Hypertension and smoking are established and independent risk factors for cardiovascular diseases. There are important inter-relationships between these two factors that may explain the aetiology of coronary heart disease. This study was conducted to determine the prevalence of hypertension and smoking in a rural community setting in Malaysia, and to identify their associated factors. A cross sectional study was conducted among residents aged 15 years and above in Mukim Dengkil, Sepang, Selangor, Malaysia from June to October 1999. Systematic random sampling was used to select the respondents. Results: Five-hundred and seventy respondents agreed to participate giving a response rate of 86.7%. The overall prevalence of hypertension was 26.8%. The prevalence was 31.7% among males, and 23.5% among females. Factors found to be significantly associated with hypertension were males and age. The overall prevalence of smoking was 21.2%. The prevalence among males was 48.7%, where as the prevalence was only 2.6% among females. The factors associated with smoking were males, ethnicity with Malays showing the highest prevalence of 27.2% and age. However, there was no significant association between hypertension and smoking. The prevalence of hypertension in this study is high. However, the prevalence of smoking in this study was slightly lower compared to the result found by the 2nd Malaysian National Health and Morbidity Survey (NHMS2).
The National Health Morbidity Survey 1996 showed only 34.2% of women aged 20 years and above had done breast self examination (BSE). This data showed the practice of BSE is still low despite of various awareness programmes and activities carried out. A cross sectional study through Systematic Random Sampling was done at Out Patient Department, Kuantan Health Office to know the knowledge and practice of BSE among women aged 20~60 years. The results showed 94.9% respondents had received information about BSE, however only 31.6% knew the appropriate time to do BSE, 14.7% knew the purpose of doing at that time and only 29.9% knew how frequent they should do BSE. 74% of respondents did BSE, however 70.2% of them did not do monthly and 67.2% did not do at the suggested time. There was an association between the practice of BSE with the knowledge and sociodemographic characteristics i.e. educational level, income, ethnic group and marital status.
Key word: Breast self-examination, breast cancer, Kuantan.
Study site: Klinik Kesihatan, Kuantan, Pahang, Malaysia
The prevalence of cleft lip and palate in human is 1 in 500 live births worldwide. Non·syndromic clefts are a complex trait with both genetic and environmental etiology. The aim ofthe study was to assess the association between maternal exposure to second-hand smoke during pregnancy and ruk of having cleft child. Unmatched case-control study was carried out among Malays in Kelantan.
1 Case and control subjects were denned as mothers of cleft children and mothers of normal children respectively. The cleft children were recruited from the Combined Cleft Clinic at Kota Bharu Dental Clinic. Normal chiMren were selected at Orthodontic Clinic, Kota Bharu. A total of 184 cases and controb with age range from 17 to 50 years were interviewed using the standard craniofacial
registration form. Multiple Logistic Regression modeling was used to estimate adjusted odds ratio of factors associated with non-syndromic oral cleft. Signijicant factors include history of miscarriage (OR: 3.40; 95% C1:1.05, 11 .08) p=0.042; duration of exposure to second-hand smoke for 15-30 minutes (OR: 2.41; 95% C1:1.42, 4.09) p 30 minutes (OR: 5.16; 95% C1:Z.87, 9.28) p
National Antenatal HIV Screening Programme has been integrated as a routine screening in antenatal care in early 1998 and in Terengganu since May 1998 involving all health centers in the state. As of December 2001, a total number of 57,882 antenatal mothers were screened (97.5% of all new antenatal mothers). The HIV prevalence rate among antenatal mothers was found to be 0.052%. All HIV positive mothers were married and majority were Malays (93 .3%). Ninety percents of them revealed that the only risk factorfor HIV was through sexual contact. HIV positive status was confirmed in 66 .7% ofthe husbands. All twenty eight mothers that managed to be followed up delivered to live birth babies. All newborns reported to have good Apgar score (9 at 5 minutes of life). Mean birth weight was 3 .08 kilograms 1- 0.45 and only 8% were premature babies. The observed rate of HIV vertical transmission was 6.25% and this is lower than the expected mother to child transmission rate of 30% without intervention.
The hand, foot, and mouth disease (HFMD) outbreak occurred in the state of Johor, Malaysia in the months 0f October and November 2000 aber the HFMD outbreak started in Singapore in September 2000. The HFMD notification and investigation forms sent to the Epidemiology Unit of the Johor Health Department from district health offices and hospitals during the outbreak were analysed. Patients’ specimens were sent to the Institute for Medical Research, Kuala Lumpur and the Universiti Malaya Medical Centre, Kuala Lumpur for viral isolation. A total of 1,122 HFMD cases were notified during the outbreak period with 2 deaths giving 0.2% casefatality rate. From all the cases, 544 (48.5%) patients were admitted to the hospital while the rest were treated as outpatients. Majority (81.7%) of children with HFMD were aged below 5 years old with the commonest age group (46.9%) being between 1 to 2 years old. Sixty-eight patients had positive specimens for viral isolation belonging to enteroviruses namely Enterovirus 71 (43 cases), Coxsackievirus Type A16 (11), Echovirus 7 (3), and Coxsackievirus Type B (2); and non-enteroviruses namely Herpes Simplex Virus Type 1
(5), and Adenovirus (4). Fever and mouth ulcer were the two most common symptoms among HFMD children but vesicles on palms and soles were more common than rashes in children with positive enteroviral isolation.
Study site: University Malaya Medical Centre (UMMC)
The main objective of the study was to determine the oral health status and possible factors influencing oral hygiene in the institutionalized elderly in Sabah. A cross sectional study in all four institutions for the elderly in QM ii Sabah was conducted using oral examination and interview/questionnaires. Qualitative assessment using Focus Group Discussion was carried out in the caregivers of the institutions. Plaque score was used to assess oral hygiene status. A total of 94.0% of inmates were above 55 years old. There were 13.4 % non-respondents in the total sample of 284. Of the n0n—respondents, 42.4 % had mental disorders and this was statistically signnicant. Of those who responded 34.6% had good 33.3% fair and 32.1% poor oral hygiene. 33.5% were completely edentulous, 86.4% had gingivitis which required scaling, 22.0% had decayed teeth and 54.9% required extraction. Gingivitis, decayed teeth and number of teeth for extraction were signwcantly associated with poor oral hygiene. 14.2% had at least one type of oral disease. Dental abscess was the most common muco»cutaneous lesion found. Mental disorders showed a trend towards poor oral hygiene and this was statistically signyicant. Although 40.8% had physical handicap, 23.3% visual impairment and 8.2% hearing impairment, there was no significant association with oral hygiene status. In conclusion, oral health status of the population is poor and treatment needs are high. Although there was high objective need for oral care (88.6%), perceived need was low (32.0%).
On March 17, 2003 the Kelantan Health Department was notihed about a possible typhoid outbreak following a wedding party. An investigation was carried out to identiy the source and recommend control measures. Active case detection, yield investigation and case»control study were conducted. Cases were symptomatic attendees with a stool or blood culture positive for Salmonella
typhii. Each control had a negative culture and denied symptoms. Of the more than 1 OOO guests, 477 experienced fever; 152 met the case definition. The party hostess was found to be an Salmonelb typhii carrier. Syrup prepared with untreated well water was identified as the most likely source for this outbreak, with an odds ratio 14.0 (95% C1: 2.9, 104.1). This was a common source
outbreak of typhoid. We recommend that all food handlers at large parties be screened for typhoid and other foodborne diseases and samples of higherisk foods should be kept for few days after each event in case they are needed for testing.
Backache is a common health problem associated with non ergonomic working environment. A cross sectional study amongst the rubber tappers was conducted to determine the prevalence of low back pain and ergonomic factors related to it. The respondents were 116 male rubber tappers from Felda scheme in the state of Pahang who were selected by random sampling. The result showed prevalence of low back pain was 60.3% and has significant association with history of backache (p<0.05). Rubber tappers were 6 times more higher to develop low back pain if they had history of backache (Odd Ratio =6.24, 95% CI). There were no significant association between socio-demographic factors and low back pain. Ergonomic factors such as bending during tapping, respondents’ height and duration of the tapping showed no significant association with low back pain. Further study should be done in ergonomic aspect to explore the problem.
Key words: Low back pain, rubber tapper, Felda, ergonomic.
Satu kajian keratan rentas telah daalanlcan ke atas kanak-lcanak yang tinggal 0.5 km dari sebuah lcuari di Sungai Siput Utara. Objelctif kajian ini ialah untulc mengkaji hubungan PM10 dengan fungsi paru-paru kanak-kanak tersebut. Seramai 51 orang kanak-/canak yang ringgal berhampiran kuari dan terdedah dengan debu kaur tehih dipilih, manakala 37 orang kanak-kanak yang tinggal berjauhan tetapi di daerah yang sama telah dipilih sebagai perbandingan untuk lag ian ini. Borang soalselidik telah digunakan untuk mendapatlcan maklumat latarbelakang dan sejarah respiratori dari ibu bapa kanalc-kanak terlibat. Fungsi paru-paru kanak-kanak pula diukur dengan menggunakan Pony Graphic S pirometer. Min kepekatan PM1 0 selama 24 jam di dalam rumah kediaman di kawasan terdedah ialah 76.66 (g/m3 dan di kawasan perbandingan 41 .55 (g/m3. Perbezaan kepekatan PM10 di antara kedua kawasan ini adalah signifikan (p=0.01). Hasil ujian fungsi paru-paru menunjukkan perbezaan yang signifikan di antara fungsi paru-paru kanalc-kanalc terdedah dengan kanak-kanak perbandingan dari segi FVC % jangkaan (t = -8.227, p = 0.01) dan FEV1 % jangkaan (t = -8.729, p = 0.01). Min fungsi paru-paru kanak-kanak lelaki di kawasan terdedah, (FVC % jangkaan = 68.05, FEV1 % jangkaan = 73.71) adalah lebih rendah daripada kawasan perbandingan (FVC % jangkaan= 89.78, FEV1 %~ jangkaan = 86.97). Min fungsi paru-paru kanak-kanak perempuan di kawasan terdedah (FVC % jangkaan= 69.64, FEV1 % jangkaan =74.90) juga adalah lebih rendah daripada hawasan perbandingan ( F VC % jangkaan = 90.99, FEV1 % jangkaan : 87 .7 9). Prevalens kejejasan parurparu FVC % jangkaan l
A cross-sectional study on helminthiasis among rural primary schoolchildren aged 9 to 10 years Bachok, Kelaritan was perfumed. A total of 680 schoolchildren participated in the study. Stool specimens were examined for the presence of the ova of Ascaris lumbricoides, Trichuris trichiura and hoolcwonn. The worm load was then measured using the modified Stoll`s volumetric dilution
technique. The overall prevalence of helminthiasis was 77 .2%. Trichuris trichiura were the commonest type of heminth noted - 66.8%, compared with Ascaris lumlrricoides (49.7%) and hookworm (1.8%). Mixed infections with Ascaris lumlyricoides and Trichuris trichiura was the commonest type of infection 249(41 .5%) . For Ascaris lumbncoides, 34.6% had mild and 5 I .3% had moderate worm load while for Trichurb trichiura, 66.5% had mild and 30.8 % had moderate worm load. Only 14.1% and 2.7% 4 of the schoolchildren had a heavy load of Ascaris lumlwicoides and Trichuris trichiura respectively. All the schookhildren with hookworm were only mildly infected. Targeted mass treatment for rural Mahysian schoolchildren is still essential, especially in areas where poverty and malnutrition are still prevalent.
Aspek pantang larang dalam pemakanan dan perkhidmatan bomoh merupakan entiti unik dalam budaya masyarakat Orang Asli. Satu kajian irisan lintang di kalangan masyara/cat Orang Asli pinggiran (di Pos Betau) dan pedalaman (Pos Sinderut) Kuala Lipis telah dijalankan pada 25hb September hingga 6 Oktober 1999 bagi mengetahui pola pemakanan dan amalan pantang larang dalam aspek pemakanan yang mempengaruhi tahap pemakanan seseorang. Seramai 255 orang responden telah ditemuduga oleh kakitangan terlatih menggunakan borang soal selidik berpandu dimana 15 orang dari kawasan pinggiran dan 104 orang dari pedalaman. Hasil kajian menuruukkan Orang Asli pinggiran lebih kerap mengombil makanan dalam sehari (p
Corporate culture can simply be defined as “The way we do things around here". It comprise of assumptions, values, norms and tangible signs. Ministry of Health has started its culture building in 1991. Prior to this study, there have been two studies to evaluate its implementation. There were two types of respondents, where administered questionnaires were sent to all head of departments and all U3 medical ojjicers in public services in Malaysia, About 50% (n=126) of head of departments and only 18% (n=1321) of medical ojjicers responded. The study shows that at least 83% of head of departments perceived that the three core value of corporate culture has been implemented in their departments. However for rites and rituals, less than habf of them have implemented it. Singing of corporate song is done more in hospital as compared to health. As for medical officer, only 28% of them have received training on corporate culture. Among those who have received training, only a quarter understood the meaning of corporate culture. Doctors were also asked to give opinion on how to generate a caring doctor. About one-third suggested to reduce the workload of doctors. Apart from increasing manpower, workload can also be reduced by reengineering the system and upgrading the doctors’ competency.
HIV/AIDS is a global issue and the fourth biggest killer worldwide. Report from Ministry Of Health Malaysia showed factory workers are among the social group that are mostly infected (10.4%). A cross~sectional study was carried out to determine the socio-demographic factor and its relationship with knowledge, attitude and HIV-related risk behavior among factory workers in Selangor, Negeri Sembilan and MaIacca. This study involved 3300 factory workers selected randomly and were given self-guided questionnaire. With response rate about 95.4% (3148), the level of knowledge was high (97.3%) and the attitude was positive (81 %). However there was still an amount of fear towards HIV/AlDS patient. Logistic regression showed significant difference (p<0.05) between level of knowledge and ethnic group, income and level of education and between attitude and income and level of knowledge. About 27.7% of respondents smoked cigarette. 4.2% involved with drugs of which 0.7% administered intravenously, 2.3% were homosexuals, 2.5% were bisexuals and 3.1% were hererosexuals. HIV/AIDS prevention and control intervention should take into consideration the local socio-cultural factors and commitment from the top level management in the factory·
A cross-sectional study to determine the prevalence of malnutrition and some associated factors among primary one schoolchildren, aged 7 years from rural areas of Tumpat and Bachok in Kelantan was carried out. A total of 922 chiMren from 18 primary schools were examined. The parents completed self-administered questionnaires eliciting demographic and socio-economic information. The weight and height of each child was taken. The nutritional status was assessed by the z-scores of weight-for-age (WAZ) , height- or-age (HAZ) and weight-for-height (WHZ). The prevalence of underweight was 25 .2% , stunting was 21 .1% and wasting was 6 .2%. Less than 1 .0% ofthe children were overweight. Risk factors of underweight were lueinga male (OR=l .4),
having an unemployed father (OR=2 .6) and a monthly family income of RM 251 -500 (OR=2 .0) . Being a male (OR=1 .6) was the only risk factor for stunning and working mother (OR=2 .0) was the only risk factor of wasting. In conclusion, there is still a high prevalence of undemutrition among primary one schoolchildren in rural areas of Tumpat and Bachok. This may be due to the poor socioeconomic status of the rural community and the lack of emphasis ofthe supplementary feeding program on the late preschool children. A comprehensive nutrition support program is essential, especially targeting the preschool children in these rural communities
A cross sectional study was carried out to identify and compare factors that contribute to patient satisfaction towards the medical care services provided at the outpatient clinic in government health clinics and private clinics in Mulcim Labu, Sepang, Selangor. Systematic sampling for government clinic and universal sampling for private clinics were done and data was collected via face-to-
face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 181 patients aged 15 to 75 years old were selected, comprising 90 patients from the government clinics and 91 patients from private clinics. The majority of the patients were males (62.4%), Malay (79.0%), aged between 25 to 34 years with a mean age of 34.6 years and acutely ill (80.7%). Generally, all patients were satisfied with the services provided in both government and private sectors. Patients in private clinics, however, had a significantly higher satisfaction score as compared to the respondents in government clinics. There was signilqcant correlation between patient satisfaction score and household income in government and private clinics. Significant correlation was also found between patient satisfaction score and age in government clinic. Patients in private clinics were more satisfied towards the interpersonal manners, availability and continuity of care of the clinic compared to patienw in government clinics. Whereas patients in government clinics were more satisfied towards the service charges. This study provides important in ormation that could be used by roviders o health care services to monitor and im roved the ualit o medical care in the respective sectors.
The aim of this study was to determine the pattern of health care utilization amongst the rural community and the prevalence of complementary health care in Kampung Giching, Sepang, Selangor, A cross sectional study was conducted in 2001. Out of the 154 respondents selected by universal sampling, only 131 completed the questionnaires giving a response rate of 85.1 %. The
respondents were asked to recall the presence of any illness during the past 6 months and their use of health care, Twenty-four respondents claimed to be healthy without having any illness (18,3%), 33 respondents (25,2%) reported that they had chronic illnesses, while the rest (n=74) reported having acute illnesses. There were 54.2% of the respondents admitted trying self-medication and 10.3% seelced traditional medication for their respective illnesses. Among the self»medicated respondents, 48,3% used modem medicine, 48 .3% used traditional medicine, 1.7% used both modern and traditional medicines and 1 .7% respondent used home remedies. The results of this study show that both modern and traditional practitioners play important roles in giving information on self-medication, These practitioners as well as the public should be advised on the benejits and side»e]j"ects of both types of medication (modern and traditional).
The aim of this study was to describe the sociodemographic aspect, clinical presentation and laboratory support, behaviour factor and vector situation of dengue outbreak. Data was obtained from standard investigation format of 84 cases of suspected dengue fever in two main outbreaks localities in Temerloh District from December 2001 to January 2002. The result showed that most of the cases occurred among 11 years old and above, especially in the age group of 11 to 20 years old. Students and female were the most high risk groups. Rashes and petechiae were more prevalent in Taman Sri Semantan which reflect the case incidence there. Serological result showed that seroprevalence for IgM was 66.1 %. Based on dengue rapid test, secondary infection was more prevalent in Taman Sri Kemuning whereas those in Taman Sri Semantan had more primary infection. About 25% of the cases came late to hospital for treatment. Both localities had different mosquito breeding areas. Further studies are needed to identify behaviour aspect of the population with regard to dengue fever in previous main outbreak localities. A more valid and rapid serological test is required for better case identification.
Keywords: Dengue outbreak, risk factors, patient factor, clinical finding, serological test
Breast cancer is the commonest female cancer in Malaysia with a prevalence of 86.2 cases per 100,000 women in 1996. Pronling breast cancer patients is important for better planning of preventive and screening strategies for Malaysian women. The aims of this cross-sectional study were to identify histological presentation, socio-demographic and reproductive characteristics and prevalence of risk or protective factors of breast cancer among women with breast cancer in Kelantan. A total of 175 female breast cancer patients who were diagnosed in 1991 to 2000, were interviewed using standardized questionnaires. The mean (sd) age was 47.0 (9.6) years with 77.7% Malay, 20.6% Chinese and 1.7% others. About half (52.6%) had 9 years or less of formal education, while 59.4% were housewives/unemployed and 60.6% had a monthly family income of less than RM1 ,000. The commonest histological type was innltrative ductal carcinoma (73 .7%) . Presentation of breast cancer with the stage lll or Vl was 59.4%. The prevalence of nulliparity · 13.1%, breastfeeding longer than two years - 58.9%, premenstrual period - 72.0%, menarche at 11 years old or less - 5 .7%, positive family history - 14.4%, overweight/obesity - 48.0%, oral contraceptives use 30.3%, hormone replacement therapy » 1.1%, cigarette smoking - 4.6%, consuming akohol - 3.4%, previous benign breast disease - 6.3%, previous breast biopsy - 2.9% and previous oophorectomy - 4.6%. The patients were younger compared to other studies. The ethnic distribution did not represent the population distribution of Kelantan. The prevalence of overweight/obesity and smoking were higher than the national prevalence among women, thus they should be included in the prevention strategies for breast cancer. Further studies are recommended to investigate why many of breast cancer patients in Kelantan presented at a younger age and at advanced stages of cancer.
A cross sectional study was conducted in Kelantan state with the objectives to determine the prevalence of smoking in 2004 and to determine the relationship between smoking and age, sex, educational level, family and peer influence. All residents aged 15 years and above from all the selected households were included in this study. A standardized pre-tested structured questionnaire was used in this study. Out of 1025 respondents interviewed the prevalence of ever and current smokers was 34% and 25.1% respectively.The prevalence of ever smokers and current smokers was significantly higher In males as compared to females (p.<0.001). The mean initiation age for the males current smokers was 10.4 (95% CI = 19.4, 21.5) years with a range from 7 to 66 years. For the females the mean initiation age was 31 (95% Cl =26.8, 35.2) years with a range from 15 to 64 years. The difference between the mean initiation age between male and female smokers was statistically significant (p<0.0001). The overall mean duration of smoking was 23.9 years with a median of 23 years. It ranged from less than 1 year to 66 years. There was no significant difference between the mean duration of smoking between male and females current smokers (p =0.59). There was a significant association between current smoking status and education level (p<0.01 ) and between smoking and peer influence (p<0.01). There was no significant difference in smokers whose parents were smokers as compared to non-smokers whose parents were smokers. In conclusion the prevalence of smoking in Kelantan state in 2004 is lower than the reported prevalence in 1996. However, it is still very high especially in the males.
Key words: Smoking, peer influence, Kelantan
Exposure to secondhand smoke has consistently been linked to adverse health effects in children, including reduced lung function and various respiratory diseases. There is also increasing evidence that secondhand smoke exposure is associated with cognitive impairment and behavioral problems in children, This cross sectional study was done on 795 chiildren to determine the association between secondhand smoke exposure and peak expiratory flow rate (PEFR) and cognitive performance among the primary school children in Kota Bharu Kelantan. A questionnaire was used to obtain information on socio-demography and smoking status of the household. The PEER was measured using a child Mini Wright peak expiratory flow meter while cognitive performance was assessed by four subtests of Weschler Intelligence Scale For Children (WISC III). Data analysis was done using SPSS version 11. Children were classified as exposed to secondhand smoke when at least one househoH member smoked. There were 442 (55 .6%) children exposed to secondhand smoke at home. The mean (SD) PEFR for unexposed and exposed children were 266.18 (60.80) l/min and 266 .06 (57. 70) l/min respectively, The mean (SD) scores for Digit Span Forward, Digit Span Backward Coding and Arithmetic in unexposed chiMren were 6.84 (1.80), 4.Z7(1.68), 45.25 (9,99) and 8.04 (1.04) respectively. The mean (SD) scores for exposed children were 6.73 (1 .77). 4.07 (l .65), 45.1 I (1 I ,03) and 8.13 (1 .00) respectively. Multivariate analysis of variance showed no signincant dijference in the PEFR (p=O.816) and the cognitive scores between exposed and unexposed primary school children in Kota Bharu, Kelantan