Displaying publications 81 - 100 of 101 in total

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  1. Sharifa Ezat Wan Puteh, Norin Rahayu Samsuddin, Sharifah Noor Akmal Syed Hussain, Shamsul Azhar Shah, Syed Mohamed Aljunid
    Int J Public Health Res, 2011;1(1):13-22.
    MyJurnal
    Accepted 10 August 2011.
    Introduction Cervical cancer (CC) is the second most prevalent female cancer in Malaysia. Almost 70% of its’ causal factors are attributable to oncogenic human papillomavirus (HPV) types 16, 18 and other risk factors. HPV genotypes distributions are also noted to differ by geographical area.
    Methods This was cross sectional study conducted in 2007, to determine the influencing factors of HPV positivity and prevalence of HPV infections among patients with cervical cancer in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patients’ paraffin-embedded cervical tissues kept in the Pathology Department from 1999 to 2007 were randomly selected. A total of 81 medical records with complete information were chosen as samples and patients were contacted for consent. Tissue samples were further derived for PCR DNA for HPV genotyping. Analyses included descriptive statistics; bivariate χ2 test and correlation were used to determine relationship between factors and HPV positivity. Significance level of less than 0.05 was taken as statistically significant.
    Results Mean age of cancer diagnosis was at 52 ± 12.2 years. Women of Chinese ethnicity was the highest ethnicity to be HPV positive at 65.4% and squamous cell carcinoma was more commonly found (59.3%) compared with other types of cancers. The prevalence of HPV positivity was 92.6% with type 16 being the most common (74.1%), followed by type 33 (30.9%) and 18 (22.2%). Multiple HPV infections were a common finding at 54.3%. Factors thought to influence positivity i.e. age of intercourse, number of sexual partners, number of parity, smoking status of patients and their partners, oral contraceptive usage, presence of chronic illnesses and cancer stage were not significantly associated with HPV positivity. Increased CC severity level was not associated with increased number of HPV infections (Pearson correlation 0.58; p =0.607).
    Conclusions High HPV positivity at 92.6% was found among ICC patients. Factors thought to influence HPV positivity were not significant. The top three HPV genotypes were type 16 followed by type 33 and 18. However, local women HPV serotypes findings need to be replicated in a larger population sample.
  2. Rozita Hod, Azimatun Noor Aizuddin, Shamsul Azhar Shah, Mohd Rohaizat Hassan, Nazarudin Safian, Mohd Hasni Jaafar
    Int J Public Health Res, 2011;1(1):1-6.
    MyJurnal
    Accepted 21 July 2011.
    Introduction The extensive and intensive use of pesticides in agricultural practices has exposed farmers to various hazards resulting in varying degrees of health
    outcomes.
    Methods We conducted a cross-sectional study among paddy farmers in Sabak Bernam district, Malaysia. The objective of this study was to gather baseline information on chlorpyrifos blood level and its relationship with pesticides exposure symptoms.
    Results We detected chlorpyrifos in farmers’ blood in 7 percent of the respondents, with mean 7.29 nanogram per millilitre blood (sd 5.84 nanogram per millilitre). The percentage of farmers who experienced at least one pesticide exposure symptoms was 75 percent. However, we found no significant association between chlorpyrifos blood level and its exposure symptoms. The farmers had low scores on safe practice of pesticide use even though they have high marks on knowledge and attitude. We found no significant association between the scores on knowledge, attitude and practice on pesticide use and the chlorpyrifos blood level.
    Conclusions The presence of pesticide exposure symptoms proved that most of the farmers were exposed to hazardous effects of pesticides. Specific trainings on safe use and handling of pesticides should be given on regular basis to these farmers to ensure they are protected from hazardous effects of pesticides exposure.
  3. Rahmah Mohd Amin, Noraishah Jaafar
    Int J Public Health Res, 2011;1(1):7-12.
    MyJurnal
    Accepted 24 August 2011.
    Introduction Elderly are often associated with multiple social and health problems. Family members are important in helping them doing their daily activities. For elderly diabetics, family support has a role in diabetes management and glucose control. The aim of this study is to explore the perceptions of elderly diabetics regarding the role of family support on their glucose control.
    Methods This qualitative technique was a part of the study on glucose control and its associated factors among elderly diabetics. It was conducted from February until May 2009 in Kulim. Ten respondents were purposively sampled based on their glucose control. HbA1c 6.5% or less was considered as good glucose control. In depth interview, using semi-structured interview guide was used in this study. The conversation had been taped, transcribed to verbatim and analyzed manually using thematic analysis.
    Results All ten respondents perceived that family support did not play a role on their glucose control. They believed that self-awareness and self-determination were important to control the glucose level. Those with good glucose control practiced healthy diet, and not affected by food prepared by their family members compared to those with poor glucose control. However, both groups claimed that, they did not receive much advice from their family members and no special food was prepared for them. Conclusions Elderly diabetics should be motivated on self-determination and focusing on good glucose control. Health education should be given to patients and their family members to increase their diabetes knowledge especially on useful advice and proper food preparation. It could motivate the elderly diabetics to control their glucose level.
  4. Toh, Teck Hock, Wong, See Chang, Muhamad Rais Abdullah
    Int J Public Health Res, 2011;1(2):33-40.
    MyJurnal
    Introduction More school children were referred for learning difficutly (LD), especially after the introduction of LINUS sccreening programme by Ministry of Education Malaysia.
    Aims To study the clinical diagnosis and non-verbal ability of primary-one school children with LD after paediatric assessment, as well as associated behavioural issues and socio-economincal background.
    Methods Assessment findings by Paediatricians and Naglieri Non-Verbal Ability Test®(NNAT®) results of all primary-one school children referred in year 2010 with LD were studied retrospectively.
    Results Ninety-three children were included (62.4% male), and 72.0% of them failed the LINUS screening programme. The commonest diagnoses were Borderline Intellectual Disability (ID, 37.6%) and Mild ID (19.4%). Other diagnoses included Attention Deficit Hyperactive Disorder (ADHD, 11.8%), Specific Learning Disability (SLD, 10.8%), Autistic Spectrum Disorder (n = 5) and Severe Language Disorder (n = 3). Mean NNAT scores were 84.6 ± 11.8 (n = 85), of which 9.4% children scored less than 70 (
  5. Kadhim Jawad Obaid
    Int J Public Health Res, 2011;1(2):41-49.
    MyJurnal
    A prospective study done In al Zaafaranya General Hospital in Baghdad/Iraq In the period between April 2003 and February 2007. Ninety two patients admitted to the surgical wards diagnosed as Intestinal obstruction. The aim is to find out the possible common conditions resulting in causing this common surgical emergency. Also to compare the provisional clinical diagnosis about ischemic obstruction and the definitive post operative diagnosis. To encourage post graduate students to use their clinical abilities with the few laboratory and radiological facilities available needed to decide about the management of those patients.
  6. Lim, Kuang Hock, Sumarni Mohd Ghazali, Kee, Chee Cheong, Hejar Abdul Rahman, Amal Nasir Mustafa
    Int J Public Health Res, 2012;2(1):85-92.
    MyJurnal
    Accepted 8 February 2012.
    Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
    Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
    Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
  7. Halimatus Sakdiah Minhat, Ahmad Fareed A Rahman, Nur Fatihah Oh Abdullah, Natrah Mohd Saad
    Int J Public Health Res, 2012;2(1):122-128.
    MyJurnal
    In July 2010 Universiti Kebangsaan Malaysia (UKM) and Niigata University (NU) signed a memorandum of agreement to continue collaboration in joint planning and implementation of education, research and practice services in the field of medicine.This collaboration is also a good opportunity for Doctor of Public Health (DRPH) postgraduate candidates to gain experience on the practice of public health in handling public health issues, planning the healthcare facilities, delivering a quality public health services, enforcing public health policies/regulations and finally learn about the health systems in general at other countries especially from developed country like Japan. Experiencing Health Care and Culture in Niigata, Japan.
  8. Mohd Rizal Abdul Manaf
    Int J Public Health Res, 2012;2(1):129-136.
    MyJurnal
    Accepted 1 March 2012.
    Introduction Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. This paper presents some information regarding medical ethics, including the values and principles of ethical conduct. Later the requirements of consent form is presented to guide the researchers before conducting a study.
  9. Kamaliah Mohamad Noh
    Int J Public Health Res, 2011;1(2):50-56.
    MyJurnal
    Primary health care is an approach to health and a spectrum of services beyond the traditional health care system while primary care is just one element within PHC that focuses on health care services. The present status of PHC in Malaysia and the strides it has made in uplifting the health status of the nation is described. The challenges that the Malaysia health system are facing have necessitated a review of the structure of the whole health system and reforms in PHC will ensue in due course. The concept of 1Care, the proposed re-structuring of the health system, is discussed with emphasis on the reform in the PHC delivery system. The reforms are aimed at addressing three main concerns on seamless integration of care especially for the management of chronic diseases, ensuring universal coverage and responsiveness of the health system in the face of increasing client expectations and patient safety. The opportunity for macro reform to improve the health of Malaysians by developing a sustainable and high performing health care system is being seized by the Ministry of Health in 1Care. The micro reforms are discussed as regards to increasing access to services, development of primary health care teams to deliver comprehensive PHC, the application of ICT, the renewed emphasis on health promotion & prevention activities and a renewed focus on community empowerment and participation. Support in terms of human resource, governance & funding models, capacity building in monitoring & evaluation as well as change management to affect the reforms are identified. The paper concludes with lessons learnt from other countries and the importance of systemic reform for a well functioning health delivery system.
  10. Norlen Mohamed, Noradrenalina Isah, Fadhli Yussof
    Int J Public Health Res, 2011;1(1):48-54.
    MyJurnal
    Accepted 11 August 2011.
    Introduction Despite of its importance for preventing fatal and severe injuries in an event of a crash, limited studies were conducted to find out the status of seatbelt use among rear passengers in Malaysia. This study was conducted to the determine seatbelt use among rear passengers in Malaysia in conjunction with the introduction of the rear seatbelt law that took effect on 1st January 2009.
    Methods Two methods were used; the roadside observations and surveys. A total of 4180 rear passengers were observed during the road side observation and 793 rear passengers were interviewed in the survey.
    Results About 41.8 % (95 % CI: 38.3, 45.4) of rear passengers interviewed reported that they “Always/Often’ wore safety belts, while roadside observation recorded slightly lower rate (36.2 % [95 % CI: 34.8, 37.7]). Based on the roadside observation method, male rear passengers were more likely to use rear seatbelts as compared to female rear passengers (with Odd Ratio: 1.17 (95 % CI: 1.03, 1.33)). Both methods consistently reported that rear passengers of Multipurpose Vehicle (MPV)/Sport Utility Vehicle (SUV) (survey method “always wear”: 39.3 %, Odd Ratio: 2.02 [95 % CI: 1.13, 3.61], roadside observation method: 51.9 %, Odd Ratio: 2.23 [95 % CI: 1.89, 2.62]) were two times more likely to wear seatbelts as compared to rear passengers of a car.
    Conclusions The two research methods indicate rear passengers in Malaysia were consistently having low seatbelt usage rate. As the rear seatbelt advocacy and enforcement programme are new in Malaysia, efforts to advocate rear seatbelt use should be strengthened. The changes in rear seatbelt usage rate need to be tracked regularly and as an alternative to roadside observation method, interview survey method could be used to measure the seatbelt usage rate and to identify the reason for not using safety belt among rear passengers.
  11. Fateh Addin Nejm Addin Al-Emad, Zaleha Md. Isa
    Int J Public Health Res, 2017;7(1):783-790.
    MyJurnal
    The aim of the study was to assess the knowledge and attitude of secondary school students in Sana'a Yemen related to exposure to second-hand smoking.
  12. Narwani Hussin, Hafizah Jumat, Mabelle Wong, Liau Siow Yen, Jeremy Robert Jinuin Jimin, Beh Boon Cong, et al.
    Int J Public Health Res, 2017;7(1):757-764.
    MyJurnal
    Rheumatic heart disease is still endemic in developing countries and among the indigenous population in developed countries. However, there is no comprehensive data on rheumatic heart disease patients in Malaysia. The Cardiology Department of Queen Elizabeth ll Hospital (QEH ll), Sabah started this hospital-based registry in 2010. The objective of this analysis was to report the demographic profile, severity of disease, types of valve involvement and the practice of secondary prophylaxis among these patients.
  13. Kamal Kenny, Zoharah Omar, El Sheila Kanavathi, Priya Madhavan
    Int J Public Health Res, 2017;7(1):765-773.
    MyJurnal
    Health care systems play a vital role in providing health services and in optimising the population’s health of each nation. The Malaysian health care system primarily consists of the public and private health services. One of the prominent private health care services offered in the General Practitioner’s (GP) Clinic. Despite the prominent role GPs play in the health care system in this country, little is known about their practices, the issues and challenges faced by GPs in this country. The objective of this study was to describe the current GP practice operations in Malaysia in terms of its general operations, financial expenditure and revenue, market competitiveness and laboratory services offered by the clinics.
  14. Muhammad Adil Zainal Abidin, Hayati Kadi @ Shahar, Rosliza Abdul Manaf
    Int J Public Health Res, 2017;7(1):774-782.
    MyJurnal
    Smoking is the leading preventable cause of non-communicable disease mortality worldwide. Therefore, effort for the effective measure in smoking cessation is important. However, the central problem in the nicotine addiction treatment is relapse. A retrospective cohort study was done at Tanglin Quit Smoking Clinic to determine the outcome of smoking cessation and its predictors. A cohort of 770 smokers between 2008 and 2015 were identified through simple random sampling. Smokers were defined as current smoker, while smoking abstinence is defined as cessation more than 6 months and relapse as any smoking episode even a puff since the quit date. Majority were Malays, Muslims and had secondary or higher education. The mean initiating age for smoking was 17.6 years old, with majority smoke between 11 to 20 sticks, and had high nicotine dependence score (43%). At the end of the study 52.5% of them abstinence from smoking. The predictors for smoking cessation were number of quit attempt (1 to 10 times) (AOR = 1.582, 95% CI = 1.012-2.472) and pharmacotherapy (AOR = 0.711, 95% CI=0.511-0.989). More frequent follow up was required during the first crucial 6 months to prevent relapse. Number of follow up can enhance not only the medication compliance but also motivational aspect to smokers to reduce relapse rates. Healthcare provider should give extra attention to the potential relapser especially to those who attempt for the first time.
    Keywords: Malaysia, Quit Smoking Clinic, Smoking Cessation, Cohort, Survival analysis
  15. Idayu Badilla Idris
    Int J Public Health Res, 2017;7(2):829-835.
    MyJurnal
    Emotional and behavioural problems among children have been increasing in many western as
    well as the eastern countries. Although the problem has been given attention and priority in
    terms of early detection, many children with early symptoms of emotional and behavioural
    problems has still not been detected at the early stages. This phenomenon is worrying as mental
    health problems were shown to be stable in the long run and if left undetected it may manifest
    into various problems in adulthood. This paper explores the issues on emotional and
    behavioural problems in terms of its definition, prevalence, aetiology, long term consequences
    and treatment. It also explores on mental health problems in a non-western country, i.e.
    Malaysia including its prevalence and intervention strategies which has been carried out in
    overcoming this worrying issue. Finally this review paper stresses the importance of providing
    a well-designed epidemiological study in Malaysia in assessing the current prevalence of
    emotional and behavioural problems in young children and adolescent
  16. Mohd Rohaizat Hassan, Mohd Hafiz Yahya, Normala Basiron, Zairizam Zakaria, Mohd Rizam Abdul Rahman, Hazlina Mohd Miskam, et al.
    Int J Public Health Res, 2017;7(2):836-844.
    MyJurnal
    Introduction A study was conducted to determine the level of mothers' perception on children with cleft deformity and its associated factors
    Methods This was a cross sectional study involving 110 mothers with children attending the Plastic And Reconstructive Surgery Clinic. Data was gathered from a face to face interview based on a questionnaire that assesses the level of perception and its associated factors. The level of perception was evaluated from a scoring method and divided into four domains namely psychosocial, care management, treatment and education.
    Results The level of perception was high in all four domains ranged from 62% for treatment and 80% for education. Factors that were significantly associated with the level of perception were ethnicity, religion, type of cleft deformity and level of information.
    Conclusions Information regarding cleft deformity must be tailored toward mothers’ personal characteristics and type of cleft deformity to improve mothers' perception on this problem.
    Study site: Plastic And Reconstructive Surgery Clinic, Hospital Kuala Lumpur, Malaysia
  17. Norlen Mohame, Lokman Hakim, S., Thahirahtul Asma Zakaria, Anis Salwa Kamarudin, Ahmad Riadz Mazeli, Sirajuddin Hashim
    Int J Public Health Res, 2017;7(2):814-828.
    MyJurnal
    Introduction: Most health advisories related to outdoor physical activity during haze are general in nature. The advisories normally advise everyone to reduce or limit prolonged exertion or heavy exertion without mentioning the acceptable duration for performing outdoor physical activity causing difficulty for public to decide to stop or cancel a particular outdoor or sport event. The aim of this paper is to determine the acceptable duration for performing outdoor physical activity pattern during haze based on API level.

    Methods: Health risk assessment approach that comprises of hazard identification, exposure assessment, dose-response, and risk characterization steps was used to determine the potential inhaled dose and risk associated with performing the physical activity during haze. We have considered many factors that include time spent for physical activity patterns for Malaysian adult, age and physical intensity-specific inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. A hypothetical exposure scenario of PM10 was created using the breakpoints of PM10 concentration for the calculation of respective API levels during haze.

    Results: The association between physical activity pattern, API level and risk quotient were presented in the form of risk radar diagram. Based on the 50th percentile inhalation rate, all prolonged exertion and heavy exertion should be avoided when API reach >201 (very unhealthy) and >175 (unhealthy) respectively. Below the said API, the duration for performing prolonged exertion and heavy exertion should be reduced according to the API level. When API reaches 140, high intensity physical activity should be limited to < 90 minutes. A football match which requires 90 minutes, should be postponed of cancelled if API > 140. Whereas, for the same API level, prolonged exertion (moderate intensity physical activity) should be limited to 4 hours.

    Conclusions: Reducing the physical activity is an effective strategy to lower the dose of inhaled pollutants and reduce the health risk during poor air quality. Based on the assessment, taking into account the uncertainty of risk assessment methodology, we proposed all prolonged exertion should be avoided when API reach very unhealthy status (>201). Below the said API level, outdoor physical activity should be reduced according to the level of API respectively. The recommendation is not applicable for the sensitive groups. The computed risk radar provide a valuable guide for the public to organize or considering postponing an outdoor event during haze.
  18. Hasnor Hadi Asim, Normawati Ahmad, Abu Bakar Rahman, Nik Mansor Ibrahim, Mohd Nasir Abdullah, Md Sabtuah Royali, et al.
    Int J Public Health Res, 2017;7(2):807-813.
    MyJurnal
    Introduction Tong Nibong is a Bidayuh village located at Sarawak Kalimantan border.
    Since the year 2004 to 2009, a total of 537 cases of malaria were recorded in
    Serian District of which 14 cases were reported from Kampung Tong
    Nibong. Community empowerment programme for malaria infection
    prevention showed tremendous improvement in implementation. This
    intervention study aims to gauge the effectiveness of community
    empowerment approach in malaria elimination programme in Kampung Tong
    Nibong Serian.
    Methods An intervention study was conducted with pre and post data collection. Data
    was collected using validated questionnaire by face to face interview.
    Universal sampling method was used to select respondents from head of
    household and post data was collected after intervention activities were
    carried out within a year of study period.
    Results The study showed significant difference on level of knowledge of
    respondents on vector of malaria between pre and post data with a P < 0.05.
    There was significant difference between pre and post data on practices on
    control and prevention of malaria with a P < 0.05. The same goes to level of
    positive attitude of respondents towards malaria control.
    Conclusions In conclusion, the study can be considered successful because there is
    significant difference in knowledge, attitude and practice among the
    respondents between pre and post data. This indicates that community
    empowerment (voluntary participation) measures can be implemented in high
    risk or endemic areas where malaria is a persistent problem to the community
    and health institutions faces many limiting factors.
  19. Diana Maha, Zaleha Md Isa, Azmi Mohd Tamil, Mohd Ihsani Mahmood, Fatimah Othman, Rashidah Ambak
    Int J Public Health Res, 2017;7(2):860-870.
    MyJurnal
    Introduction The most effective and affordable public health strategy to prevent
    hypertension, stroke and renal disease is by reducing daily salt consumption.
    Therefore, this study aims to determine the association of knowledge, attitude
    and practice on salt diet intake and to identify foods contributing to high
    sodium intake.
    Methods Secondary data analysis was performed on MySalt 2016 data. It was
    conducted from November 2015 until January 2016 which involving Ministry
    of Health Staff worked at 16 study sites in Malaysia. Salt intake was
    measured using 24 hours urinary sodium excretion. Food frequency
    questionnaire was used to determine the sodium sources. Knowledge, attitude
    and practice of salt intake were assessed using a validated questionnaire
    adapted from WHO. Demographic data and anthropometric measures also
    were collected. Sodium levels of more than 2400mg/day was categorised as
    high sodium intake. Data were analysed using SPSS software version 21.
    Results The mean sodium intake estimated by 24 hours urinary sodium excretion was
    2853.23 + 1275.8 mg/day. Food groups namely rice/noodles (33.8%),
    sauces/seasoning (20.6%), meat and poultry (12.6%) and fish/seafoods
    (9.3%) were the major contributors of dietary sodium. In multiple logistic
    regression analysis, being a male (aOR=2.83, 95% CI 2.02 – 3.96) and obese
    (aOR=6.78, 95% CI 1.98 – 23.18) were significantly associated with high
    urinary sodium excretions. In addition, those who were unsure that high salt
    intake can cause hypertension (aOR=1.24, 95% CI 0.65 – 2.36), those who
    think that they consumed too much salt (aOR=2.10, 95% CI 1.13 – 3.87) and
    those who only use salt rather than other spices for cooking (aOR=2.07, 95%
    CI 1.29 – 3.30) were significantly associated with high urinary sodium
    excretion.
    Conclusions This study showed that the main sources of sodium among Malay healthcare
    staff is cooked food. Poor knowledge and practice towards reducing salt
    consumption among them contributes to the high sodium consumption. The
    practice of healthy eating among them together with continuous awareness
    campaign is essential in order to educate them to minimize sodium
    consumption and to practice healthy eating.
  20. Rozita Zakaria, Lim, Ming Tsuey, Norsiah Ali, Nurainul Hana Shamsuddin, Norseha Isnin, Siti Hafsah Abdul Halim, et al.
    Int J Public Health Res, 2017;7(2):871-877.
    MyJurnal
    Introduction Congenital malformations (CM) comprise a wide range of abnormalities of
    body structure or function that are present at birth and are of prenatal origin.
    It has contributed to a significant proportion of infant morbidity and
    mortality. The aims of this study were to determine the extent and investigate
    the relationship between CM and its associated demographic variables.
    Methods Data was extracted from Ministry of Health (MOH) database compiled from
    the reports on Stillbirth & Under 5 Mortality from year 2013 to 2014.
    Results Out of 9,827 child death, 2,840 (28.9%) were classified under CM as defined
    under ICD-10 classification. Majority of those with CMs died at neonatal
    stage (62.7%) and among mothers aged between 20 to 35 years old (67.3%).
    The mean age of mothers among CM children was 30.8±6.5 years old.
    Approximately 5.8%, 6.7% and 3.3 % of total CM were neural tube defects,
    heart defects and hydrops fetalis respectively. The prevalence of CM in males
    was 15% higher than females. The difference were evident between CM and
    age of death of children under 5 years old (p
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