PIP: The effectiveness and impact of the Population and Family Health Project in the rural areas of Malaysia is evaluated. A total of 790 women who delivered during the past 3 years from the time of the survey, were identified from 2,013 women aged 15-49 years, during the 2nd Family and Health Survey (1979) in Peninsular Malaysia. The rural health districts which were selected by random sampling include: Perlis, Kubang Pasu, Sebeang Perai Selatan, Kuala Selangor, Hulu Langat, Melaka Utara, Kota Bharu/Tumpat, and Pasir Mas. The pattern of maternal care during pregnancy, delivery and puerperium are examined with respect to selected variables. These women are further classified into 2 groups by type of birth attendant at delivery and these 2 groups are also examined in relation to selected socioeconomic variables. The major proportion of women had their 1st antenatal visit during the 2nd and 3rd trimester of pregnancy. The highest % (28.3%) of 1st antenatal visits occurred during the 5th month of pregnancy. Use of a trained medical practitioner is preferred (82.5%), while only 17.5% of women preferred the services of traditonal birth attendants. Women in this latter group had less education and were in lower income groups, than the former group of women. Majority of women in all ethnic and age groups had no postnatal check after their last childbirth.
Ultimately, the majority of our medical graduates ends up in primary health care either in private practice or in the government service. It would be appropriate that their education and training should meet not only the requirements of their eventual vocation, but just as importantly, the expectations of a more discerning community at large. Rising pressures on the profession to provide more cost-effective and affordable health services of good quality would put an increasing emphasis on the development and promotionof primary health care to higher standards. Primary health care workers would be hard-pressed to provide more health information and to actively participate in disease prevention and control as part of their professional duties. As medical specialisation and technology contibute towards more fragmented, complex and dehumanising forms of practice, the greater will be the need for the integrative skills of the primary physician providing personal and continuing care. The future nature of medical care will have to respond to this community demand.
There is universal concern on the current inequitable coverage and low quality of health care. The lead roles of medical practitioners in health care and how they are prepared for such roles are being re-examined in many countries. This paper attempts to rationalise the need to reorientate medical education towards primary health care, and to suggest possible emphasis and direction for change.
Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.
Matched MeSH terms: Primary Health Care/organization & administration*
This article examines the numerous problems faced by primary health care in Malaysia, care that traditionally has been a private sector activity. While general practitioners have adapted, and are continually adapting, to the needs of a multiracial society with diverse cultural patterns, it is hoped that with the emergence of a dynamic discipline of family practice, family doctors will be able to provide a sophisticated form of primary health care that will serve the needs of the people.
Matched MeSH terms: Primary Health Care/organization & administration*
Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 27-30
Citation: Kasah A. Country report on nutrition communication activities in Malaysia. Kuala Lumpur: United Nations University; 1988
The primary health-care approach in Malaysia is an integral part of the government community development movement, or Gerakan Pembaharuan (Operation Renewal), launched in 1972. Nutrition communication activities form a major component of the existing basic health services. The activities are channelled through various health and nutrition services. Group talks, cooking demonstrations with group discussions, individual advice in clinics, and home visits are provided through maternal and child health services. The health education unit is responsible for producing educational materials such as posters and leaflets at both national and state levels. Health education mobile units, fully equipped with audio-visual aids, provide films and slide shows, arrange talks and dialogue sessions, and distribute leaflets. A mass media programme using radio and television was introduced in July 1983 as a joint effort of the ministries of Health and Information. The messages include a wide range of health and nutrition information. Health education materials are used extensively and local radio broadcasts will be utilized to overcome dialect problems. The applied nutrition programme started in 1969 uses an intersectoral approach towards PHC. Four main ministries are involved, namely, Health, Agriculture and Rural Development, Education, and Information. Health and nutrition education is one of the main tasks. Nutrition surveillance is also used as a channel for nutrition communications. In addition, both formal education, such as that provided in nursing schools, and in-service training for health personnel are being conducted by various training schools. The present trend of the health service is shifting from a clinic-based to a community-based approach, in which health staff work closely with community leaders. Attempts to encourage more active community participation in health activities are being made through committee meetings on development at the village and district levels.
The Department of Primary Care Medicine was established in UHKL in 1987. This article examines the philosophy of primary care, the clinical services provided by UHKL Family Practice Clinic and the quality assurance activities.
Rosalind Benster and Judith Stanton went to Sarawak to study child health care. Their aim was to highlight areas of most need so that the tiny health budget could be channelled in the relevant directions. They found cultural and environmental differences to account for significant differences in the nutritional status of children from different tribes. They suggest remedies to this situation.
Matched MeSH terms: Primary Health Care/standards*
A primary health care system is being developed in Baram District, Sarawak, Malaysia, for the benefit of the Penans, who, until recently, were largely nomadic. Many of them are now attempting to adopt a settled mode of existence, and this in itself creates special health problems because the people lack the skills needed for living in one place. Substantial progress has already been achieved in mother and child care and in immunization coverage.
Citation: Manderson L. Political economy and politics of gender: maternal and child health in colonial Malaya. In: Cohen P, Purcall J (editors). The Political Economy of Primary Health Care in Southeast Asia. Canberra: Australian Development Studies Network an ASEAN Training Centre for Primary Health Care Development; 1989, p79-100
PIP:
Experiencing remarkable decreases in mortality rates over the past 3 decades, Malaysia currently has one of the lowest mortality rates among developing countries, a rate that compares favorably with those of developed countries. Between 1957 and 1989, the crude death rate dropped from 12.4/1000 population to 4.6. Over the same period, Malaysia recorded even greater decreases in the infant mortality rate, from 75.5/1000 births to 15.2. The Maternal mortality rate also declined from 1.48 in 1970 to 0.24 in 1988. The data indicates that mortality rates vary from state to state, and that rural areas have a higher mortality than urban areas. According to a study by the National Population and Family Development Board, the use of maternal and child health services has played an important role in reducing neonatal, perinatal, infant, child, and maternal mortality rates. Nearly all women in Malaysia receive antenatal services. While the country has achieved great gains on mortality rates, programs focusing on specific age and socioeconomic groups could lead to even greater reductions. The Minister for National Unity and Social Development, Dato Napsiah Omar, has called for the development of programs designed to improve the population's quality of life.
PIP: At the Population and Natural Resources Workshop of the World Conservation Union (IUCN) General Assembly in Perth, Australia, December 1990, population and quality of life issues were stressed as one of the central items to be placed on the 1992 Agenda of the UN Conference on Environment. The pace of environmental degradation is quickening, the causes are becoming more entrenched, and indecision will narrow our options. Poverty and population growth are making development unsustainable. Technological miracles will not appear to restore balance. Deforestation, soil erosion, decertification and loss of water resources are fueling urbanization. Therefore the World Commission on Environment and Development, known as the Brundtland Commission, ranks human resources development as a top priority in sustainable development and quality of life. Human resources can be improved by providing maternal and child care, family planning and improving the status of women. Successful family planning programs as seen in Thailand and Malaysia can show results very quickly once national population policies, institutions and capacity are in place.
Citation: Abu Bakar Suleiman. Seminar on Postgraduate Family Medicine Programme. Pusat Kesihatan Padang Serai, Kulim, Kedah, Malaysia. 28th September 1991.
The Malaria Eradication Program was started in 1967 in Peninsular Malaysia. Since then and up to 1980, there was a reduction in the number of reported malaria cases from 160,385 in 1966 to 9,110 cases for Peninsular Malaysia. Although the concept of eradication has changed to one of control in the 1980, the anti-malaria activities have remained the same. However, additional supplementary activities such as the use of impregnated bednets, and the Primary Health Care approach, have been introduced in malarious and malaria-prone areas. Focal spraying activity is instituted in localities with outbreaks in both malaria-prone and non-malarious areas. Passive case detection has been maintained in all operational areas. In 1990, 50,500 cases of malaria were reported of which 69.7% (35,190) were from Sabah, 27.8% (14,066) from Peninsular Malaysia and 2.5% (1,244) from Sarawak. Until June 1991 a total of 18,306 cases were reported for the country. Plasmodium falciparum continues to be the predominant species, contributing to 69.6% of the parasites involved. The case fatality rate for 1990 was 0.09%. There were 43 deaths all of which were attributed to cerebral malaria. The problems faced in the prevention and control of malaria include problems associated with the opening of land for agriculture, mobility of the aborigines of Peninsular Malaysia (Orang Asli) and inaccessibility of malaria problem areas. There is need to ensure prompt investigation and complete treatment of cases especially in malarious areas. The promotion of community participation in control activities should be intensified. Primary Health Care should be continued and intensified in the malarious areas.(ABSTRACT TRUNCATED AT 250 WORDS)
Matched MeSH terms: Primary Health Care/organization & administration