Citation: Prevalence survey of sexually transmitted diseases among sex workers and women attending antenatal clinics: Malaysia (1999-2000). Manila: World Health Organization, Regional Office for the Western Pacific; 2001
This paper describes the nutritional status of pre-school children and analyzes its relationship to various household socio-economic indicators. Padi, rubber and fishing villages from the Functional Groups Study (1992-1996) were selected for having a high prevalence of child undernutrition, and all children between the ages of 12 and 72 months were measured for their weights and heights in April-May 1998. The NCHS reference values were used to calculate z-scores, which were categorised according to WHO (1983) recommendations. Children between minus 2SD and minus 1SD of reference median were classified as mildly malnourished. Prevalence of underweight was higher (30.5%) than stunting (22.3%), while wasting was only 9.7%. Padi villages had the highest prevalence of undernutrition, followed by fishing, and then rubber villages. Mean household incomes were found to be significantly lower for children with worse nutritional status, and undernutrition was higher in households below the poverty line income. The odds ratios for having stunted children were significantly higher for households whose heads were agricultural own-account workers (OR 3.66, 95% CI = 1.37-9.79), agricultural waged workers (OR 2.75, 95% CI = 1.06-7.10), and non-agricultural manual workers (OR 2.49, 95% CI = 1.04-6.00) compared to non-manual workers. Various household socio-economic indicators showed significantly higher odds ratios for underweight, stunting and wasting. After adjusting for confounding effects by logistic regression analysis, however, only mother's education was found to be a significant predictor for stunting, while poverty level and access to piped water supply were significant predictors for both underweight and stunting. Households without livestock were significant predictors for wasting. Thus, this study identified specific socio-economic factors that should be prioritized for policy and research towards the amelioration of childhood malnutrition in rural areas.
A cross sectional descriptive study on breast feeding practices in an urban clinic was conducted among 136 mothers aged between 21-49 years who were interviewed using a questionnaire. Malays constituted 61% of the respondents, Chinese 22.8% and Indians 16.2%. Mojority of these were working mothers and although the initiation of breastfeeding was high (99.3%), exclusive breastfeeding was only 12.5%. A large proportion (33.8%) dtopped prior to 3 months. Majority of the Chinese mothers (61.3%) stipped before 3 months as compared to the Indian (40.9%) and Malay (21.7%) mothers (p<0.001). Mean age of introducing complementary foods at 3 months is below the accepted age of 4 to 6 months for weaning. Ever-breast feeding rate is high in this urban setting but more efforts are needed to effect a higher rate of exclusive breastfeeding and longer duration of breastfeeding.
The number of deliveries increased very signdicantly in all hospitals in Terengganu since 1986. It is in line with the promotion of Safe Motherhood Initiative' with the aim to reduce maternal mortality and morbidity in a Terengganu. The aim of the study was to determine the pattern of choice for place of deliveries by local people in Terengganu and also to identdy risk factors related to their place of choice. A total of 9741 deliveries home January 1999 to 30”’ of June 1999 were included in the study. About 46% delivered in Hospital Kuala Terengganu, where 72% of them were high-risk mothers. Whereas deliveries in the district hospitals were 9.9% in Kemaman Hospital, 9.7% in Besut Hospital, 7.2% in Dungun Hospital and 3.4% in Hulu Terengganu Hospital. About 67% of district hospital deliveries were high-risk mothers. Only 12.4% of deliveries were home deliveries, however 49% of them were high-risk mothers. Utilization of alternative birthing centre in health clinics was only 1.7%. The study revealed that mothers’ risk factors are the factors signaicantly influence the place of choice for deliveries. The study jindings call for an urgent need of three essential services, Firstly an urban birthing centre conducted by obstetrician or the medical ojicers to be developed at the vicinity of the present general hospital to cater for the high percentage of high—risk pregnancies in the state. Secondly, all or selected district hospital to be given post for obstetrician, and thirdly it is a need to evaluate the current ‘High Risk Checklist for Antenatal Mothers’ to ensure treatment priority is indeed given to those really in need based on appropriate risk factors.
Smaller family size and advancing parental age have increased the demand for prenatal diagnosis.
Prenatal cytogenetic diagnoses currently used, such as amniocentesis and chorionic villus
sampling, are usually not preferred by the expectant couples due to the risk imposed on the mother and child. High false positive rates (5%) of current non-invasive screening methods, such as serum analysts or ultrasound, cause a large number of unnecessary invasive practices to be performed, which apart from the associated risk, place considerable psychological distress on the couples
involved (Wald et al., 1999). (Copied from article).
Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.
Health impact related to smoking is a critical public health predicament especially in pregnancy. However there is not much data available to describe the magnitude of the problem. Hence this study was conducted to determine the prevalence of smoking and its socioeconomic factors among antenatal mother and their opinion related to tobacco control measures. A cross sectional study was carried out involving newly registered antenatal mothers attending all government health clinics in Penang. Prevalence of ever smoking among antenatal mother is 1.4%, of which 42.4% is still smoking at first antenatal visit. It was found that single mothers are more likely to smoke (OR, 14.23: C12.52-53.27). It was also noted that spouse smoking (OR, 5,14: CI 1.95-17.09), primigravida (OR, 2.7: C1 1.3-5.62), age group less than 30 years old (OR, 2.41; CI 1.03-6.09) and living in urban area (OR, 2.33; CI 1.01 — 6.47) have a higher risk to indulge in smoking behaviour. Muslim OR 0.29; C1 0.14 - 0.60) and Malay (OR 0.22; CI 0.10 - 0.47) pregnant mothers are noted to be less likely to smoke as compared to non Muslim and non Malay. More than 85% of them agreed with the tobacco control measures regardless of their smoking status. Most of respondents agreed the influential people in community L;11T · such as medical personnel, teachers and parents should not smoke.
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.
This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural areas. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.
Chronic disability in children imposes great strains on a family. The responsibility of mothering disabled children may be detrimental to the well-being of mothers. This study aims to assess the different types of coping styles of mothers with disabled children and its influencing factors. It is a cross-sectional study using Coping Inventory Stressful Situation (CISS) scale to determine the mothers' coping styles. A sample of 81 mothers with disabled children attending two rural Community Rehabilitation Centres, were included in the study. Overall, the mothers were using a mixture of coping strategies. However, they scored more in the task-oriented (mean T score = 52.88) and emotion-oriented (mean T score = 50.52) coping styles, while the other subscales of coping styles, namely avoidance, distraction and social diversion were below average (mean T score < 50). Divorced mothers (p=0.04) and those with low educational level (p=0.00) were more inclined to use emotion-oriented coping strategies while mothers with younger children (< 5 years old) used more avoidance coping strategies (p=0.01). There were no significant difference of coping styles in association with the mothers' age, ethnicity, duration of marriage, number of siblings, child's birth order or gender. By understanding the mothers' coping styles, health care workers would be able to educate the mothers with effective coping strategies and consequently reduce their psychological distress.
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
This study determined the concentrations of polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), organochlorine (OC) pesticides, and tris(4-chlorophenyl) methane (TCPMe) in human breast milk samples collected in 2003 from primipara mothers living in Penang, Malaysia. OCs were detected in all the samples analyzed with DDTs, hexachlorocyclohexane isomers (HCHs), and PCBs as the major contaminants followed by chlordane compounds (CHLs), hexachlorobenzene (HCB), and TCPMe. The residue levels of DDTs, HCHs, and CHLs were comparable to or higher than those in general populations of other countries, whereas PCBs and HCB were relatively low. In addition, dioxins and related compounds were also detected with a range of dioxin equivalent concentrations from 3.4 to 24 pg-TEQs/g lipid wt. Levels of toxic equivalents (TEQs) were slightly higher than those in other developing countries but still much lower than those of industrialized nations. One donor mother contained a high TEQs level, equal to the mean value in human breast milk from Japan, implying that some of the residents in Malaysia may be exposed to specific pollution sources of dioxins and related compounds. No association was observed between OCs concentrations and maternal characteristics, which might be related to a limited number of samples, narrow range of age of the donor mothers, and/or other external factors. The recently identified endocrine disrupter, TCPMe, was also detected in all human breast milk samples of this study. A significant positive correlation was observed between TCPMe and DDTs, suggesting that technical DDT might be a source of TCPMe in Malaysia. The present study provides a useful baseline for future studies on the accumulations of OCs in the general population of Malaysia.
OBJECTIVE:A cross-sectional study design was utilized to examine factors associated with obesity in Chinese-American children.
SUBJECTS:Chinese-American children (8 to 10 years old) and their mothers (N = 68) in California participated in the study.
MEASUREMENTS:Mothers completed demographic information, the Family Assessment Device, Attitudes Toward Child Rearing Scale, and Suinn-Lew Asian Self-identity Acculturation Scale. Children's body mass index was measured, and children completed a self-administered physical activity checklist, Food Frequency Questionnaire, and the Schoolagers' Coping Strategies Inventory.
RESULTS:Results indicated three variables that predicted children's body mass index: older age, a more democratic parenting style, and poor communication (R2=.263, F=8.727, p = .0001). Children whose mothers had a low level of acculturation were also more likely to be overweight than were children whose mothers were highly acculturated.
CONCLUSION:This study revealed that children's ages, a democratic parenting style, and poor family communication contribute to increased body mass index in Chinese-American children. Other factors related to children's BMI and dietary intake include acculturation level of the mother and family affective responses. Future studies should examine the change in BMI over time and in different age groups and why parenting and family communication impact children's body weight.
Traditionally, Chinese women adhere to special dietary practices during the month following childbirth. This paper discusses the dietary practices and food taboos practised by Chinese women in Kuala Lumpur. A total of 134 Chinese mothers of children below one year were recruited from three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur. Questionnaires and in-depth interviews were used to obtain information on socioeconomic background, dietary practices, food taboos and cooking methods during the confinement period. Food intake was assessed by multiple 24-hour dietary recall among 34 mothers during their confinement month (zuo yuezi). Body weight and height were measured, and body mass index calculated. Majority of the respondents had secondary school education (77.6%), household income between RM1001 and RM3000 (64%), and were homemakers (48.5%). The women were aged 18-39 years, and 68% were of normal weight. Most women (82%) practised 30 days of confinement, during which they adhered to special dietary practices. The diet was directed at attaining yin-yang (cold-hot) balance, whereby “hot†foods were most commonly used and “cold†foods were avoided. Ginger, rice wine and sesame seed oil, considered “hot†foods, were used in large amounts in the cooking. Rice, chicken and pork were also consumed in large amounts. Most vegetables and fruits were considered “cold†and were prohibited during confinement. Most mothers drank specially-prepared teas boiled from Chinese herbs. Mean energy intake was 19% below RNI, while mean protein intake was 93% above RNI (NCCFN, 2005). Mean intakes of thiamin, riboflavin and niacin were above 75% of RNI, while vitamins A and C were at half of RNI or less. Mean iron and calcium intakes were at 222% and 67% of RNI, respectively. It is concluded that most Chinese women in Kuala Lumpur do conform to special dietary practices during zuo yuezi.
Study site: three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur
Even though vaccines are effective for prevention of diseases, compliance with recommended schedules of immunisation in early childhood is not always complete. Identification of potential risk factors associated with under-immunisation may help increase vaccination uptake. The objectives of this study were to determine the prevalence and risk factors of under-immunisation in hospitalised preschool children in Universiti Sains Malaysia Hospital (HUSM). Children aged 1 month to 2 years admitted between December 1998 and December 2000 in medical paediatric wards at HUSM were studied. Parents/guardians were interviewed during admission regarding immunisation status and potential risk factors. Children who did not have home-based cards during admission were excluded. Among 401 children, 37.9% had complete immunisation, 43.4% had delayed immunisation and 34.9% had incomplete immunisation. The uptake of BCG, DPT/OPV 1, DPT/OPV2, Hepatitis B3, DPT/OPV3, and measles were 98.5%, 90.7%, 83.2%, 81.4%,79.2% and 72.9% respectively. Vaccines scheduled to be given at later ages were significantly less likely to be taken (p=0.002) compared with vaccines scheduled to be given at an earlier age. Significant independent risk factors for under-immunisation were elderly mothers (3 40 years old) (OR 3.0, 95% CI: 1.2-8.0), low birth weight £2.0 kg (OR 6.2; 95% CI: 1.8-21.4) and presence of chronic illness in the child (OR 4.5; 95% CI: 2.5-7.9). In children whose father's education was low (primary school or no education), low maternal education was significantly associated with lower rate of under-immunisation (p = 0.005, OR 0.11 95%CI 0.02-0.51).
In conclusion this study showed that a large proportion of hospitalised preschool children were under-immunised, and vaccines scheduled to be given at a later age had lower uptakes. The situation can be rectified if every opportunity is taken to immunise all children, who have lapsed in their immunisation schedule.
Breast-feeding offers many benefits to the baby and the mother. For instance, breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler. Even though breastfeeding is a natural process, it is not always easy. In certain situations, some mothers are unable to breastfeed their babies or the babies are unable to adapt to breastfeeding. This will lead to the use of bottle-feeding. The effect of breast-feeding and bottle-feeding on physical growth has been well established but less has been concentrated on the craniofacial growth and dental development. This review reveals the effects of breast-feeding and bottle-feeding on craniofacial growth and dentoalveolar development based on the available literature.
Iodine is an essential micronutrient for normal physical and mental development. Iodine deficiency is endemic in 130 countries worldwide, including Malaysia. This is a cross-sectional study done to determine the prevalence and risk factors of iodine dejiciency among 342 rural mothers attending antenatal clinics in Bachok, Kelantan. A self-adrninistered questionnaire on the knowledge, attitudes, practices and other risk factors relating to iodine deficiency was done. Physical examination for thyroid enlargement was carried out and urine samples were taken for urine iodine determination. The prevalence of iodine deficiency based on urine iodine Q level of less than 100 mcg/l was 63.0 % (95% CI: 57.8, 68.2). The mean urinary iodine level was 87.3 mcg/l with a median of 78.0 mcg/l. However, the goiter prevalence was only 9.4%. The total mean scores of knowledge, attitudes and practices were generally low at 58.6 (SD 7.9), 52.9 (SD 7.9) and 42.9 (SD 10.9) respectively. Logistic regression analysis found that a smoking husband is a risk for iodine deficiency (OR=2.0). In conclusion, iodine deficiency disorders among rural antenatal mothers were still prevalent in Bachok. Their level of knowledge on the causes, effects, prevention and clinical presentations of Q iodine deficiency disorders were poor. In addition, having a husband who is a smoker increases the risk of the antenatal mothers developing iodine denciency.
Study site: Antenatal clinic (klinik kesihatan), Bachok, Kelantan, Malaysia
On December 26, 2004, an earthquake triggered a devastating tsunami that caused death and destruction in twelve countries including India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka and Thailand. One of the authors was a volunteer with FELDA WAJA AMAN MALAYSIA medical relief team that served the Aceh victims from 16th February to 24th February 2005 (8 weeks post tsunami). A study to determine the pattern of health ailments was conducted among children aged 18 years and below based at Seuneubok Camp, 30 km from Banda Aceh. All respondents were from Pulau Aceh and the total number of children seen and examined was 60. About 18% had lost their fathers, 10 % had lost their mothers and 27% had lost one or more of their siblings. 77% suffered some form of health ailments. The common health ailments were diarrhea (61%), respiratory complaints (59%) and fever (20%). About 38 % of preschoolers had loss of appetite and 28% had sleep disturbances. About 35% of the elementary school children suffered from sleep disturbances, 29% of the young adolescents suffered from headaches and 24% had sleep disturbances. Nearly a quarter (24%) of all the children felt fearful and anxious about the disaster. Nevertheless, 56% of the respondents wanted to return back to Pulau Aceh, although 14 % did not want to go back. Interestingly, 73% of the children voiced their gratitude to God for having been saved from death.