The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.
Study site: outpatients, inpatients; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.
The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
A survey was carried out in a Malay-speaking Muslim community in southern Thailand to obtain baseline data for planning of long term multidisciplinary research and development. By using a 30-cluster sampling technique, 210 households of 1,308 subjects were studied in the post-Ramadan period. It was found that the community was in a social transition. The crude birth rate was 4% and 37.6% of the households had at least one migrant. About half of these migrants had been to Malaysia and mainly worked in rubber plantations. Ninety-five per cent of the households had electricity whereas only 23.8% had a latrine. Boiled or rain water was regularly drunk in only 13.3 per cent of the households. Home-grown agricultural products were not sufficient to provide adequate food. Twenty-six per cent of the adults were unemployed and 24.6% were illiterate. Of the pregnancies 26.7% had no antenatal care and complete tetanus toxoid was given to only 27.8%. Traditional birth attendants conducted 81.1% of the deliveries and only 28.9 and 24.4% of the umbilical cords were correctly cut and correctly dressed, respectively. Breast feeding was still a common (87.8%) practice. However, complete immunization was given to only 10.8%, and 37.8% of the infants had at least one diarrheal episode in the previous month. It was concluded that high birth rate, high migration, low education, low income and bad health of infants are major problems. These problems were interlinked and needed a special multidisciplinary approach. In addition to common obstacles for routine health delivery, migration may create international complications, particularly related to maternal and child care.
The prevalence of sexually transmitted diseases was determined among 370 prostitutes in Kuala Lumpur, Malaysia. Chlamydial cervicitis (26.5%) was detected more frequently than gonorrhoea (14.25%) and was associated more often with pelvic inflammatory disease. Concurrent infections and asymptomatic infections were common. Seropositivity to hepatitis B and syphilis were 66.3% and 13.6% respectively. Women under 20 years of age had significantly higher rates of infection with Chlamydia trachomatis and hepatitis B virus than older women.
Study site: private clinic, Kuala Lumpur, Malaysia
A cross-sectional survey involving 303 6-15-year-old aboriginal children was carried out in Selangor, West Malaysia. Dental caries status was assessed on the basis of the methods of the World Health Organization Oral Health Survey. The findings indicated a generally low prevalence of dental caries with a mean df of 4.94 for children below the age of 10 years. Mean DMFT and DMFS values of 1.71 and 3.22, respectively, were also observed for the 6-15-year-old children.
PIP: Contraceptive prevalence was determined in the Kelantan region of Malaysia, an area with relatively poor health indices. 350 women attending health clinics on rubber and palm-oil estates and living in surrounding suburbs were surveyed by clinic workers or during home visits. The sample included 273 Malays, 64 Indians and 13 Chinese. This area of Peninsular Malaysia is noted for the highest infant mortality rate (17.7), second highest crude birth rate (35.2) and highest dependency ratio (88%) in the country. 44.9% practiced contraception, highest in Chinese and lowest in Indians. Methods used were pills by (55%), traditional methods (19%), tubal ligation (18%), safe period (14%), injections (5.5%), IUD (4.7%), and condom (2.3%). The Malaysian traditional methods are herbal preparations from tree bark or roots, herb pills, and exercises after coitus. 34% of the non contraceptors had used contraception before but stopped because of side effects, religious or spousal objections, or desire to conceive. 74% had married in their teens. 46% of the non-contraceptors were spacing their children by prolonged breastfeeding.
In a cross-sectional study of 7-12 year-old primary school children in Kuala Lumpur city, lung function was assessed by spirometric and peak expiratory flow measurements. Spirometric and peak expiratory flow measurements were successfully performed in 1,214 and 1,414 children, respectively. As expected, the main predictors of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow between 25% and 75% of vital capacity (FEF25-75), and peak expiratory flow rate (PEFR) were standing height, weight, age, and sex. In addition, lung function values of Chinese and Malays were generally higher than those of Indians. In multiple regression models which included host and environmental factors, asthma was associated with significant decreases in FEV1, FEF25-75, and PEFR. However, family history of chest illness, history of allergies, low paternal education, and hospitalization during the neonatal period were not independent predictors of lung function. Children sharing rooms with adult smokers had significantly lower levels of FEF25-75. Exposures to wood or kerosene stoves were, but to mosquito repellents were not, associated with decreased lung function.
In a study of 249 opiate (mainly heroin) addicts special attention was paid to adjunctive drug use. Generally, nicotine (cigarette smoking), alcohol and cannabis preceded the use of heroin, and continued to be used as adjunctive drugs after the establishment of heroin addiction. Nicotine was the most common substance used together with opiates. Alcohol and cannabis were used as adjunctive drugs in about two-thirds of the cases. In the late stages of heroin addiction, benzodiazepines were also used concomitantly with opiates. The most frequently reported reason for the use of adjunctive drugs was to intensify the effect of the opiate. Three-quarters or more of the addicts had used different adjunctive drugs to boost the euphoric feeling derived from the primary drug, i.e. heroin. Attempt at self-treatment of withdrawal symptoms was a less frequently reported reason for adjunctive drug use. The findings show that heroin addiction is the major problem. The use of adjunctive drugs, especially benzodiazepines, can be partly explained on economic grounds. They must be clearly distinguished from the primary drug of abuse, heroin. For policy-making decisions, it is important that the elimination of heroin abuse through effective prevention measures would ultimately wipe out the problem of adjunctive drug use, while reduction of the overall supply of heroin without reduction in actual demand might result in an increasing trend to adjunctive drug use.
The effects of indoor environmental factors on respiratory illness were studied in 15017-12 year old school children in Kuala Lumpur. Exposure to mosquito coil smoke for at least three nights a week was independently associated with asthma and persistent wheeze. Passive smoking, defined as sharing a bedroom with an adult smoker, was independently associated with a chest illness in the past year. No relationships were found between exposure to kerosene stoves, wood stoves, fumigation mat mosquito repellents or aerosol insecticides and respiratory illness. Host factors predictive of at least one respiratory outcome included family history of chest illness, history of allergy, male sex, hospitalization in the neonatal period and low paternal education. With 95% confidence, avoidance of regular exposure to mosquito coil smoke and passive smoking could reduce the prevalences of persistent wheeze, asthma and chest illness by up to 29%. Measurements of lung function confirmed the validity of questions pertaining to wheezing and asthma in the study questionnaire.
In a study of 124 adult patients with bronchial asthma, 65% of them had associated rhinitis. In the asthmatics who had associated rhinitis, both diseases usually started within two years of one another but either disease might develop first. In 21% of the patients, asthmatic attacks were preceded or precipitated by rhinitis symptoms. In the patients who had asthma alone or those associated with rhinitis, no significant difference were found in terms of age and sex distribution, age of onset, and a positive family history of asthma, rhinitis or allergic diseases. Response to skin prick test using six different types of allergens also showed no difference in the two groups of patients. Sensitivity to house dust was common among both groups of patients as well as in the normal controls suggesting a common occurrence of house dust mite in our community and making the skin prick test using this allergen unsuitable as a test for atopy in our population.
Study site: Chest clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Eight general practitioners participated in a survey of content of general practice. This is useful as an indicator or morbidity in the community as well as of workload of general practice. A total of 3164 consultations were recorded, of which 2764 (87%) were because of an illness and the rest (13%) for other reasons like medical examinations, antenatal check, family planning advice, pregnancy tests, pap smear and vaccination. The old and the young have high consultation rates for an illness, men consulted as often as women. The most common illness seen was upper respiratory tract infections, accounting for 37% of all illnesses. Other common minor illnesses were skin infections (6%), genito-urinary infections (5%), minor musculoskeletal (6%) and gastrointestinal (6%) complaints as well as minor injuries and cuts (4%). Major disorders form an unusually low proportion (18%) of all illnesses seen, in comparison with figures from United Kingdom. The common major disorders seen were hypertension, asthma, chronic rheumatic disorders and diabetes. Circulatory disorders were remarkably rare, accounting for only 1% of illnesses. Psychological disorders, both major and minor, were also rarely seen, accounting for only 1% of illnesses which is in marked contrast with figures from the United Kingdom. Factors contributing to these notable findings are discussed.
The prevalence, age at diagnosis, clinical characteristics and treatment of young diabetics, younger than 40 years were determined on the basis of a cross-sectional study of medical records of 2 health districts in Pahang, Malaysia. There were only 20 insulin-dependent diabetics (IDDM), prevalence 0.07 per 1000 inhabitants. There were 84 non-insulin-dependent diabetics (NIDDM), prevalence 0.3 per 1000 inhabitants. Three of the NIDDM patients could have malnutrition-related diabetes. Many NIDDM patients were asymptomatic which is an important reason why many of them remain undetected in the community. Seventy-four percent of the patients below the age of 30 years at diagnosis had NIDDM, 56% of the patients below the age of 20 years at diagnosis also had NIDDM and 54% of the NIDDM patients had a strong family history of diabetes. Many NIDDM patients were misdiagnosed as IDDM, especially if they were underweight, leading to considerable overuse of insulin. This study confirms that IDDM is rare in Malaysia, as in other Asian countries. Most young diabetics have NIDDM and have a strong family history. This pattern of diabetes in the young is unlike that seen in the West.
An audit to assess the adequacy of hypertension care was performed by examining the records and interviewing 55 selected hypertensive patients on treatment and follow-up at the outpatient department of a hospital. The patients selected had no previous record of drop out of treatment and had excellent compliance with drug therapy, so that ineffective blood pressure control cannot be attributable to these two reasons. Adequacy of care was measured by the number of patients whose management as indicated in their records complied with pre-defined criteria of adequate care. Only 18% of patients had achieved adequate blood pressure control. Assessment of patients was inadequate. None of the patients had been screened for secondary causes though 16% of patients had some basic investigations (urinalysis, blood urea and serum potassium), 5% had an assessment of target-organ damage, and 2% had been screened for other cardiovascular risk factors. Only 5% had a surveillance of side-effects from drug-therapy, 45% of the patients demonstrate adequate knowledge concerning complications of hypertension. The use of non-drug treatment was non-existent. The results of this study suggest that there were considerable deficiencies in the management of hypertension. Measures needed to overcome this are discussed.
The stools of 97 children with acute gastroenteritis, attending a private paediatric clinic, were studied for infectious agents. Putative pathogenic microorganisms were identified in 47 cases (48.5%). Food poisoning Salmonella was the most common bacteria detected, 25 cases (25.8%). Rotavirus was present in 9 cases (9.2%). Interview of the parents and care-persons revealed a general lack of knowledge in the proper cleaning and sterilisation of milk bottles, rubber teats and pacifiers. In 44 households there were at least one animal kept and there were positive bacterial isolates from 47% of such households. However, positive isolates were found in only 26% of households with no kept animals. The implications of these findings are discussed. (Copied from article).
The relationship between malnutrition, goitre and thyroid hormones was studied among Aborigines and Malays in Ulu Langat, Malaysia. Fifty Aborigines aged >=7years were selected randomly for anthropometric, clinical and hormonal assessment. Fifty Malays of similar age from the nearby Malay village were chosen as controls. The Aborigines had a higher prevalence of malnutrition and goitre compared to the Malays. The prevalence of goitre was 26.5% amongst Aborigines and 19.6% among the Malays. All the nutritional indexes measured were significantly different between the two communities, especially among females. The differences corresponded to significant differences in levels of thyroid-stimulating hormone (TSH) measured using a highly sensitive TSH assay. By univariate analysis the increase in TSH corresponded to the decrease in body mass index (BMI). On the other hand, no association was found between BMI and goitres. No thyroid autoantibodies were detected and all subjects were clinically euthyroid and had normal thyroxine and triidothyronine levels. However, consumption of cassava conferred a four-fold risk of developing goitres. The high prevalence of goitres in malnourished subjects in this region which is not known to be iodine deficient could be due to cassava consumption.
A study was undertaken to determine the extent of morbidity associated with asthma and to audit the management of asthma in two out-patient clinics of two district hospitals. Patients were recruited for the study during a 3-month period from December 1990 to February 1991. Seventy asthmatic patients were studied. Eighty-six percent of the patients had their sleep disturbed by asthma, 77% took daily medication regularly, 63% felt that their activities were restricted by asthma, 60% had at least one acute exacerbation in the preceding six months. Of those who had their peak expiratory flow rate (PEFR) measured, 40% had a PEFR below 50% predicted, and only 11% had normal PEFR (greater than 80% predicted). The morbidity of asthma was thus considerable. On the other hand, the drug treatment of these asthmatics was grossly inadequate. They were prescribed on average 2.1 item of drugs, which for most patients comprised an oral beta agonist and a theophylline. Only 43% of the patients received inhaler therapy, but no patients were given steroids, inhaled or oral. The drug treatment was unrelated to the severity of patients' asthma. Further, objective measurement of severity was under-used in the assessment of asthma, only 8.5% of patients ever had their PEFR recorded. This study has found that asthma is poorly managed in out-patient clinics. We need to improve the training of doctors in the optimal management of asthma.
Study site: General outpatient clinics, district hospitals, Pahang, Malaysia