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.
Hepatitis C virus (HCV) is the chief aetiologic agent for the parenterally transmitted Non-A, Non-B (NANB) hepatitis. This preliminary study was done to determine the prevalence of anti-HCV in the blood donor population. Blood from 3,540 donors who donated blood to the Blood Services Centre, Hospital, Kuala Lumpur, from 25th August 1991 to 13th January 1992, was tested for anti-HCV using both the Ortho and Abbott 2nd Generation ELISA test kits. ELISA positive specimens were repeated twice but no confirmatory test was done. There were 53 out of 3,540 (1.49%) blood donors who were repeatedly reactive to anti-HCV by ELISA. We plan to do further tests to confirm the results, using RIBA-2 or Abbott Neutralising test. Twenty eight out of 1,713 (1.63%) Malays, 22 out of 1,373 (1.60%) Chinese and 2 out of 393 (0.50%) Indians had antibodies to HCV. There was no significant difference in prevalence in the different age groups. The majority of donors tested were males (3,511 out of 3,540) of which 53 (1.50%) were anti-HCV positive. Only 29 females were tested and all were negative. To determine infectivity of the anti-HCV positive cases we would like to introduce testing for RNA by polymerate chain reaction (PCR). Screening all donated blood for anti-HCV will decrease, but not totally eliminate, post-transfusion hepatitis.
Fifty cases of septicaemic melioidosis were reviewed. There was a preponderance of disease among males (male:female ratio 3.2:1) and those aged over 30 years. The presenting clinical features were very varied and not pathognomonic, ranging from fever, cough and septicaemia to fulminant septicaemia and shock. Pulmonary involvement was recorded in 58% of the patients. Skin and soft tissue sepsis was seen in 24%, but many had signs and symptoms of multiorgan involvement. Associated underlying illness was identified in 76% of patients, diabetes mellitus being the commonest (38%), while 34% had more than one predisposing factor. The mortality of 65% in our series is a reflection of the less than satisfactory status of the diagnosis and therapy of septicaemic melioidosis. Only 24% of our patients received appropriate empirical antibiotic therapy. A high index of suspicion of melioidosis in endemic areas and the use of appropriate empirical antimicrobial therapy would be a step towards reducing the high mortality rate.
The prevalence of human skeletal muscle sarcocystosis in Malaysia was determined by serial examination of formalin-fixed, paraffin-embedded sections of tongue tissues obtained from consecutive, routine autopsies of subjects aged 12 years or more. Of 100 tongues examined, 21% were found to contain Sarcocystis; 66 cysts were found. The number of cysts per case varied from 1 to 13. In one case, 5 cysts were found in a single tissue section. The age range of positive cases was from 16 to 57 years (mean 37.7 years). Prevalence did not differ with regard to race, sex or occupation. The prevalence of human muscular sarcocystosis in our study was higher than that reported elsewhere. Preferential localization of Sarcocystis in tongue or head and neck and/or genuinely high prevalence in south-east Asia are possible explanations for this observation.
Cytophagic histiocytic panniculitis (CHP) is a recently recognized entity that frequently poses a perplexing diagnostic problem. Although the classical case presents with a relapsing fever, subcutaneous nodules, pancytopenia and liver dysfunction, most patients have in addition a multitude of other manifestations which confuse the clinical picture. Notwithstanding the variable clinical course, the disease frequently terminates in fatal hemorrhage. Diagnosis is based on histological features. A lobular panniculitis with an infiltrate of cytologically benign cytophagocytic histiocytes in skin nodules is the sine qua non of CHP. Hence, a deep skin biopsy which includes subcutaneous fat is mandatory to establish the diagnosis. Published information regarding this newly described entity remains scarce and we report two cases of CHP, one occurring in a 30-year-old Kadazan man and another in a 17-year-old Chinese woman seen at the University Hospital, Kuala Lumpur. The latter case presented with exudative ascites, an unusual feature, possibly due to intra-abdominal panniculitis. In addition, we record the development of cirrhosis in the same patient.
This report examines Malaysian women's perceptions of the contraceptive effect of breastfeeding, the determinants of their perceptions, and any effect these perceptions might have on nursing duration and contraceptive use. The report also considers whether women are consciously replacing breastfeeding with modern contraceptive methods. Data from the 1976 Malaysian Family Life Survey are analyzed, and the author concludes that Malaysian women do perceive that breastfeeding has a contraceptive effect, but that this perception is not universal. Ethnicity and desire for a particular family size are the most significant determinants of this perception. Finally, Malaysian women's recognition of the contraceptive effect of nursing does not influence either the duration of their breastfeeding or their adoption of contraception. Malaysian women may not be abandoning breastfeeding to adopt contraception. More probably, breastfeeding declines and contraceptive prevalence increases with modernization.
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
A cross-sectional study of 753 Melanesian children in Vanuatu and 904 Malay children in Malaysia included measurement of refractive error and ocular dimensions. All children were between the ages of 6 and 17 years. The prevalence of myopia in Malay children was 4.3% at 7-8 years and 25.6% at 15-16 years with corresponding figures of 0.8% and 4.3% for Melanesian children. The range of refractive error was greater for Malay children at all ages. Mean refractive error for Malay children showed greater hypermetropia, together with a shorter axial length at 6 years, than Melanesian children, but at 17 years the situation reversed and Malay children had more myopia and longer axial lengths than their Melanesian counterparts.
A study based on the WHO model of community-based rehabilitation in Guangzhou City, China, is described. Preliminary epidemiological data are reported, and compared with analogous data from Korea, Vietnam, Malaysia, Mexico, Indonesia, and Pakistan. Confidence levels for estimates of the prevalence of limb dysfunction, visual dysfunction, hearing and/or speech dysfunction, and mental retardation are also reported.
Ninety five patients with perennial rhinitis were examined clinically and various investigations were done in order to find out the common allergens and to assess the value of various tests in perennial rhinitis. In this study group 94% of cases were proven to be cases of allergic rhinitis. Cat fur was found to be the commonest allergen. Grass pollen which is a common allergen in European countries was found in only 18% of cases in the present study. X-ray of the paranasal sinuses as a routine investigation was not found to be of much use in perennial rhinitis. There was significant correlation between results for allergens tested by enzyme immunoassay and skin prick test.
The gastrointestinal helminth infection status of 1574 children living in a slum area of Kuala Lumpur, Malaysia was assessed by quantitative coprology. Almost two-thirds were infected with Trichuris trichiura, 49.6% with Ascaris lumbricoides, and 5.3% with hookworm. Infection prevalence rose rapidly to a stable asymptote at 7 years of age, and the age-intensity profile was convex with maximal values in the 5-10 year age classes. This pattern was the same for males and females, but differed markedly between different ethnic groups. The frequency distributions of A. lumbricoides and T. trichiura were highly overdispersed (k values were 0.21 and 0.27, respectively), and age-dependent over the 0-8 year age classes. This suggests that the force of infection with these nematodes is lower in infants than in older children.
An epidemiological survey of filariasis and malaria in Banggi Island and Upper Kinabatangan, Sabah, revealed microfilarial rates of 7.2% and 8.6% respectively and malaria prevalence of 9.7% and 16.9% respectively. Wuchereria bancrofti was a rural nocturnally periodic type with a periodicity index of 137.2 and average peak hour at 01.32 hrs; 9.2% of microfilaremic carriers as compared to 2.4% amicrofilaremic subjects had clinical filariasis. The Plasmodium falciparum: P. vivax: P. malariae ratios were 1:1:0.17 and 1.4:1:0.12 for Banggi and Upper Kinabatangan respectively. Anopheles flavirostris was incriminated as a new malaria vector in Banggi where the well-known primary malaria vector is An. balabacensis. The latter was also found for the first time to be a vector of rural W. bancrofti in Upper Kinabatangan. Experimental feeding also showed that L3 larvae of W. bancrofti were recovered at low rates from An. balabacensis. Aedes togoi appeared to be a suitable laboratory vector for W. bancrofti.
A case of rare retinal lesion occurring in a young girl suffering from lepromatous leprosy is described. Fundus lesions in leprosy are extremely rare but do occur in some cases without causing any threat to vision. Their response to antileprotic treatment is not clearly known.
A 70 million population for Malaysia by the year 2010 has been officially targetted for in the Mid-Term Review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth. For this exercise, infant mortality rate was used as the health indicator. From trends seen vis-a-vis population growth, it appears that thus far, population growth has not been associated negatively with health (as measured by IMR). In recognition of the relevance of the medical, economic and education factors to health, trends in Malaysia's population ratio, per capita GNP and rates of school enrolment were also drawn; the selection of these as proxies being based on completeness of time-serial records. Although statistical regressions established the high correlation between medical doctors.population ratio and school enrolment rate with IMR, the limitations in this analysis did not permit any reliable inferences. In view of the difficulties in projections of trends, a comparison of health and related variables was carried out for several countries with high populations as near to 70 million as were available. The characteristics associated with low mortality and high life expectancy (health indices) were identified as low population growth, high literacy and high per capita GNP; this being stated with explicit qualifications. Other determinants of health were also discussed in brief, and the need for careful planning in the distribution of human and material resources was noted.
A total of 52 cases of NPC were found in a five-year survey from 1978 to 1982 in Malaysia. The annual rate of occurrence was 3.4, 3.0, 2.4 and 1.8 for Chinese, Malays, Kadazans and Sarawakians, respectively. The age-specific incidence rates per 100 000 were highest for Kadazans (2.34 to 7.59) in comparison to the other races (0.11 to 1.24). The proportion of NPC in young Malaysians formed 1.2% in Chinese, 7.2% in Malays and 6.9% for others. A sexual bias was present in Chinese (male:female = 2.2) and Sarawakians (1.7) but not in Kadazans and Malays (0.9). In most Chinese, the primary tumour histologically is of the poorly differentiated characteristic and this type is the predominant tumour in the country. The Kadazans presented with well differentiated primary tumour and the Malays with all three histological types i.e. well-, poorly- and undifferentiated. At first examination enlarged lymph nodes were found in 95.7% of the patients and 65.2% had epistaxis and growth in the postnasal space. Antibodies to IgA anti-VCA were present in half of the 6 patients serologically studied.
Schistosomiasis in Southeast Asia, caused by Schistosoma japonicum, Schistosoma mekongi and Schistosoma japonicum-like, have been reported from six different countries. The S. japonicum infections are highly prevalent in the Philippines with Oncomelania hupensis quadrasi as the vector snail, and in localized areas in Indonesia with O.h. lindoensis as the snail vector. The S. mekongi infections are recent discovery in the Lower Mekong Basin in Laos and Kampuchea, with Tricula aperta as the vector snail. The S. japonicum-like infections are found as isolated cases diagnosed by the finding of S. japonicum-like eggs in the faeces, rectal biopsy, tissue biopsy or at necropsy in Thailand and Malaysia. The control measures of schistosomiasis have been implemented in the Philippines and Indonesia, while further research studies are being conducted in Thailand and Malaysia.