Sexuality of persons with spinal cord injury has received increased attention especially in the Western countries. However, in the local context, studies pertaining to the sexuality of the disabled are almost nil. This paper utilized a qualitative approach in assessing sexual knowledge, attitudes and practices of persons with spinal cord injury. Eight focus group discussions consisting of 28 adult spinal cord injured persons were carried out. The results showed that the frequency of sexual activity decreased following injury. The disabled themselves have a negative self-concept and a low self-esteem and this affects their attitudes towards sexuality and their sexual behaviour. Health care professionals tend to neglect this issue perhaps due to their insensitivity to the sexual needs for the disabled or a lack of understanding and expertise in this area. A need for sexual information related to their disability is warranted in the areas of reproduction, contraception and their ability/disability in achieving an erection or ejaculation. This study indicated a need for more comprehensive research in this neglected area of sexual issues of persons with disabilities. Public health education and counseling is deemed necessary for the disabled themselves so as to accommodate their sexual lives to their physical capabilities and desires. Attitudes and misconceptions of the public need to be corrected. Above all, there is a need for education and training for health care professionals in the area of sexual rehabilitation, which is currently non-existent in the country. Perhaps, it is timely to incorporate sexual rehabilitation as part of a holistic medical rehabilitation of the disabled.
There is no doubt that gender bias has been inherent in medical and public health education, research, and clinical practice. This paper discusses the central question for medical and public health educators viz. whether women's health concerns and needs could be best addressed by the conventional biomedical approach to medical and public health education, research, and practice. Gender inequalities in health and gender bias in medical and public health education are revealed. It is found that in most public health and prevention issues related to women's health, the core issue is male-female power relations, and not merely the lack of public health services, medical technology, or information. There is, thus, an urgent need to gender-sensitize public health and medical education. The paper proposes a gender analysis of health to distinguish between biological causes and social explanations for the health differentials between men and women. It also assessed some of the gender approaches to public health and medical education currently adopted in the Asia-Pacific region. It poses the pressing question of how medical and public health educators integrate the gender perspective into medical and public health education. The paper exhorts all medical and public health practitioners to explore new directions and identify innovative strategies to formulate a gender-sensitive curriculum towards the best practices in medicine and public health that will meet the health needs of women and men in the 21st century.
In recent years, the concept of a Health-Promoting School has received much interest. In Malaysia, dental nurses are ideally placed to play a lead role in promoting Oral Health within the school setting. This study aims to provide information on the knowledge, perception and perceived role of Oral Health Promotion in schools, among dental nurses. A postal questionnaire was used to measure dental nurses' knowledge, perception and perceived role of Oral Health Promotion. The majority (60%) of dental nurses had good knowledge of Oral Health Promotion. Generally, they perceived that they play an important role in promoting Oral Health in schools. However, a sizeable proportion (25%) did not think they had a role to play in working together with school authorities to provide children with healthy food choices in school canteens. The majority (60%) of dental nurses did not perceive Oral Health Promotion to be important as a whole. They had a good perception of the concepts: it supports behaviour change, it has appropriate goals, it integrates oral health and general health and relieves anxiety. However, they had a poorer perception of the concepts; diverse educational approaches, participation, focus on prevention, early intervention, "spread of effect" of dental health education and "make healthier choices the easier choices". Years of service was not significantly associated with knowledge and perception of Oral Health Promotion. Dental nurses should be reoriented towards a more holistic practice of Oral Health Promotion. Workshops that invite active participation from dental nurses should be conducted to equip them with the necessary knowledge and skills.
This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.
A house to house survey on elderly subjects aged 60 years old and above was undertaken in a large district in Malaysia. A total of 486 subjects in randomly selected Enumeration Blocks were interviewed and examined. The prevalence of oral precancerous lesions was recorded at 3.3%, of which leukoplakia was the most common. When the ethnic distribution of these oral precancerous and cancerous (OPC) lesions was compared, 72% of those inflicted were Indians. Oral cancer was detected in two subjects (0.4%), both of whom were of Indian origin. Among subjects with OPC lesions, 4.2% were smokers, 12.7% were betelquid chewers, 11.8% had indulged in both habits, whilst one subject had not practised any of the oral habits of interest (0.4%). The findings suggest the occurrence of OPC lesions to be related to betelquid chewing.
Publication year=1996-1997
From January 1983 to December 1992 a total of 20,874 salmonella were serotyped in the Bacteriology Division IMR, which showed an increase of 100% compared to the previous ten-years. There were 97 serotypes which belonged to 22 Kauffmann-white groups. Twenty two serotypes hitherto were seen in this study period. S. typhi was the commonest serotype isolated. Overall there was a rise in the isolation of non-typhoidal salmonella particularly S. enteritidis which increased by 760% and S. blockley which increased by 720%. However there is a drop in the isolation of S typhimurium by 223% and S. paratyphi B by 319%.
Publication year=1996-1997
Suicide statistics are generally recognised to be unreliable. This study of the reported rates of suicide in West Malaysia between 1966-1990 shows that the mean crude suicide rate between 1966-1974 was 6.1 per 100,000, but had dropped drastically between 1975-1990 to a mean of 1.6 per 100,000. Three lines of evidence are presented to show that this reduction in the suicide rate is due to a systematic misclassification of medically certified suicides as deaths due to undetermined violent deaths (which refers to violent deaths not known to be accidentally or deliberately inflicted). Firstly, the large drop in reported suicide rates corresponds closely to an increase in the rate of deaths due to undetermined violent deaths. There is a highly positive negative correlation between the two rates (coefficient of correlation, r = -0.9). Secondly, the misclassification appears to be mainly a problem with the medically certified deaths which follow the ICD classification. The mean ratio of uncertified to certified suicides before 1975 was 0.8, but from 1975 onwards the mean was 3.1. This is in contrast to the corresponding ratio for deaths due to all accidents which has remained fairly constant throughout these years. Thirdly, the race and sex differences for the rates of undetermined violent deaths are identical to those of suicide. Taking the misclassification into account the corrected suicide rate for West Malaysia is estimated to be between 8-13 per 100,000 since 1982.
Given the magnitude of drug addiction in Malaysia, the government has given top priority to this issue. It is timely that an assessment of knowledge, attitudes and perceptions related to drug abuse and drug dependents among the general public be carried out. Thus, a nationwide survey was undertaken. A representative sample of 2,591 respondents aged 13 years and above from households were surveyed throughout the 11 states and the Federal Territory of Kuala Lumpur in Peninsula Malaysia. The results revealed that the respondents are moderately knowledgeable on drug abuse, especially information pertaining to treatment, rehabilitation and aftercare services, including education to families against drug abuse. The public possess a negative attitude towards drug dependents. Majority felt that drug addicts do not have the will power to rid themselves of drugs and they also lack a supportive family network system. Many believe that the most vulnerable group are the adolescents. Respondents were aware of the type of drugs commonly abused, although they failed to realise their long-term effects. Respondents do not attribute low education, large family and marginal income to the background of drug dependents. The findings showed gaps and misconceptions in terms of knowledge, attitudes and perceptions of the public. Accurate knowledge on, and right attitudes and perceptions towards drug related issues would certainly benefit the public in timely prevention of drug abuse.
The aim of this study was to determine the prevalence of sickness absenteeism among the three types of agencies, government, semi-government (boards) and private (public) companies. The methodology involved eliciting retrospective data on medical leave over the year 1990 by requesting the agencies to fill up a questionnaire (Appendix I), and calculating the indices of absenteeism from this data. The results show that the private agencies scored higher for all the indices but only the "lost time" percentage was significantly increased. Females also had significantly higher severity of sickness absenteeism rates in all the agencies. Overtime work was associated with higher absenteeism indices, markedly noted in the private agencies. In conclusion, agencies showed work out their own indices of absenteeism so that it could be compared with national rates.
The study was designed to determine if the activity pattern of pregnancy women on an intake of energy lower than that recommended will affect fetal growth. Subjects who volunteered were either attending public or private hospitals. Pregnant women in the "private" group were significantly older (p < 0.001) weighed somewhat less and significantly taller (p < 0.001) when compared to the "public" group. Differences in energy intake during the second and third trimesters between the "public" and "private" groups were small; 1608 +/- 334, 1726 +/- 271 kcal and 1627 +/- 367, 1778 +/- 260 kcal, respectively. However, daily activity patterns revealed that the "public" group was more active as reflected by the higher energy expenditure of 1412 +/- 74 kcal and 1578 +/- kcal during the second and third trimesters respectively. There was a significant difference (p < 0.01) in birth weight between the "public" and "private" groups; 2951 +/- 377 g and 3173 +/- 357 g respectively. This study indicates that energy intakes lower than recommended and sedentary lifestyles have no direct influence on birth weights of babies.
Fecal specimens collected from 456 school children in Gombak, Malaysia, revealed an overall prevalence rate of 62.9%. The most common parasite found was Trichuris trichiura (47.1%) followed by Giardia intestinalis (14.7%), Entamoeba coli (11.4%), Entamoeba histolytica (9.9%) and Ascaris lumbricoides (7.9%). Infection rates were high among the Indonesian immigrant workers' children (90%) followed by the Orang Asli (79.5%), Malay (59.4%) and Indians (36.4%). Females (66.3%) had a higher prevalence rate than the males (58.5%). The prevalence of infection was found to be associated with the socio-economic status, water supply, sanitary disposal of feces and family size. Albendazole administered as a single dose (400 mg) was found to be effective against Ascaris (100%) and hookworm (92.3%) but was not effective against Trichuris (39.2%).
The delay in the diagnosis of oral cancer has been variously reported as being contributed by the clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.
This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.
In the wake of the east Asian economic crisis, the health budget for the public sector in Malaysia was cut by 12%. The Ministry of Health responded swiftly with a series of broad-based and specific strategies. There was a careful examination of the operating expenditure and where possible measures were taken to minimise the effects of the budget constraints at the service interface. The MOH reprioritised the development of health projects. Important projects such as rural health projects and training facilities, and committed projects, were continued. In public health, population-based preventive and promotive activities were expected to experience some form of curtailment. There is a need to refocus priorities, maximise the utilisation of resources, and increase productivity at all levels and in all sectors, both public and private, in order to minimise the impact of the economic downturn on health.
Observational and survey methodologies were used to probe human behavioral factors influencing the use of insecticide-impregnated bednets to control malaria in rural Sabah, Malaysia. One aim was to investigate why a field trial of such nets in an interior area yielded disappointing results. A second aim was to gather baseline data prior to a field trial proposed for a coastal area. Interior villagers reported a significantly higher net usage rate than that observed directly, suggesting that subject self-reports need to be validated in some way. The poor results of the interior field trial appeared related to reluctance to regularly use nets, which were not in wide use previously. Prospects for reducing malaria transmission through bednets appeared better for the coastal area since nearly half of observed villagers were sleeping in them. However, significantly more coastal than interior villagers were observed watching television at night, an activity that may increase malaria risk by keeping villagers awake and out of bednets.
A questionnaire survey on smoking was conducted among 395 medical students (40% males, 60% females) at the School of Medical Sciences, University Sains Malaysia at Kubang Kerian, Kelantan. Thirty-five students (9%), all of them males, were current smokers. Twenty-eight percent of the smokers smoked more than ten cigarettes per day and 88% began smoking before entering the medical school. Social influence and cigarette advertisements were the main reasons given for starting smoking. Both smokers and nonsmokers were adequately informed of the common adverse effects of smoking. Ninety percent of smokers had tried to give up smoking but failed. Among the ex-smokers and nonsmokers, the main reasons given for not smoking was that smoking was useless. Among the female students, one-third felt that cigarette smoking was socially unacceptable among females. This was one of the three main reasons for not smoking. Very few of the students (4.6%) considered that doctors' advice would play an important role in smoking prevention.
The Australian penchant for monitoring overseas developments in general and health matters is noted. The face validity of the findings of the International Project on Culture and Management (IPCM) is assessed positively and certain structural commonalities of the health systems of the USA and Australia are identified, without attributing causality in the development of managers' attributes. Linkages between Australia, Malaysia and Hong Kong are also explored briefly. In addition, key attributes of the sample of Australian managers are discussed together with the limitations related to emerging forms of provision and organization in health services and to their distribution in the study sample. The IPCM findings may be used in course design but are unlikely to cause any major change, although one may debate on the values of applicants towards health service management education courses. The findings may help to stimulate the establishment of performance measures for management education in Australia.
Injuries are one of the leading causes of death in the world. In Malaysia, injuries form one of the three main causes of mortality. They are also an important cause of permanent and temporary disability and work absenteeism in the productive age group. Increasing affluence and industrialization coupled with growing population and transportation needs in rapidly developing countries like Malaysia have resulted in a surge of road and occupational injuries. Three quarters of fatalities due to road, occupational, drowning and home injuries occur in those below 45 years of age. A majority of injuries in these categories are attributed to "human" factors and therefore can be prevented by public education and enforced training of workers. The total annual economic loss due to all types of injuries is estimated to be 2 billion Malaysian Ringgit (US$1 = MR2.76 approximately). The government is currently in the process of setting up full-time departments for road safety and occupational health and safety.
This study was based on a hepatitis B screening program conducted in one of the states in Malaysia in 1989. The majority (84.6%) of the 2986 health employees were screened. One quarter (25%) was found to have serological markers for the Hepatitis B Virus (HBV); 2.1% had Hepatitis B surface Antigen (HBsAg) and 22.8% had antibody to the Hepatitis B surface Antigen (anti-HBs). The occurrence of HBsAg was higher in ethnic Chinese (6.3%) compared to Malays (1.8%) and Indians (0.9%), even when analyzed by sex, but not with age, type of institution and geographical locality. The distribution of anti-HBs was higher with ethnic Chinese (41.6%), male sex (27.2%) and age. There was a wide variation of the prevalence of serological markers among occupations and increased relative risks of HBsAg were found among medical assistants (RR3.7; 95% CI 1.4-9.1) and laboratory staff (RR 3.2; 95% CI 1-8.8), and that of anti-HBs among medical assistants (RR 2.8; 95% CI 1.8-3.7). The variations of HBsAg among occupations by type of institutions was marginal while that of anti-HBs was higher among attendants and midwives in hospitals, medical assistants in health departments, and assistant nurses and dentists in dental centers. The patterns of distribution of serological markers of HBV among health staff reflect the situation in the community with high endemicity and resemble specific occupational factors noted in previous studies in the West.
Publication year is 1992-1993
Dengue fever (DF) has been endemic in Malaysia since 1902 and reached epidemic proportions in 1973. The incidence rate of the disease in 1973 was 5.4 cases per 100,000 and reached 10.4 cases per 100,000 in 1987. The Chinese are the main ethnic community affected showing an overall morbidity rate of 9.0 cases per 100,000 followed by Malays 2.9 cases per 100,000 and Indians 2.4 cases per 100,000. The ethnic race ratio between Chinese, Malays and Indians which was 3.7:1:1.3 in 1975 reached 3.7:1:0.9 in 1987. The attack rates were observed to be higher in the males. The mean male:female ratio among Chinese was 1.1:1, while for Malays and Indians it was 1.5:1. The age-specific morbidity rate was highest in the 10- to 19-year age group followed by the 20- to 29-year age group. Epidemics of dengue fever were found to occur seasonally with the appearance of two peaks, viz. one in June and the other in August. Dengue fever, a rural disease before, has established itself as an urban disease.
Publication year=1992-1993