RESULTS: Based on 517 cases of AFP reported during this 5-year period, the overall rate of AFP was 1.2 per 100 000 children below 15 years old. The major clinical diagnosis associated with AFP were Guillain-Barre syndrome (30.2%), central nervous system infection (16.2%), transverse myelitis (10.6%) non-polio enterovirus infection (6.2%), and hypokalaemic paralysis (5.2%). This unusual pattern with an excess of CNS infection and non-polio enterovirus infection was attributed to the outbreak of enterovirus 71 infection nation-wide in 1997. According to the WHO virological classification, there was no case of poliomyelitis due to wild poliovirus. Three cases were 'polio compatible', there were no cases of vaccine-associated paralytic polio (VAPP), while 62 cases (12.0%) were merely classified as 'non-polio AFP'.
CONCLUSION: Overall, these data suggest the absence of circulation of wild poliovirus in Malaysia from 1997 to 2001. The pattern of AFP in this study is different from other published reports.
METHODS: Retrospective review of cases of acute gastroenteritis admitted to the children's ward of the University of Malaya Medical Centre, Kuala Lumpur, Malaysia, between 1996 and 1999.
RESULTS: During the study period, 333 cases (24%) of 1362 stool samples, obtained from children admitted with acute diarrhoea, were positive for rotavirus. Acute gastroenteritis constituted 8.2%, and rotavirus infection 1.6% of all the paediatric admissions each year. Of the 271 cases analysed, 72% of the affected population were less than 2 years of age. Peak incidence of admissions was between January to March, and September to October. Dehydration was common (92%) but electrolyte disturbances, lactose intolerance (5.2%), prolonged diarrhoea (2.6%) and cow's milk protein intolerance was uncommon. No deaths were recorded.
CONCLUSIONS: Rotavirus infection was a common cause of childhood diarrhoea that required hospital admission in an urban setting in Malaysia.
METHODS: The present study was a cross-sectional survey conducted from September to November 2001. Schoolchildren were recruited from primary schools that were selected randomly from a list of all primary schools in Petaling Jaya, Malaysia, using random sampling numbers. Information concerning recurrent abdominal pain, socio-economic status, life events, demographic and other details was obtained using a combination of questionnaires and interviews. Academic achievement was assessed using a score based on the Malaysian Primary School Achievement Examination. An overall score at or above the mean was taken to indicate high academic achievement while a score below the mean indicated poor academic achievement.
RESULTS: A total of 1971 children were studied (958 boys and 1013 girls: 1047 Malays, 513 Chinese and 411 Indians). Of these children, 456 (23.1%) fulfilled the criteria for recurrent abdominal pain. Using the method of binary logistic regression analysis, the following factors were found to be independently associated with poor academic performance: a low socio-economic status (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.25-1.35); male sex (OR 1.61; 95% CI 1.26-2.05); the death of a close relative (OR 2.22; 95% CI 1.73-2.85); the divorce or separation of parents (OR 3.05; 95% CI 1.73-5.40); the commencement of work by the mother (OR 1.34; 95% CI 1.02-1.76); hospitalization of the child in the 12 months prior to the study (OR 1.83; 95% CI 1.12-3.01); lack of health-care consultation (OR 1.80; 95% CI 1.36-2.36); missing breakfast (OR 1.47; 95% CI 1.07-2.02); and lack of kindergarten education (OR 1.35; 95% CI 1.04-1.75).
CONCLUSIONS: Many factors, such as socio-economic status and recent life events, were associated with poor academic performance. Recurrent abdominal pain did not correlate directly to academic performance. Stress may be a means by which various factors cause children to struggle academically.
METHODS: A randomized controlled study was carried out in the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia over a 12-month period. Fifty-four healthy term infants with severe hyperbilirubinemia were randomized to receive either solely enteral feeds (n = 27) or both enteral and intravenous (n = 27) fluid during phototherapy.
RESULTS: There were no significant differences in the mean birthweight, mean gestational age, ethnic distribution, gender distribution, modes of delivery and types of feeding between the two groups. Similarly, there was no significant difference in the mean indirect serum bilirubin (iSB) level at the time of admission to the NICU between the enteral (359 +/- 69 micromol/L [mean +/- SD]) and intravenous group (372 +/- 59 micromol/L; P = 0.4). The mean rates of decrease in iSB during the first 4 h of phototherapy were also not significantly different between the enteral group (10.4 +/- 4.9 micromol/L per h) and intravenous group (11.2 +/- 7.4 micromol/L per h; P = 0.6). There was no significant difference in the proportion of infants requiring exchange transfusion (P = 0.3) nor in the median duration of hospitalization (P = 0.7) between the two groups. No infant developed vomiting or abdominal distension during the study period.
CONCLUSION: Severely jaundiced healthy term infants had similar rates of decrease in iSB levels during the first 4 h of intensive phototherapy, irrespective of whether they received oral or intravenous fluid supplementation. However, using the oral route avoided the need for intravenous cannulae and their attendant complications.
METHOD: A prospective cohort study of 31 consecutive newborn infants with UAC-associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty-two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra-indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals - 26.0, - 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.
CONCLUSION: Low dose streptokinase infusion was effective and safe in thrombolysing UAC-associated aortic thrombi.
METHODOLOGY: The linear growth of 101 children with CP and of their healthy controls matched for age, sex and ethnicity was measured using upper-arm length (UAL). Nutritional parameters of weight, triceps skin-fold thickness and mid-arm circumference were also measured. Total caloric intake was assessed using a 24-h recall of a 3-day food intake and calculated as a percentage of the Recommended Daily Allowance. Multiple regression analysis was used to determine nutritional, medical and sociodemographic factors associated with poor growth (using z-scores of UAL) in children with CP.
RESULTS: Compared with the controls, children with CP had significantly lower mean UAL measurements (difference between means -1.1, 95% confidence interval -1.65 to - 0.59), weight (difference between means -6.0, 95% CI -7.66 to -4.34), mid-arm circumference (difference between means -1.3, 95% CI -2.06 to -0.56) and triceps skin-fold thickness (difference between means -2.5, 95% CI -3.5 to -1.43). Factors associated with low z-scores of UAL were a lower percentage of median weight (P < 0.001), tube feeding (P < 0.001) and increasing age (P < 0.001).
CONCLUSION: A large proportion of Malaysian children with CP have poor nutritional status and linear growth. Nutritional assessment and management at an early age might help this group of children achieve adequate growth.
METHODOLOGY: Twenty-four children referred consecutively to the University of Malaya Medical Centre who fulfilled Apley's criteria (at least three episodes of abdominal pain severe enough to affect normal activity over a period longer than 3 months) were tested for lactase deficiency using a pocket breath test analyser (BreatH2 meter; Europa Scientific, Cheshire, England). Lactulose was used to check for hydrogen-producing capacity.
RESULTS: There were 14 males and 10 females in the study, consisting of five Malays, 14 Chinese and five Indians. Mean age was 9.9 years. Seventeen of the 24 children (70.8%) with recurrent abdominal pain who underwent the breath hydrogen test had a positive result. In those with a negative result, subsequent lactulose administration resulted in a positive rise in breath hydrogen. None of the 24 children developed abdominal pain during the test. All the Indian subjects, 71.4% of the Chinese subjects and 40% of the Malay subjects with recurrent abdominal pain had lactase deficiency. The proportion of boys and girls with lactase deficiency was similar (71.4 vs 70.0%, respectively). There was no significant difference between lactase sufficient and deficient children with recurrent abdominal pain with regard to sex, age, ethnic group and clinical features. Following a lactose-free diet, none of the children in the breath hydrogen positive and negative groups reported any appreciable difference in pain symptoms.
CONCLUSIONS: The prevalence of lactase deficiency among this group of Malaysian children with recurrent abdominal pain was high, but lactase deficiency did not appear to play an important role in causing the symptoms.
METHODOLOGY: A prospective observational study carried out over a 2-year period between 2 September 1996 to 2 September 1998. For every training course conducted, the instructors completed a NRP course report form (Form A) that documented the instructors involved in the course. For every participant who attended the course and successfully completed it, the instructors submitted a record form (Form B) that contained the name, hospital address, department, profession, place of work, language used for training and the marks obtained by the individual participant. After each course, completed forms A and B were returned to the NRP secretariat for compilation.
RESULTS: Of the 37 core instructors, 35 (94.6%) carried out training courses in their respective home states. A further 513 new instructors and 2256 providers were trained subsequently. A total of 2806 health personnel from all 13 states of Malaysia were NRP-certified during the first 2 years. However, 61.2% (n = 335) of the 550 instructors were inactive trainers, having trained less than four personnel per instructor a year. Most of the NRP-certified personnel were either doctors (32.0%) or nursing staff (64.4%). More than 60% of these worked either in the labour rooms, neonatal intensive care units or special care nurseries. At least one person from all three university hospitals and all general hospitals, 89.3% (92/103) of the district hospitals, 3.5% (73/2090) of the maternal and child health services, and 21% (46/219) of the private hospitals and maternity homes, were trained in the NRP.
CONCLUSION: Dissemination of the NRP in Malaysia during the first 2 years was very encouraging. Further efforts should be made to spread the program to private hospitals and the maternal and child health services. In view of the large number of inactive instructors, the criteria for future selection of instructors should be more stringent.