The population of Malaysia is approximately 14 million and theoretically 1 in 2500 marriages are between heterozygotes for thalassaemia and 1 in 10,000 children can be expected to have thalassaemia major. Hypertransfusion is not possible because of insufficient blood supplies and each child requires an iron chelator, Desferal, at US$5800 a year for life: this high cost makes it sizeable proportion of the 'active reproductive' population. Abortion is not legal and antenatal diagnosis has not bee established. An approach to the prevention of this disease would be public education and identification of carriers. Numerous techniques have been utilised in population screening for traits of thalassaemia and haemoglobinopathy. These include osmotic fragility tests; blood smear examination for basophilia, microcytosis, and hypochromia; and genetic studies. Blood smear examinations are extremely subjective and interpretations depend upon the skills of a trained technologist. Osmotic fragility tests although cheap are cumbersome and require accurate preparations of saline solutions. Genetic studies are not available in the region. The medical examination for entrance to colleges and institutions includes investigative procedures such as chest x-ray and urine examinations. In addition a blood sample could be analysed for the red cell parameters. A similar study could be attempted for all secondary school leavers. The current estimated cost on the Coulter S as in this study was 80 cents (U.S.) in contrast to the prohibitive costs of managing a case of transfusion-dependent thalassaemia. These two groups would cover a sizeable proportion of the 'active reproductive' population. Analysis of the red cell parameters provides useful information for the identification of carriers of alpha-, beta-, delta-beta-thalassaemia and HbE. Additional studies which include haemoglobin analysis and serum ferritin would provide the necessary evidence for the confirmation of these findings.
Hereditary haemolytic anaemias, in particular, thalassaemia and the haemoglobinopathies, have been found to be a significant cause of hereditary haemolytic disease in West Malaysia. Theoretically 1 in 2500 marriages are between heterozygotes for beta-thalassaemia and 1 in 10,000 children can be expected to have thalassaemia major. An approach to the prevention of this disease would be public education and identification of carriers: to develop some approach to the identification and genetic counselling of beta-thalassaemia trait.
The first report of dengue haemorrhagic fever was in 1962 in Penang. Subsequently several outbreaks had been reported. A high index of suspicion is needed for early recognition.
A review of recent data available on the nutritional health of Indian children seems to suggest that malnutrition is a major problem among poor Indian preschool and school children. Examination of indirect indicators of malnutrition reveals that for Indians, the annual percentage decrease in TMR is the lowest and incidence of low birth weight and perinatal mortality rate the highest. While there is very little documentation in the extent and severity of protein-malnutrition among Indian children, hospital admission returns for severe PEM show a predominance of Indian preschool children. This suggest that moderate forms of malnutrition may even be more widely prevalent amongst this group of the population thus posing a great problem from the public health point of view. The prevalence of moderate PEM as represented by acute ("wasting") and chronic forms ("stunting") was found to be the highest among Indian urban and rural children. Biochemical studies indicate widespread prevalence of anemia, vitamin A and B deficiencies especially among Indian preschool children. The presence of high parasitic infections may exacerbate such deficiencies. The causes of malnutrition are multiple and complex. Low family income as a consequence of high unemployment rate (8%) and low wages, lack of basic sanitation and adequate housing, large family size, alcoholism and apathy among parents, ignorance of good nutrition and disturbed conditions in the home environment have been identified as some of the factors that may contribute towards malnutrition in this community. Thus the viscous cycle of malnutrition appears to have gained a foothold in the poor Indian community. As has been well documented, the social implications of malnutrition are many, the most important being its effect on education. It is now well known that malnutrition hinders intellectual development; it interferes with a child's motivation, ability to concentrate, and ability to learn and cope with the school situation. Malnutrition thus could be one of the contributory factors to the generally poor performance in studies, to the low aspiration for higher education and to the alarming drop-out rate (60%) found among Indian school children. While this review attempts to highlight some of the nutritional problems confronting the Indian poor, it is clearly essential from a national view-point that community level surveys should be further undertaken to assess the nutritional health of this group. The problem of malnutrition among poor Indian children is real and needs urgent recognition and remedial measures from both public and political sectors alike.