Despite the numerous changes made in accordance with the Baby Friendly Hospital Initiative at the University Hospital, Kuala Lumpur, the low rates of breastfeeding have persisted. This study aims to examine the current trend in infant feeding, and the influences of some perinatal and sociodemographic factors on breastfeeding. Five-hundred mothers with singleton pregnancies and healthy infants were interviewed at 6 weeks post-partum. Only 124 (25 per cent) mothers were practising exclusive breastfeeding (EBF), and 132 (26 per cent) mothers were using exclusive infant formula feeding (EIF). On logistic regression analyses, mothers who followed EBF were more likely to have had antenatal plans to breastfeed (Odds ratio 2.44, 95 per cent confidence interval 1.75-3.45), not in paid employment post-natally (OR 1.76, 95 per cent CI 1.31-2.36), of older age group (> 27 years) (OR 1.48, 95 per cent CI 1.13-1.93), had female infants (OR 1.38, 95 per cent CI 1.05-1.80) and of Indian ethnicity (compared to Chinese) (OR 3.87, 95 per cent CI 2.16-6.89). Breastfeeding difficulties were associated with decreased odds of EBF (OR 0.21, 95 per cent CI 0.13-0.34). Parental education, fathers' ages and incomes, primigravida status, Caesarean section, present of episiotomy, late first breastfeed, phototherapy, and length of hospital stay were not significant predictors of failure of EBF. In comparison, predictive factors for increased use of EIF were mothers who have had breastfeeding difficulties, < or = 9 years of schooling, and of Chinese descent. In conclusions, the overall rate of EBF by 6 weeks of age in infants born in this urban hospital had remained poor. The adverse factors for EBF identified in this study warrant further in-depth studies to determine effective ways of improving EBF rates.
Tracheobronchial foreign bodies, which are common in children, are a leading cause of accidental deaths in children under four years of age. Three cases of tracheobronchial foreign bodies in children less than two years old are described. One of the foreign bodies was unsuspected; the other two were probably related to food habits. All three cases improved without sequelae following prompt bronchoscopic intervention. Young children should not be given food containing bones or hard chitinous shells.
Hospital records of children admitted to the department of Paediatrics, University Hospital, Kuala Lumpur, from January 1981 to December 1990, who were diagnosed to have acute rheumatic fever (ARF) were studied. 134 children satisfied the Jones' modified criteria, thus giving a hospital incidence of 21.2/100,000 paediatric admission per year, of which incidence of first attack was 15.8/100,000 per year and recurrent attack was 5.38/100,000 per year. The M:F ratio is 1.39:1. Majority of cases occur in the 6-11 years age group with 6 cases encountered below the age of 5. The Indians had a higher relative risk to develop both the first acute attack as well as recurrences with a relative risk of 2.4 and 4.10 respectively as compared to the Malays. Majority of the patients, irrespective of the ethnic group, came from families with low income.
PIP: Data from 297 interviews among married patients attending prenatal clinics in Malaysia in 1993 are used to determine the number, spacing, and timing of pregnancies. Only live born children are included. Findings indicate that 92.2% of women were 18-35 years old, 4.2% were under 18 years of age, and 3.6% were over 35 years old. 86.2% had 4 or fewer children and 13.8% had 4 or more children. 69.7% spaced children 2 or more years apart and 30.3% had birth spacing of under 2 years. Over 90% of women had their pregnancies during the ages of 18 and 35 years.
The infection rate and relationship of enterobiasis with socio-economic status were determined in children aged 1-8 years, living in a rural area in Malaysia. Of the 178 subjects 40.4% were infected with Enterobius vermicularis. The distribution of enterobiasis among these children were analyzed in relation to age groups and sex. The rate of infection was significantly higher in older children (5-7 years). The association of enterobiasis with other factors studied such as number of persons per house, household income per months and mother's employment status were not significant. The sensitivity of three successive days anal swabs compared to a single swab was found to be statistically significant.
The distribution of anti-toxoplasma antibodies among the aborigines in Malaysia and its association with other soil transmitted infections and eosinophilia were studied. A total of 415 serum samples were collected and tested by IFA test. Overall prevalence was 10.6%, lower than previously reported. The antibody titers showed a unimodal distribution peaking at 1:8 dilution. There was a higher proportion of high antibody titer (> 1:128) in the adult compared to the children with no significant difference in prevalence rate by sex. The pattern of infection does not differ from other soil transmitted infections and there was no association between raised Toxoplasma antibodies with eosinophilia.
A study of 128 jaundiced term neonates showed that 28 (22 per cent) had hearing loss based on brain stem-evoked response. There was no significant difference in the percentage of neonates with hearing loss between those with peak serum bilirubin levels of less than 340 mumol/l (16 per cent) and those with hyperbilirubinaemia > 339 mumol/l (33 per cent) (P = 0.11). Logistic regression analysis showed that severe jaundice which required exchange transfusion and earlier age of onset of hyperbilirubinaemia were statistically significant risk factors associated with hearing loss (P = 0.038 and P = 0.012, respectively).
A retrospective study of 95 patients with retinal vein occlusion was carried out to determine the clinical presentation and pattern of distribution in the local Malaysian population. There was no significant difference found in its distribution with regards to sex. In comparing branch retinal vein occlusion with central retinal vein occlusion, no significant differences were found in its racial distribution. Branch retinal vein occlusion occurred more commonly among the older patients whereas the converse is true for central retinal vein occlusion. Reduced vision represents the commonest mode of presentation. Hypertension, diabetes mellitus, hyperlipidaemia and haematological disorders are important associated systemic conditions.
Breast cancer is the most common cancer among Malaysian women. There is a marked geographical difference in the worldwide incidence of breast cancer, with a higher incidence in developed countries compared to developing countries. From 1998 to 2001, new cases of breast cancer presenting to the breast clinics at Hospital Kuala Lumpur and University Malaya Medical Centre, Malaysia, were reviewed; the race, age and stage at presentation were analysed. Of 774 cases seen in Hospital Kuala Lumpur, only 5.2% (40/774) were impalpable breast cancers diagnosed on mammography. The prevalent age group was 40 to 49 years, and the median age was 50 years. The average size of the tumour was 5.4 cm in diameter. Malay women appear to have larger tumours and a later stage at presentation than other ethnic groups; 50% to 60% were in late stages (Stages 3 and 4). During the same period, 752 new cases of breast cancer were seen in the University Malaya Medical Centre. The average tumour size was 4.2 cm, and 30% to 40% were in late stages. The age incidence was similar. The delay in presentation of breast cancer was attributed to a strong belief in traditional medicine, the negative perception of the disease, poverty and poor education, coupled with fear and denial. A prospective, population-based study is required to determine the demographic pattern of breast cancer and the factors delaying presentation. These findings will have important implications in future programmes to promote the early detection of breast cancer, as well as in understanding geographical as well as racial variations in the incidence of breast cancer.
The aim of this study was to determine the age and sequence of eruption of permanent teeth, as well as gender differences, in children and adolescents in Kelantan, Malaysia. Cross-sectional data on permanent teeth eruption were collected by examining pre-school, primary and secondary school children of 5-17 years of age. The subjects were drawn by multistage random sampling from the school registers. There were 2,382 subjects in the sample, 1,062 boys and 1,320 girls. The data were subjected to probit regression analysis. The mean age of eruption of lower first molar was 6.0 (95%CI: 5.8, 6.2) years. The median age of eruption of each tooth was earlier in girls than in boys. Although the range of years during which the permanent teeth erupted was similar in both sexes, i.e. 6-12 years, the sequence of the tooth eruption differed. All mandibular teeth, with the exception of first and second premolars in both males and females, tended to erupt earlier than their maxillary counterparts. The findings seem to correspond to earlier studies done in the other parts of the world.
A canonical/lognormal model for human demography is established, specifying the net maternity function and the age distribution for mothers of new-borns using a single macroscopic parameter vector of dimension five. The age distribution of mothers is canonical, while the net maternity function normalizes to a lognormal density. Comparison of an actual population with the model serves to identify anomalies in the population which may be indicative of phase transitions or influences from levels outside the demographic. Tracking the time development of the parameter vector may be used to predict the future state of a population, or to interpolate for data missing from the record. In accordance with classical theoretical considerations of Backman, Prigogine, et al., it emerges that the logarithm of a mother's age is the most fundamental time variable for demographic purposes.
Analyses of the spatial distribution pattern, spatial genetic structure and of genetic diversity were carried out in two tropical tree species with contrasting breeding systems and different ploidy levels using a 50-ha demographic plot in a lowland dipterocarp forest in Peninsular Malaysia. Shorea leprosula is a diploid and predominantly outcrossed species, whereas S. ovalis ssp. sericea is an autotetraploid species with apomictic mode of reproduction. Genetic diversity parameters estimated for S. leprosula using microsatellite were consistently higher than using allozyme. In comparisons with S. leprosula and other tropical tree species, S. ovalis ssp. sericea also displayed relatively high levels of genetic diversity. This might be explained by the lower pressure of genetic drift due to tetrasomic inheritance, and for autotetraploids each locus can accommodate up to four different alleles and this allows maintenance of more alleles at individual loci. The observed high levels of genetic diversity in S. ovalis ssp. sericea can also be due to a random retention of more heterogeneous individuals in the past, and the apomictic mode of reproduction might be an evolutionary strategy, which allows the species to maintain high levels of genetic diversity. The spatial distribution pattern analyses of both species showed significant levels of aggregation at small and medium but random distribution at the big diameter-class. The decrease in magnitude of spatial aggregation from small- to large-diameter classes might be due to compensatory mortality during recruitment and survival under competitive thinning process. Spatial genetic structure analyses for both species revealed significant spatial genetic structure for short distances in all the three diameter-classes. The magnitude of spatial genetic structure in both species was observed to be decreasing from smaller- to larger-diameter classes. The high spatial genetic structuring observed in S. ovalis ssp. sericea at the small-diameter class is due primarily to limited seed dispersal and apomictic mode of reproduction. The similar observation in S. leprosula, however, can be explained by limited seed and pollen dispersal, which supports further the fact that the species is pollinated by weak fliers, mainly of Thrips and Megalurothrips in the lowland dipterocarp forest.
The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children's fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month: the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10-20 degree angulation in midshaft fractures, and a 20-30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.
The relationship between environmental factors and human health has long been a concern among academic researchers. We use two indicators of environmental pollution, namely particulate matter (PM10) and carbon dioxide (CO2) to examine the effects of poor air quality on human mortality. This study explores an issue that has largely been ignored, particularly in the African literature, where the effect of air pollution on human mortality could be influenced by gender specification. We analyse a panel data from 35 African countries and our result suggests that the elevated levels of PM10 and CO2 have a significant effect on the increasing mortality rates in infants, under-five children and adults. Although the effect of poor air quality on adults is found to differ between genders, such difference is not statistically significant. We conclude that the air pollution effects, on average, are similar between genders in the African countries.
Orangutans have a long period of immaturity and the longest inter-birth interval (IBI) of all mammals, which can be explained by their solitary life style, preventing the mother from rearing two offspring simultaneously (solitary life hypothesis) [corrected]. We collected data on mother-offspring dyads living in a primary lowland forest in Danum Valley, East Borneo in an effort to examine the developmental and behavioral patterns of the subspecies Pongo pygmaeus morio. We analyzed developmental changes in mother-offspring distance, contact, and activity budgets in orangutans ranging from 1 to 7 years of age. The results indicated decreased resting and playing with increasing age, whereas feeding, traveling and social play all increased significantly. Mothers' feeding and traveling time were good predictors of their offspring's feeding and traveling activities. Mother-offspring contact lasted longer in resting contexts; contact during traveling was almost non-existent after 4 years of age. Comparisons with previously published data on the Sumatran species Pongo abelli revealed no fundamental differences in these behavioral measures. However, a shorter association time with the mother after behavioral independence is documented for this East Bornean population in comparison to Sumatran populations. These results are best explained by the solitary life hypothesis, in agreement with previous studies. We suggest that environmental constraints in Bornean forests, as well as a lower population density, should be considered when interpreting the differences between Sumatran and Bornean orangutans in both the period of association with mother and the IBI.
The Klang area of Peninsular Malaysia has experienced rapid industrial growth with intense activities, which can increase the concentration of pollutants in the environment that significantly impact on habitats and the human health. The purpose of this study was to determine the levels of selected heavy metals (Cu, Zn, Ni, Fe, and Pb) in the heart, lung, brain, liver, kidney, muscle tissues, and feathers of house crow, Corvus splendens, in Klang, Peninsular Malaysia. House crow samples were collected from the Klang area through the Department of Public Health at Majlis Perbandaran Klang. Quantitative determination of heavy metals was carried out using atomic absorption spectrophotometer (AAS). The result shows the presence of heavy metals in all biological samples of house crows. For heavy metals in all the house crow tissues analyzed, Fe concentrations were the highest, followed by those of Zn, Cu, Pb, and Ni. The feathers and kidney accumulated high concentrations of Pb, whereas the liver accumulated high concentrations of essential heavy metals (Fe > Zn > Cu > Ni). Significant variations were also detected in the concentrations of Pb among adult and juvenile and male and female bird samples. The results also revealed significant positive correlations between Pb metal concentration in the breast feathers and all internal organs. Accumulation of toxic heavy metals in feathers reflected storing and elimination processes, while the accumulation of toxic heavy metals in the kidney can be consequential to chronic exposure. The present study clearly shows the usefulness of house crow breast feather as a suitable indicator for heavy metal accumulation in the internal organs of house crows in the Klang area.