Unmet need as a significant factor affecting quality of life in later life has recently received considerable attention in gerontological research. The main aim of this study was to identify the prevalence, predicting factors, and negative consequence of unmet need among older Malaysians. The findings may be useful to reduce unmet need and the burden of its adverse consequence. The sample for this study consists of 400 functionally disabled elderly people aged 60 and over was obtained from a large national survey. Unmet need was operationally defined based on Manton's (1989) criteria. The findings from the present study showed about 18.0% of functionally disabled older Malaysians suffer from unmet need. Logistic regression revealed that gender (being male) and chronic health conditions are statistically associated with increased odds of unmet need after adjusting for other possible risk factors. Further results indicated that unmet need statistically increases odds of fall as a negative consequence of unmet need. The high prevalence rates of unmet need among disabled elderly men and chronically ill older persons suggest that policy makers should pay more attention to this vulnerable group to achieve good quality of life. The implications and limitations of the present study are discussed.
Alternative Southern consumer activism, undertaken for example by the Consumers' Association of Penang (CAP) in Malaysia, presents significant sites of nodal governance through which local and global health rights are claimed. This alternative consumer approach distinctively integrates health with development, social justice and environmental issues. It has not always explicitly employed rights language, but consumer activism fits with rights-based approaches, emphasising entitlements, accountability and participation. This case-study traces the development of networked consumer campaigns to contest and shape global health governance. It highlights the important, yet under-researched role of Southern nodes within global networks mobilizing health rights and public health. Alternative consumer activism re-interprets the consumer as a countervailing force, collectively mobilizing citizens to claim their health rights.
This study examines the determinants of Papanicolaou Smear Test (PST) screening for cervical cancer among women in Malaysia. Attention is focused on the reasons different population subgroups give for non-screening. We find that Indian women are the least likely to have had a PST and also the least likely to know the reasons why one is screened. Malay women are less likely than Chinese women to have received a PST and are more likely to report embarrassment as the reason for not being tested. Urban women are less likely than rural women to have been tested and more likely to state lack of time as the reason. These results suggest targeted interventions may be necessary to increase screening rates in Malaysia.
Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.
The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.
In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.
This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.
Within the current exercise of reforming the health care system, underlying all issues, is the reassessment of the role of government. It is a government's responsibility and concern that the health sector be accessible and equitable to the population, and more important that the health sector be more efficient and affordable. Many governments in the world attempt to provide universal health care services to their population through public health care provisions. This paper reviews and analyses the experience of the Malaysian health system, focusing on the performance of the system in relation to access and equity. The performance of the Malaysian health system has been impressive. At minimum cost it has achieved virtually accessible and equitable health care to the entire population. This is evident by analysing almost all the commonly used indicators. These clearly show that when matched to comparable countries, health outcome is even better than predicted value.
Recent efforts to promote child survival and development internationally have focused new attention on the importance of the household as a mediator of both environmental risks and programmatic interventions to promote better health. In this paper, we introduce a theoretical framework, the 'developmental niche,' derived from studies of children's behavior and development in different cultural contexts, as a tool for analyzing the household production of health. The developmental niche is conceptualized in terms of three basic components: (1) the physical and social settings of the child's everyday life; (2) culturally regulated customs of child care and child rearing; and (3) the psychology of the caretakers. The relevance of each of these components to the household production of health is illustrated through examples from research in several cultures, including Malaysia, Kenya, Bangladesh, India, and the U.S. Further discussion centers on three corollaries of the developmental niche framework that point to the interactive relationships among the three components, between the niche and the larger environment, and between the niche and the child (or any individual seen from a developmental perspective). It is suggested that this approach is useful for identifying and collecting relevant information on household-level factors that affect health outcomes, and thus for organizing more effective interventions. At a theoretical level, the developmental niche framework also facilitates understanding processes of mutual adaptation between the individual and the environment as they are filtered through the constraints of household settings, customs and caretaker psychologies.
Iban categories of hot and cold are examined in the context of humoral medical systems in southeast Asia. These categories are more than binary and oppositional: they are also contradictory and can only be understood in terms of their capacity for transformation in 'depth'. Analysis of the Iban epistemology of temperature sensation reveals the limitations of reductionist empirical approaches to hot and cold. Illness is apprehended, at one level, in terms of unusual conjunctions of opposite temperatures which signify a deeper disturbance in the relationship between body and soul, humans and spirits. Iban therapy redefines and relocates these categories in their proper place and at their appropriate level. It progresses from hot lay treatments to cool ritual treatments, yet cannot be accounted for within a limited framework of homeostatic balance. This paper develops an ethnographically grounded definition of humoralism which emphasizes non-reductive logic, cultural practice and transformation. The key element, transformation, is defined as a transition between categories and a shift in the level of interpretation which fundamentally alter the Iban experience of body and illness.
In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services.
The principal etiologic agent of human eosinophilic meningitis, Angiostrongylus cantonensis, was first detected in rats in Canton, China in 1933. The first human case was detected on Taiwan in 1944. Epidemic outbreaks were noted on Ponape (E. Caroline Is.) from 1944 to 1948. The disease may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF. Since 1961 it has been known that human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria and fresh-water crustacea. There is no effective specific treatment. The African land snail, Achatina fulica played an important role in the panpacific dispersal of the organism: it will be important in Africa in the future as well. Rats were, and will continue to be the principal agents of expansion of the parasite beyond the Indopacific area. During and just after WWII the parasite was introduced, and/or spread passively from South and Southeast Asia into the Western Pacific islands and eastward and southward through Micronesia, Melanesia, Australia and into Polynesia, sequestered in shipments of war material and facilitated by post-war commerce. In the 1950s numerous cases were identified for the first time on Sumatra, the Philippines, Taiwan, Saipan, New Caledonia, and as far east as Rarotonga and Tahiti. Then cases were detected in Vietnam, Thailand, Cambodia, Java, Sarawak, the New Hebrides, Guam and Hawaii during the 1960s. Subsequently in the Pacific Basin the disease has appeared on Okinawa, other Ryukyu islands, Honshu, Kyushu, New Britain, American Samoa and Western Samoa, Australia, Hong Kong, Bombay, India, Fiji and most recently in mainland China. The parasite in rats now occurs throughout the Indopacific Basin and littoral. Beyond the Indopacific region, the worm has been found in rodents in Madagascar (ca 1963), Cuba (1973), Egypt (1977), Puerto Rico (1984), New Orleans, Louisiana (1985) and Port Harcourt, Nigeria (1989). Human infections have now been detected in Cuba (1973), Réunion Island (1974) and Côte d'Ivoire (1979) and should be anticipated wherever infected rats of mollusks have been introduced. Caged primates became infected in zoos in Hong Kong (1978) and New Orleans and Nassau, Bahamas (1987). The use of mollusks and crustacea as famine foods, favored delicacies and medicines has resulted in numerous outbreaks and isolated infections. Economic and political instability, illicit trade, unsanitary peridomestic conditions and lack of health education promote the local occurrence and insidious global expansion of parasitic eosinophilic meningitis.(ABSTRACT TRUNCATED AT 400 WORDS)
Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.
The concept of epidemiological transition is now quite widely recognized, if not so widely accepted. The transition appears to progress at varying speeds and to different extents spatially; it seems that there can be considerable international, regional and local variations in its progress. The paper examines this contention in the case of a number of countries in Southeast Asia, principally Hong Kong, Malaysia and Thailand. Drawing on evidence from this region, the paper highlights the importance when researching epidemiological transition of the time period under consideration; socio-cultural variations; the nature and quality of data, and spatial scale. It makes some suggestions as to the potential of the concept of epidemiological transition in health care planning and development studies.
Semai descriptions of their beliefs about health and disease vary from person to person. Moreover, at different times the same person expresses mutually incongruent beliefs. This amorphousness and fluidity merit analysis rather than neatening. This paper details Semai beliefs, loose ends and all, and suggests that their formal peculiarities are due to the prevalence of synecdoche in conceptual organization. Their inconsistency and fluidity may stem from individualistic egalitarianism within Semai society and powerlessness in the face of nonSemai attack. Finally, it is suggested that construing indigenous medicine as a crude form of Western medicine leads to overtidiness and consequent error.
In comparing shamanistic healing with Western psychotherapy, the principal distinctions advanced by psychiatrists and psychologists have been: (1) that the shaman's patients receive 'remission without insight' while Western psychotherapy provides patients with a learning experience; and (2) that Western psychotherapy is based upon rational theory, whereas psychotherapeutic elements in shamanistic rituals are by-products of irrational magical activity. Anthropologists, on the other hand, have demonstrated the logic behind the shaman's seance, and its uses as a projective system which locates the patient's problems in external entities rather than within his own psyche. An investigation of the Malay shamanistic ritual (Main Peteri) expands the scope of discussion, since it reveals that embedded within this exorcistic spirit-raising seance is a nonprojective indigenous theory of psychic functioning, employing symbols internal to the patient, which is comparable to, and no more nor less rational than, mainstream Western theories.
In Sarawak, some tribes stay in communal longhouses whilst others live in villages of single dwellings. The present study looks into the question of whether there is an association between the prevalence of leprosy and tuberculosis with the quantum of social contact that occurs in these two types of settlement patterns. It was found that the prevalence of leprosy and tuberculosis is significantly higher among longhouse dwellers compared with single house dwellers. It was also noted that social groups tended to be larger and to persist for much longer among longhouse dwellers than among those in single dwellings. This lends support to the evidence that social contact in longhouses is more extensive and contributes towards a higher prevalence of leprosy and tuberculosis.
Indigenous healers in many societies use patterned sounds, movements, colors, shapes, and odors as therapeutic techniques; yet medical anthropology remains curiously inattentive to the aesthetics of healing rituals. Based on research among Senoi Temiar of Peninsular Malaysia, I propose an approach to the therapeutic efficacy of these symbolic forms. The music of Temiar healing ceremonies is examined from three perspectives: the formal musical structures, the indigenous theories that inform those structures, and the strategies through which they are performed and experienced by participants. Temiar healing performances present a moment of articulation between two domains of knowledge and action: musical composition, performance, and affect, on the one hand, and indigenous cosmology, illness etiology, and the pathogenicity of emotions, on the other. Songs of Temiar spirit-mediums cross-cut these two domains, and demonstrate the pragmatics of aesthetics.
Prolonged lactation and early supplementation have been traditional practices among low-income mothers in Malaysia, the Caribbean, Nigeria and Zaire. Early supplementation is still the norm but there have been some substantial changes in the types of supplement offered. Thus, except in Zaire, there is now widespread use of processed milks as supplements for very young infants. The use of processed milks began in the 1920s in Malaysia and the Caribbean, but not until the 1960s in Nigeria. Processed milks are, as yet, rarely used in Zaire. The use of processed milks has not, however, led to the abandonment of traditional paps. The latter are still given as supplements to young infants in Nigeria and to older infants in Malaysia and the Caribbean. Breast-feeding duration has declined in Malaysia and the Caribbean although initiation is almost universal. In Nigeria and Zaire most low-income mothers continue to breast-feed for at least 12 months. The changes in the types of supplements used and in breast-feeding duration are analogous to the changes observed in industrialised countries from the mid-19th century, and many of the associated factors are similar: urbanisation; female participation in the labour force; increased availability of processed milks and their promotion both by companies and the health sector; and the regimentation of breast-feeding. This review highlights the negative role played by the health sector in the past, and discusses its future role in promoting and supporting breast-feeding.
In his article, 'The Effectiveness of Symbols,' Lévi-Strauss contends that the details of a Cuna birth incantation evoke specific physiological responses from parturient women, aiding them through difficult labors. His argument, which analyzes the incantation as a text divorced from its social setting, has drawn criticism from students of Cuna society on a number of substantive points, primarily centering around the difficulties that the special linguistic form of ritual language would present to a non-adept. If the patient lacks a thorough comprehension of the mythic details, how can the incantation change her physiological processes? In an attempt to evaluate the effect of myth upon a woman in labor, this article calls upon Cuna and Malay ethnographic data, and presents a Malay birth incantation as interpreted by the ritual practitioner who recited it. Following a discussion of the non-semantic aspects of the incantation and the extent to which the patient shares the interpretation of the healer in both the Malay and Cuna societies, recent biomedical studies are cited in support of hypotheses concerning the physiological and biochemical effects of myth in the management of childbirth.