One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
This article describes a study designed to test a method for assessing the cost to the health services of illegally induced abortion and the feasibility of estimating the incidence of induced abortion by a field interviewing approach. The participating centers included three hospitals in Ankara, Turkey; three hospitals in Ibadan, Nigeria; one hospital in Caracas and one in Valencia, Venezuela; and two hospitals in Kuala Lumpur, Malaysia. Hospitalized abortion cases were classified as induced or spontaneous or as "probably induced," "possibly induced," or "unknown" according to a classification scheme comprising certain medical criteria. The sociodemographic characteristics of induced and spontaneous abortion cases were subjected to discriminant function analysis and the discriminating variables best characterizing the induced versus the spontaneous abortion groups were identified for each center. On the basis of this analysis, the "probably" and "possibly" induced and "unknown" categories were further classified as induced or spontaneous abortion, with stated probabilities. Thus an overall estimate is made of the proportion of all hospitalized abortions that can be considered illegally induced outside the hospital. Selected results on costs of induced and spontaneous abortion are shown. The method further tested the feasibility of obtaining valid survey data on abortion from the communities studied by re-interviewing the women hospitalized for induced and spontaneous abortion six months later in their homes. This exercise showed a degree of under-reporting of abortion that varied widely among centers, even among women who had admitted illegal induction at the time of hospitalization. The feasibility of estimating the incidence of illegal abortion by field studies is discussed in the light of these findings.
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.
A local study, a part of a multinational and multicenter study on the efficacy and safety of Buserelin was carried out for the treatment ofpelvic endometriosis using a standard protocol. 20 women diagnosed to have moderate to severe endometriosis by laparoscopy were recruited. The women were given 900 micrograms Buserelin acetate daily by intranasal spray for a fixed period of 6 months. 8aseline hormona/and biochemical parameters were taken prior to treatment and the parameters were repeated during each follow-up at weekly and monthly intervals. In addition. changes in
symptoms were monitored. A second look laparoscopy was performed at completion of therapy and patients were followed up for a further 6 months. There was 100 percent suppression of oestradiol levels dUring the 6 months treatment period. An improvement of implants according to AFS classification occured in all patients. One patient discontinued because of side effects. Restoration of cycles after completion of therapy occured within 7 weeks. There were 7 pregnancies (64%) in the first 6 months after treatment for those wanting pregnancies. During therapy, dysmenorrhoea, pelvic pain and dyspareunia improved ,considerably. Buserelin was proven to be effective in the management of pelvic endometriosis a.~d is well tolerated and safe.
Haemoglobin Bart's hydrops fetalis syndrome is totally lethal. Globin chain electrophoresis on mylar backed cellulose acetate strips, by a method modified from Ueda and Schneider has been established to demonstrate total absence of alpha chains in this syndrome. This simple test can identify fetuses, stillbirths and newborns with homozygous αo-thalassaemia. In this region where DNA studies are limited, and prenatal diagnosis is unavailable, this test which describes the phenotypic expression of Hb Bart's syndrome will improve genetic counselling of women at risk of homozygous αo-thalassaemia.
Haematologic abnormalities are found in patients who develop acute ischaemic syndromes including acute myocardial infarction (AMI). A coronary care unit population of 660 consecutive patients were studied for their haematologic parameters on admission. There were 263 patients who had AMI, 207 who had non-infarct acute ischaemic syndromes (CAD), and the other 190 non-coronary patients served as controls. Overall patients with AMI had signijicantly higher haemoglobin (145 ± 2.2 vs 12.9 ± 3.0 g/dl, p<0.0001), haematocrit (45.4 ± 5.8% vs 41.2 ± 8.8%. P < 0.001). red cell count (5.0 ± 0.7 vs 4.5 ± 10^12 p<0.001), but there were no significant differences in their leucocyte count, platelet count or mean corpuscular volume. Patients with CAD had higher haemoglobin and red cell counts (p<0.002, p<0.02 respectively). Although infarct women tended to have lower counts (p<0.001), they still had significantly higher haemoglobin (p<0.01), haematocrit (p<0.02) and red cell count(p<0.002) when compared with controls. Interestingly, there were no ethnic differences at all with regard to haematologic values for infarct patients; haemoglobin, haematocrit, and red count were each significantly higher than controls. Our results suggest that a relatively high baseline Hb, haematocrit or RBC count may be associated with increased likelihood of acute ischaemic syndromes including AMI among Malaysians. Increased viscosity and abnormal haemorheological characteristics may contribute to the development and subsequent outcome of unstable coronary syndromes. Keywords: acute myocardial infarction, coronary artery disease, haemoglobin, haematocrit, haemorheology.
Hypertensive disorders of pregnancy is a major cause of fetal and maternal morbidity. Epidemiologic observations have shown an inverse association between calcium intake and incidence of eclampsia. Calcium supplementation has been reported to decrease blood pressure in pregnant women, although this remains controversial. The mechanism responsible for the effect of calcium on hypertinsion in pregnant women is unknown. This paper is a review of some of the recent calcium supplementation trials that have been carried out and their effectiveness in reducing systolic and diastolic blood pressure and decreasing the incidence of hypertensive disorders of pregnancy.
Anaemia still constitutes a public health problem in the world, especially in the developing countries (1). Nutritional deficiency remains a major causative factor (2). During pregnancy, growth of the foetus, placenta and the larger amount of circulating blood in the expectant mother will lead to an increase in the demand for nutrients, especially iron and folic acid. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies. In pregnancy, anaemia has been shown to be associated with an increased risk of maternal and fetal morbidity and mortality (3,4,5). Iron and folic acid supplementation is routinely given to pregnant mothers in Malaysia. It is anticipated that pregnant mothers who comply strictly with the prescribed iron supplement will maintain adequate iron stores at parturition. However, the compliance rate among rural mothers in Kelantan is often poor (6). Kelantan is also one of the most socio-economically underdeveloped
Nutrient intake was surveyed by the total food duplicate method in 49 adult ethnically Malay women (at the ages of 18 to 47 years and mostly at 30-39 years) working in Kuala Lumpur, Malaysia. Simultaneously, hematological examinations, serum biochemistry, anthropometry and clinical examination were conducted. Nutrient intakes were estimated in reference to the weight of each food item and the standard food composition tables. Lunch was the most substantial meal of the day with rice as a staple food. Compared with the Recommended Dietary Allowance (RDA) values, daily intakes of energy (1,917 kcal as an arithmetic mean), protein (62.2 g), vitamin B1 (0.83 mg) and vitamin B2 (1.18 mg) were sufficient, but intakes of minerals [i.e., calcium (347.8 mg) and iron (12.5 mg)] and some vitamins [i.e., vitamin A (equivalent to 627 micrograms retinol) and niacin (7.84 mg)] were less than RDA. When evaluated on an individual basis, the prevalence of those who took less than 80% RDA was highest for iron (92%), followed by niacin (80%), calcium (57%) and vitamin A (57%). The presence of 7 hypohemoglobinemia cases may be related to the insufficient iron intake. Overweight cases (14 women) were also detected, the prevalence of which increased at advanced ages. Lipid intake was rather high (28% of total food on energy basis), for which the major source was plants with limited contribution from fish/shellfish.
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.
From country to country and even regionally, the roles of women in agriculture vary, but most of their labor is in unpaid subsistence production and their contributions tend to be underestimated, according to the results of the [UN] Secretary-General's report. Depending on circumstances, they have complementary roles with men, sharing or dividing tasks in the production of crops, care of animals, and forestry management. In sub-Saharan Africa, for example, women contribute 60-80% of labor in food production for both household consumption and sale, while in Malaysia the women account for only 35% of the agricultural labor force, and in Ireland the participation rate is only 10.4%. Although women make this important amount of labor contributions to agricultural production, "development policies tend to favor export crops to earn foreign exchange and the agricultural research tends to address the improvement of production and technologies for commercial production". This results in limited access for women to technical knowledge and innovations, including irrigation, machinery, farming techniques and extension services. This is strengthened by the fact that most of the extension services target farmers who own land and can obtain credit to invest in input and technology.
With data from the Malaysian Family Life Survey, I use a continuous-state hazards model to study the impact of migration on the dynamics of individuals' careers. I distinguish between the effects of family migration and solo migration by gender. The results show that migration alters the career trajectory primarily by accelerating the process of occupational mobility rather than by increasing the level of occupational attainment. Further, the effect of migration on careers varies by type of migration, especially for women. Male-female differences in the outcome of family migration, however, are visible only in transitions into and out of employment.
The majority of migrant workers studied in this pilot survey were male, from Bangladesh and Muslim. The mean age was 30 years and the majority were aged between 21-30 years. Although almost half of them had 7-13 years of schooling, or an equivalent to secondary education, the majority were work- ing in the Service industry, predominantly in cleaning services. It is noted that this enlployment trend varied from the national situation, whereby majority of legal migrant workers (Indonesian and Thai) are found in the agricultural sector. More than two thirds of the migrant workers were provided with various forms of housing by the employer. However, it is not known if such acconunodation was adequate or not, as there were no questions about housing structures aod extent of overcrowding. Majority of them stated that they had better amenities, such as piped drinking water and sanitaly toilets, here in Malaysia compared to those in their home countries. Yet, the real extent of better sani- tation is difficult to assess since verification of such amenities could not be done. From their self- reports, it appears that the majority did not engage in risk behaviours, such as smoking, alcohol and drug abuse. It is pertinent, however, to include other risk behaviours in the study, particularly the area of sexual behaviour. The pilot study yielded 28 female Indonesian migrant workers. More than two thirds of them were married. Although none of the married women reported that they were pregnant at the time of the survey, more than two thirds of then1 had betweenl-3 children in Malaysia. Since the age range of these children would be an important indicator of the need for preventive health care, it is proposed that age range of the accompanying children and their immunisation status be included in the questionnaire. Just below half of them were currently practising family planning, and more than two thirds were using modern methods, such as, pill, Norplant and IUD. It is recotnmended that in addition to pregnancy and family planning information, the study could also collect data on gynaeco- logical health and the health seeking behaviour for these problems.
This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.
On the eve of International Women's Day, 80 women representing five women's groups in Malaysia, including Persatuan Sahabat Wanita, CAW's network member, marched from Petaling Jaya to Penang to attend the Women's Day celebration. The group had organized the visitation in order to strengthen its networking. During their meeting with some reporters before their departure to Penang, they demanded that the women's groups be consulted before any guideline on the prevention and handling of sexual harassment at the workplace is drawn up. They said that they have been handling several complaints and their input would help the Human Resource Ministry formulate a comprehensive set of guidelines. This demand by the women's group was in response to the announcement by the Human Resource Minister Datuk Lim Ah Lek that in a month time a code would be ready on guidelines about the establishment and implementation of in-house preventive and redress mechanisms for dealing with sexual harassment.