pregnancy and continues after birth through a series of ritual practices in which a man contributes to female postpartum practices. The medicalisation of birth in synergy with recent literalist interpretations of Islam has impacted on these practices, making it difficult to comply with the ritual burial of the afterbirth, which constitutes the cosmological and physical anchoring of individual and ethnic identity to the soil.
Susceptibility to smoking, which is defined as a lack of cognitive commitment not to smoke in the future, has been shown to be a predictor for adolescent smoking initiation in developed countries. This study aims to evaluate the utility of a susceptibility-tosmoke measure as a predictor of smoking initiation among adolescents in Kota Tinggi district, Johor Malaysia. Susceptibility to smoking was evaluated among 1763 adolescents at baseline using a two-item construct. At follow-up 12 months later, 1288 of the 1763 adolescents (73.1%) responded. Results showed 14.9% (n=188/1260) of the respondents were susceptible to smoking at baseline. Among the susceptible adolescents, 31.9% initiated smoking after one year. Respondents who were identified as susceptible to smoking by the measure were 3.7 times (95%; CI: 2.17- 6.30) more likely to initiate smoking compared to non-susceptible respondents after adjusting for gender, school locality, percentage of friends who smoke, father smoking, parental acceptance of smoking, and belief in the positive and negative consequences of smoking. The findings suggest that the susceptibility measure is a reliable predictor and can be used as a screening tool to identify adolescents who are at risk of initiating smoking.
Adolescents are known to obtain information regarding sexual and reproductive health from a variety of sources and not just during formal lessons in schools. This cross-sectional descriptive study was carried out to determine the source of information on sexual and reproductive health among Form four secondary schools girls in the Klang Valley as well as parents’ relationship profile. A total of 520 secondary school girls were recruited for the study. In this study, the source of information on puberty and sexual topics were categorized as follows: first level of importance - mothers, second level of importance - siblings, third level of importance - fathers, fourth level of importance - friends, fifth level of importance - teachers and sixth level of importance - books/internet. A majority of respondents agreed that their mothers were the first level of importance they sought for information on puberty (74.8%) and sexual topics (53.8%). Thirty nine point three percent (39.3%) of respondents reported it was very easy to have a dialogue with their mothers while only 10.0% of the respondents said it was very easy to have a dialogue with their fathers. While this was the case, only 6.3% of the respondents reported discussing sex-related matter with their mothers.
INTRODUCTION: A qualitative comparative case study was conducted to compare and contrast food taboos and avoidance practices during pregnancy among Orang Asli or indigenous Temiar women in four distinct locations that represent different lifestyle experiences and cultural practices.
METHODS: Through snowballing sampling, a total of 38 participants took part in five focus groups: one group each in Pos Simpor and Pos Tohoi in Kelantan state, one group in Batu 12, Gombak in Selangor state, and two groups in a regroupment scheme (RPSOA) in Kuala Betis, Kelantan. All the transcripts were coded, categorised and 'thematised' using the software package for handling qualitative data, NVivo 8.
RESULTS: Variant food prohibitions were recorded among the Temiar women residing in different locations, which differ in food sources and ways of obtaining food. Consumption of seventeen types of food items was prohibited for a pregnant Temiar woman and her husband during the prenatal period. Fear of difficulties during labour and delivery, convulsions or sawan, harming the baby (such as foetal malformation), and twin pregnancy seemed to trigger many food proscriptions for the pregnant Temiar women, most of which have been passed on from generation to generation.
CONCLUSION: The findings of this study confirm that beliefs about food restrictions are strong among those Temiar living a traditional lifestyle. However, those who have adopted a more modern lifestyle also preserve them to some extent.pregnancy among Orang Asli or indigenous Temiar women in four distinct locations that represent different lifestyle experiences and cultural practices.