Lumbar puncture (LP) is an important procedure both for diagnostic and therapeutic purposes. In Kelantan, Malaysia, on many occasions consent for this procedure is not granted by patients or guardians. The aim of this study was to find out the factors that influence the decision to grant or refuse the consent for LP. This was a cross-sectional study in which 86 parents (who agreed or refused to give consent for LP on their child) were interviewed by using a standard questionnaire. A scoring system was used to assess their knowledge about the purpose and technique of the procedure. Consent for LP was granted in 23 and refused in 27 children. The refusal rate was significantly higher when family members other than parents made the decision. The factors which did not play a statistically significant role in decision-making included: age of the child and parents; gender of the patient; number of children in the family; patient's birth order among the siblings; place of residence; monthly income of the family; parents' level of education; and number of days after admission when LP was requested. The factors that positively influenced the decision to give consent included knowledge about the purpose of LP and underlying disease. In order to receive positive consent for LP it is concluded that the parents/guardians and other family members who may influence the decision-making should be explained the role of LP in (1) making diagnosis and (2) choosing right antibiotics for treatment. They should also be informed about the side-effects of antibiotics, which may be used unnecessarily in unconfirmed cases of central nervous system infections.
It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.
A cross-sectional study was conducted to ascertain the relationship between parental oral health perception on the importance of the deciduous dentition and the dental caries status of their preschool children. Clinical oral examination of the preschool children was performed and self-administered questionnaires were given to the parents to be completed. Four hundred and eight preschool children were examined and 390 of their parents responded to the self-administered questionnaire. Those parents who brought their children for regular dental check-up at least once a year; favoured restorative treatment and practised tooth brushing habit before bedtime were more likely to have children with significantly lower mean 'dft' as well as higher proportions of caries free mouth (> 50 %). Those children who started early in practising tooth brushing also had better dental caries status but the differences were not significant. However, there were no significant and appreciable differences in their mean 'dft' with respect to the frequencies of tooth brushing per day. It was concluded that parents with better oral health perception as reflected by those parents who (a) practiced regular dental check-up for their children; (b) favoured restorative treatment for their children's decayed deciduous teeth; (c) ensured their children brushed their teeth before bedtime are associated with better dental caries status of their preschool children.
A descriptive study of full-term neonates with jaundice was carried out to determine factors affecting severity of neonatal jaundice for those infants presenting to the hospital from their homes. Severe jaundice (serum bilirubin >=250 µmol/l) was significantly more likely in infants whose mothers consumed traditional herbs during the postpartum period (p<0.001) and if the jaundice was first detected by the parents or relatives rather than by medical personnel (p<0.05). In addition, the interval between detection of jaundice and presentation to hospital was significantly longer in jaundice that was first detected by parents compared to those detected by medical personnel. In conclusion, factors affecting severity of neonatal jaundice for infants who present from home could be influenced by the socio-cultural practices of maternal postpartum use of herbs, the ability of parents to detect jaundice and the urgency of tlie parents in seeking medical treatment once the jaundice was detected. Further studies need to be done to explore the association of these factors with neonatal jaundice more specifically. KEYWORDS: Hyperbilirubinaemia, socio-cultural practices, herbs.
Study site: Paediatric Institute, Kuala Lumpur Hospital, Malaysia
A cross-sectional study on the prevalence of smoking among Form 3, 4 and 5 students of a rural national co-educational school was carried out using a selfadministered questionnaire. By the age of 18 years old, three quarters of boys had tried smoking compared with 12% of girls. About a third of boys were still smokers while only 0.7% of girls were still smokers. There was a higher prevalence of smokers among students who stayed with their parents and those who were working part-time. Most smokers knew about the dangerous and addictive effect of cigarette smoking but smoked because of "influence by school peers", "curiosity" and "to increase concentration and decrease tension".
Objectives: A child's admission into intensive care is a major cause of stress for parents. However among Malaysian parents, data concerning the perception of stress are virtually absent. Therefore we conducted a study to measure the reliability of the Malay version of Parental Stressor Scale: Pediatric Intensive Care Unit (PSS: PICU) in identifying sources of stress and to study factors that might influence their stress response.
Methods: Over a six-month period, one hundred and twelve parents were requested to answer the questionnaires twice either in Malay or English, a week apart. Spearman's correlation and Cronbach's alpha coefficient was used to assess the repeatability and internal consistency of the questionnaires.
Results: Ninety-four (83.9%) and seventy-one (75.3%) parents responded to the first and second administration of questionnaire respectively. All answered in the Malay language except for three. The correlation ranged from 0.50 to 0.71 with a total score of 0.76. The Cronbach's alpha coefficient ranged from 0.75 to 0.93, with total a score of 0.95.
Alteration in parental roles was the most stressful source of stress. Fathers, parents of children with higher PRISM score and parents with no previous admission into intensive care unit scored significantly higher in staff’s communication.
Conclusion: The Malay version of PSS: PICU is reliable in identifying sources of stress. Alteration in parental roles was the most stressful source of stress. Parents' gender, previous experience and severity of the child illness may influence their stress responses.
Asthma knowledge an important components of asthma education.
Objective: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it.
Methods: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children asthma severity was classified. The questionnaire includes biodata of children and parents, types of medication and dosage duration of asthma, exposure to cigarette smoke, acute asthma admission and patient’s economic status.
Results: This mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p=0.03, CI (-3.85, -0.02)]. It correlated significantly with steroid dosage (r=0.29, p=0.02), and was significantly higher in parents of higher economic status. Patient’s asthma knowledge had no association with children’s asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission of asthma duration.
Conclusion: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.
Keywords: parent, asthma, knowledge, Kuala Lumpur, Malaysia
Study site: Respiratory clinic, Institut Pediatrik, Hospital Kuala Lumpur, Malaysia
A qualitative research was carried out in Besut and Kuala Terengganu to identyy adolescents’ health problems and needs jiom adolescent perspective, and to establish a priority area in the development of Adolescent Health Clinic in the district. A total of 61 adolescents were selected and divided into four groups and stratified according to age, 13-15 years old and 16 - 17 years old. Generally all participants wished to live in an environment free hom negative health risk factors. The obstacles they perceived were mainly related to lack of care or too much control by their parents. Some of them perceived that their parents in general had inadequate knowledge and skills on parenting. Among local behavioural problems mentioned were loafing, running away from home, vandalism, school absenteeism, aggressive behaviour, substance abuse, pre-marital sexual activities, "bohsia", “bohjan" and even involvement in crimes. More than hah' agreed that counselling service is important for adolescents, and it should be made available in the community preferably outside the schools. They perceived an adolescent friendly health clinic concept as an important concept that should be introduced. To them adolescent friendly health clinic is a clinic run by professionals who are knowledgeable, caring, good listeners, non—judgemental, and who exercise confidentiality. The clinic preferably should be situated in a location which is away from the present health facilities to avoid the image of a place for sick people. Clinic hours preferably during weekends, should provide appropriate technologies and situated in a comfortable ambience. Adolescent participation in the clinic was also mentioned as an important entity for adolescent friendly health services.
This study was designed to examine the role of parents and family in motorcycle riding practices among teenagers and motorcycle accident in FELDA Trolak Utara, Perak. This was a cross sectional study using universal sampling that involved 309 teenage riders aging from 11 to 19 years old. Only 6.1% respondents that rode motorcycle had a valid driving licenses. Mean age of starting to ride was 11.46 ± 1.75 years old. Mean years of riding motorcycle was 3.66 ± 1.95 years. The major buyer of motorcycles for the teenagers were father (78.3%) and other family members (13.7%). About 42.7% of teenagers learnt riding by themselves and in 51.8%, family members taught teenagers to ride motorcycle. The main purpose for riding motorcycle were to go to shop (37.2%), to school (32.7%) and for recreation (25.2%). From the perception of teenagers, about 82.2% parents encouraged them to ride. Mean usual riding speed (n = 296) was 58.72 ± 23.97 km/h. The mean maximum riding speed (n = 290) was 89.81 ± 30.70 km/h. There were positive correlation between years of motorcycle riding and usual motorcycle riding speed (r = 0.292, p < 0.05) and maximum motorcycle riding speed (r = 0.371, p < 0.05). The usual motorcycle riding speed was predictor factor for motorcycle accident. Parents, families and communities should play their role to make sure that their teenage children do not ride at a very young age and ride without a valid license. Reducing years of motorcycle riding among teenagers may reduce usual riding speed and consecutively reducing teenagers’ involvement in motorcycle accidents.
Key words : role of parents, teenagers’ riding practice, motorcycle
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).
A cross-sectional study was done to determine the prevalence of violence among 15-year-old adolescents and to identify associated protective or risk factors. The study involved 758 adolescents, 384 males and 3 74 females in the District of Kuala Terengganu and Besut, Terengganu. About 39.0% of adolescents under study were ever involved in violence. Percentage of girls were slightly higher 19.8% as compared to boys 19.2%. About 30% of the violent adolescents were from Kuala Terengganu and 9.1% from Besut. There was no significant relationship between violence and ethnic groups. Family total income above poverty line was significant protective towards violent behaviour < 0.01, OR 0.61, CI 0.45 - 0.82). Using univariate analysis, selected parental factors were protective against violence, such as good parental connection (p < 0.01), presence of parental regulation (p < 0.001), religious parents (p < 0.05) and parents who had dinner everyday with adolescents (p < 0.01, OR 0.59, CI 0.43 - 0.80). Adolescent who perceived to have interest in learning (p < 0.001, OR 0.32, CI 0.17 - 0.59) were less likely to involve in violence. Adolescent who felt well connected to their school (p < 0.01), and perceived themselves religious (P < 0.001) were more likely to be non-violent. Those who felt satisfied with day to day life were less likely to be involved in violence (p < 0.001, OR 0.52, CI 0.37 - 0.71). On the contrary, adolescents who ever had the feeling to run away from home (p < 0.001), had 3 times risk of violence, ever smoked cigarette had 2.4 times risk (p < 0.001, CI 1.55 - 3.69) ever been bullied by peers were 2.3 times risk (p < 0.001, CI 1.46 - 3.60) to violence. Same factors remained significant in multivariate analysis. Such factors were total family income below poverty line (p < 0.001, OR 1.82,CI 1.28 - 2.59), parental regulation (p < 0.05, OR 0.34, CI 0.13 - 0.89), had dinner every night and frequently (p < 0.01, OR 0. 62, CI 0.43 - 0.89), and adolescents' religiosity (p < 0.05, OR 0.81, CI 0.66 - 0.98) were protective, whereas ever· smoke cigarettes (12 < 0.01, OR 2.24,Cl 1.38 - 3.62), being bullied by peers (o < 0.01, OR 2. 09, C1 1.26 - 3.45), and frequently felt depressed previous one year (p < 0.001, OR 3.01,CI 1.79 - 5.07) were risk factors. The findings of the study will serve as baseline in planning adolescent health programme specifically to prevent violence behaviour from developing right from young, in the home and in the school environment.
The aim was to determine the differences in parents' perceptions of boys' and girls' body shapes and the explanations for the emphasis on body shape care of children. Subjects were low-income parents (n = 158) of preschoolers attending preschools in Kuala Lumpur, Malaysia. Parental perceptions of children's body shapes were assessed based on their rankings (scale of 1 to 7) of four attributes (ideal, healthy, fat and thin) for boy and girl figures. Parental responses to five questions on the importance of body shape were also obtained. Parental rankings of ideal and healthy body shapes were significantly lower for girls than boys (p < 0.001). However, mothers' and fathers' rankings of boys' and girls' body shapes were not significantly different. for both boys and girls, parental ratings for ideal body shape were significantly lower than for healthy body shape (p < 0.001). The majority of parents indicated that children's body shape is important for their future health, self enhancement, social interaction and career. With the increasing prevalence of body dissatisfaction among Malaysian children, these findings contribute to the understanding of parental roles in the development of body image and perhaps, in the etiology of body dissatisfaction among children.
Accidental poisoning in children is a preventable condition. It is a problem mainly in children aged 1 to 4 years. This is a descriptive study of accidental poisoning in children below 12 years old admitted to Hospital Seremban from October 15, 1994 to October 14, 1995. A major cause of household accidental poisoning was kerosene ingestion (25%) followed by ingestion of medications (22%), liniment methyl salicylate (12 %), mothballs (12%) and hypochlorinate solution (9%). There was a higher incidence of poisoning in males (50.8%), among Indians (41.2%) and in children from lower social classes (67%). A greater proportion of the accident occurred when the child was taken care by the parents (53 %) and in the house (80%). Most of the poison was ingested from its original package (81%). The immediate action taken was sending the child to the hospital (75%) without carrying out other actions such as washing the child’s mouth. The delay of sending the child to hospital was due to husband not at home (57%). Most of the cases (72.1 %) were discharged well within 1-2 days following admission.
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.
Background: Emotional disorder, one of the common human emotional states is defined as feelings of sadness and tiredness in response to life events, such as disappointments. It is one of the major problems among students and although it consists of more than half of all mental disorders, it is often left untreated each year worldwide. Aim: To determine the prevalence of emotional disorders among medical students at a university in Malaysia.
Methods: A cross sectional study design was used. All medical students at a local university in Malaysia were included in the study. A questionnaire similar to the General Health Questionnaire (GHQ-12) was used as a screening instrument.
Results: A total of 41.9% of the medical students were found to have emotional disorders. Factors found to have a significant association with emotional disorders were relationship of the respondents with their parents (chi-square=6.02, d.f.=1, p<0.05), siblings (chi-square=6.94, d.f.=1, p<0.05) and lecturers (chi-square=4.80, d.f.=1, p<0.05), as well as pressure prior to exams (chi-square=10.30, d.f.=1, p<0.05).
Conclusion: The prevalence of emotional disorders among medical students was high. There was significant association between emotional disorders and respondents' relationship with their parents, siblings and lecturers, as well as level of pressure prior to exam. Early detection of this condition is important to prevent psychological morbidity and its unwanted effects on medical students and young doctors.
Feeding difficulties in cleft lip and palate (CLP) infants is commonly observed and is the most traumatic experience the family has to face. These infants are undernourished and have compromised growth. The purpose of this study was to 1) assess general health and growth parameters in children with CLP and in normal children; and 2) investigate the feeding methods of CLP infants and normal infants. A total of 221 children from birth to six years of both sexes, with CLP (60 children) and normal (161 children) were selected. The CLP and normal children were divided into three subgroups by age. The practice of feeding the infants in subgroup I was assessed using standard piloted questionnaires. The assessment of growth was done at baseline and at six months in all the subgroups.The general well being of the children was assessed by noting the number of common infections. Results showed that a significantly higher percentage of mothers with normal babies (p < 0.01) had a positive attitude towards breast feeding. When compared to normal children, CLP children were more susceptible to infections (p < 0.05) and measured significantly lower on the height growth curve(p < 0.05). Hence, height can be used to monitor growth in CLP children.
To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.
Introduction: Parents play an important role in the management of their asthmatic children. Thus the ability of parents to recognise asthma trigger factors are very important.
Objectives: The objectives of this study were to identify the trigger factors that were recognised by parents to cause acute exacerbation in their children and analyse the association of these factors with severity of asthma and parental asthma knowledge.
Methods: Sixty-seven parents were interviewed to identify factors that can exacerbate acute asthmatic attack in their asthmatic children. The factors were then categorised as: infection, exercise, allergen, irritant, emotion and weather. The profiles of children were asthma severity status, duration of asthma, age, frequency of admission and steroid dosage. Parents' profiles were their age, number of asthmatic children and the level of asthma knowledge.
Result: Fifty-six (83.5%) parents identified more than one trigger factor for their children's exacerbation. The commonest frequency was two trigger factors (31.3%). Upper respiratory tract infection (77.6%) was the commonest trigger factor. There was no association between the number of trigger factors with the severity of asthma and level of parental asthma knowledge. The number of trigger factors significantly correlated with asthma duration (r = 0.33, p = 0.006). The asthma severity was associated significantly with weather (p = 0.042) but not with other trigger factors.
Conclusion: The majority of parents recognised more than one trigger factors to cause asthma exacerbation.