There is no doubt that gender bias has been inherent in medical and public health education, research, and clinical practice. This paper discusses the central question for medical and public health educators viz. whether women's health concerns and needs could be best addressed by the conventional biomedical approach to medical and public health education, research, and practice. Gender inequalities in health and gender bias in medical and public health education are revealed. It is found that in most public health and prevention issues related to women's health, the core issue is male-female power relations, and not merely the lack of public health services, medical technology, or information. There is, thus, an urgent need to gender-sensitize public health and medical education. The paper proposes a gender analysis of health to distinguish between biological causes and social explanations for the health differentials between men and women. It also assessed some of the gender approaches to public health and medical education currently adopted in the Asia-Pacific region. It poses the pressing question of how medical and public health educators integrate the gender perspective into medical and public health education. The paper exhorts all medical and public health practitioners to explore new directions and identify innovative strategies to formulate a gender-sensitive curriculum towards the best practices in medicine and public health that will meet the health needs of women and men in the 21st century.
This is a study to describe the health beliefs related to oral cancer (OC) in a high-risk group in Malaysia, a predominantly Indian community living in an agricultural setting called an estate. The study population was a convenient sample of 112 adults, above 20 years of age, attending oral cancer screening in two estates. The subjects consisted of 106 (94.6%) Indians and six (5.4%) Malays. Using the Health Belief Model, the perceptions of susceptibility to OC, its severity, and the benefits of and barriers to preventive actions, as well as beliefs underlying OC aetiology were investigated. About half of the subjects (n=57, 50.9%) felt susceptible to oral cancer. A majority of subjects (n=93, 83.0%) felt that oral cancer is a severe disease. Thirty four people (30.4%) perceived OC as a preventable disease, while 56 (50%) did not, and the remaining 22 (19.6%) did not know if OC was preventable or not. The majority of subjects (84.8%) believed that modifications to the betel quid habit could be beneficial. The information solicited can be used as a starting point to design health-education activities aimed at this group in particular and the population in general.
The purpose of the present study was to develop a hydration strategy for use by female English field hockey players at the 1998 Commonwealth Games in Malaysia. An additional aim was to initiate the process of acclimation. Fifteen elite players, mean age (+/-SEM) 24.1 +/- 1.19 years, height 1.67 +/- 0.01 m, and body mass 62.8 +/- 1.76 kg, took part in a 5-day training camp immediately prior to departure for the Games. In order to develop the hydration strategy, training took place under similar environmental conditions to those to be experienced in Malaysia (i.e., 32 degrees C, 80% humidity). Acclimation training consisted of 30-50 min of either continuous, low intensity cycling or high intensity intermittent cycling, which more closely replicated the pattern of activity in field hockey. Body mass measures taken each morning, and pre and post training, together with urine color measures, were used to assess hydration status. Pre-loading with up to 1 L of a 3% carbohydrate-electrolyte solution or water immediately prior to acclimation training, as well as regular drinks throughout, ensured that players avoided significant dehydration, with percent body mass changes ranging from -0.34% to +4.24% post training. Furthermore, the protocol used was sufficient to initiate the process of acclimation as demonstrated by a significant reduction in exercising heart rate and core temperature at all time points by days 4 and 5. In conclusion, although labor intensive and time consuming, the camp was successful in developing a hydration strategy that players were able to utilize once at the Games.
SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia
Diseases spread through food still remain a common and persistent problems resulting in appreciable morbidity and occasional mortality. Food handlers play an important role in ensuring food safety throughout the chain of production, processing, storage and preparation. This study is to explore the pattern of sociodemographic distribution and to determine knowledge, attitude and practice of food handlers towards food-borne diseases and food safety. A total of 430 food handlers were randomly selected from Kota Bharu district and interviewed by using structured questionnaire. Distribution of food handlers was Malays (98.8%), females (69.5%), married (81.4%), working in food stalls (64.2%), involved in operational areas (49.3%), having no license (54.2%) and immunized with Ty2 (60.7%). The mean age was 41 +/- 12 years and the mean income was RM 465 +/- 243/month. The educational level was found as no formal education (10.5%), primary school (31.9%), secondary school (57.0%) and diploma/degree holders (0.7%). A significant number of food handlers (57.2%) had no certificate in food handlers training program and 61.9% had undergone routine medical examinations (RME). Almost half (48.4%) had poor knowledge. Multiple logistic regression showed type of premise [Odd ratio (OR) = 4.0, 95% Confidence interval (CI) =1.8-7.5, p = 0.0004], educational level (OR = 4.0, 95% CI = 1.8-7.4, p = 0.0003) and job status of food handlers (OR = 0.5, 95% CI = 0.3-0.8, p = 0.0031) significantly influenced the level score of knowledge. No significant difference of attitude and practice between trained and untrained food handlers. Findings of this preliminary study may help in planning health education intervention programs for food handlers in order to have improvement in knowledge, attitude and practice towards food-borne diseases and food safety. Furthermore, it will in turn reduce national morbidity and mortality of food-borne diseases.
A survey was carried out among primary school teachers in the district of Kota Bharu, Malaysia to assess the level of knowledge on asthma and its management. Our findings revealed that primary school teachers were less informed about the management and treatment of asthma. They were relatively more knowledgeable about the causes and symptomatology of asthma. The majority of respondents had misunderstanding regarding the effect of rain, smoking and cold weather on asthma. It is important that teachers should be able to recognise symptoms of an asthmatic attack or take the necessary precautions to avoid such an attack. Many teachers agreed on the need to have an asthma education programme in their teaching curriculum.
Breast cancer is the most common cancer among Malaysian women. Nonetheless, in Malaysia there is a marked geographical difference in the incidence of breast cancer with advanced stage of presentation. The breast clinic in Kuala Lumpur Hospital diagnosed approximately 150 to 200 new cases of breast cancer a year. This number, however, represents only 12.0% to 15.0% of all breast disease seen annually in Kuala Lumpur Hospital. Between 1998 and 2001, of a total of 774 cases of newly diagnosed breast cancer in Kuala Lumpur Hospital, only 5.0% (40/774) were impalpable breast cancers. The peak age group for the three major ethnic distributions (Malay, Chinese, and Indian) ranged from 40 to 49 years. The mean tumor size at presentation was 5.4 cm (range: 1-20 cm), and the advanced stage of breast cancer is observed to be highest among the Malay ethnic group. Although it appears that the incidence of breast cancer in Malaysia is lower than in the developed countries, the difference may be attributable to the difficulty in getting accurate statistics and to underreporting of cases. Nonetheless, from the available data, it is clear that breast cancer continues to be the most common cancer among Malaysian women. The strongly negative social-cultural perception of the disease, made worse by the geographical isolation of many rural areas, accounts for the delayed diagnosis and the often advanced stage of disease at presentation. A prospective population-based study is called for to verify the demographic patterns of breast cancer, particular in Malaysia and other developing countries. The findings of such a study may have implications for future breast screening programs and for facilitating the understanding of differing risks of breast cancer among women around the world.
The Asia-Pacific Expert Committee on Hepatitis B Management recently reviewed the impact of hepatitis B in the region and assessed the differences and similarities observed in the practical management of the disease in individual Asia-Pacific countries. Hepatitis B is a major health concern in the Asia-Pacific region, and of all chronically infected carriers worldwide, approximately 75% are found in Asia. The disease poses a considerable burden on healthcare systems, and is likely to remain a cause of substantial morbidity and mortality for several decades. Disease prevention activities, including screening and vaccination programs, have been implemented successfully in some Asia-Pacific countries and similar measures are being established in other parts of the region. The management of hepatitis B in the Asia-Pacific varies throughout the region, with each country confronting different issues related to treatment options, disease monitoring and duration of therapy. The influence of cost, availability of diagnostic equipment, and patient awareness and compliance are of additional concern. Although guidelines such as those developed by the Asian Pacific Association for the Study of the Liver have been created to address problems encountered in the management of hepatitis B, many physicians in the region still find it difficult to make satisfactory management decisions because of the treatment choices available. This article examines the different approaches to hepatitis B management in a number of Asia-Pacific countries, and highlights the difficulties that can arise when adhering to treatment guidelines and disease prevention solutions that have proved to be successful in the region.
Most medical schools, especially in South-East Asia, currently are experiencing difficulties in providing the right quality and quantity of educational experiences as the curricula have failed to respond to the needs of the community and country. The pedagogic shift from traditional approach to a need-based approach requires a fundamental change of the roles and commitments of educators, planners and policymakers. Teachers of health professional education in the region are to be well-informed of the trends and innovations and utilize these to increase relevance and quality of education to produce competent human resources for the region. The purpose of this paper is twofold: (i) to discuss innovative strategies and emerging trends, which have been successfully adopted by educators around the world for the reorientation of medical education to overcome existing traditions of educational planning, review and development and (ii) to highlight their implications and importance to initiate need-based reforms of medical training in South-East Asia.
OBJECTIVE: To describe tobacco industry efforts in Malaysia to thwart government efforts to regulate tobacco promotion and health warnings.
METHODS: Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement and secondary websites; relevant information from news articles and financial reports.
RESULTS: Commencing in the 1970s, the industry began to systematically thwart government tobacco control. Guidelines were successfully promoted in the place of legislation for over two decades. Even when the government succeeded in implementing regulations such as health warnings and advertising bans they were compromised and acted effectively to retard further progress for years to come.
CONCLUSION: Counter-measures to delay or thwart government efforts to regulate tobacco were initiated by the industry. Though not unique to Malaysia, the main difference lies in the degree to which strategies were used to successfully counter stringent tobacco control measures between 1970 and 1995.
The goal of this article is to provide couple therapists and relationship educators with information to enhance the cultural relevance of their work with Asian populations. Because of the rapid social, economic, cultural, and gender role changes, the various Asian interpretations of the institution of marriage are undergoing major transformation. This article describes the general trends in marriage in several Asian nations, with a focus on the swiftly rising divorce rates and changing cultural attitudes to marriage, and discusses current relationship education initiatives in these nations. Finally, based on my experiences working with Asian populations, I present a few humble insights regarding adaptation of marriage education to render it more culturally appropriate for Asians.
PURPOSE: To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs).
METHODS: Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia.
RESULTS: A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia.
CONCLUSION: The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.
This is a cross-sectional study to determine the association between religious perception and smoking behavior of secondary male students in Kota Bharu, Kelantan. A self-administered questionnaire survey was conducted on 526 secondary four male students from eight randomly selected schools in Kota Bharu. There were 182 (34.6%) students who were current smokers, 12 (2.3%) were ex-smokers and 332 (63.1%) were non·smokers. More than half of the current smokers (53.4%) smoked regularly. Student’s perceptions on the religious opinion on smoking were signihcantly associated with smoking behavior. Other significant risk factors were having close friends who smoke, their perceptions on benefits and negative effects of smoking and the level of
y relationship with their fathers. These factors were also found to be good predictors of student's smoking status. Health education programs to control smoking should include the religious aspect of smoking to improve it’s effectiveness.
Sarawak, Malaysia has a large population of ethnic minorities who live in longhouses in remote rural areas where poverty, non-communicable diseases, accidents and injuries, environmental hazards and communicable diseases all contribute to a lower quality of life than is possible to achieve in these regions. To address these issues and improve the quality of life for longhouse people, the Kapit Divisional Health Office implemented the World Health Organization's Healthy Village programme in 2000. An evaluation was undertaken in 2003 to determine physical and behavioural changes resulting from the programme. The main changes evaluated were those involving smoking habits, exercise habits, health screening, fire safety, environmental improvements and food preparation and hygiene. A qualitative evaluation was conducted using participant observation and key-informant interviews, focus groups and observation. Results indicate that the programme is inspiring changes in various behavioural and physical characteristics of the study population. It is clear that the Healthy Village programme is a widely accepted way of improving health outcomes in longhouses, and that it is succeeding in making beneficial health changes.
INTRODUCTION: This study aimed to qualitatively explore adolescents' sexuality and their relation to human immunodeficiency virus (HIV) risk in Malaysia.
METHODS: This study was conducted in 2002 among 16 male and female private college students aged between 18 and 22 years old, all of whom were sexually active. Semi-structured individual interviews were carried out.
RESULTS: There were definite differences in gender roles in terms of how adolescents perceived sex, selection of sex partners and communication with their partners. Definitions of stable and casual relationships differed between males and females. Most participants were concerned about pregnancy rather than sexually transmitted diseases or HIV infection when they interpreted safe sex. Reasons for not practising safe sex include trust between sex partners, complacency, low perception of risk, and negative attitudes towards condom use.
CONCLUSION: These findings were closer to those observed in the developed countries. The findings from this study will serve as a guide to plan for local adolescent health education. It can also serve as a basis for more in-depth quantitative and qualitative research on adolescent sexuality.
Study site: Students, private colleges, Klang Valley, Malaysia
The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.
Study site: Klink HUKM Taman Jaya, Cheras, Kuala Lumpur, Malaysia (primary care clinic for Hospital University Kebangsaan Malaysia)
Dietary intakes and lifestyle habits during adolescence may predict the occurrence of obesity and other diet-related chronic diseases later in life. The purpose of this study was to determine dietary intake of adolescents in a fishing community in Tuaran District, Sabah. A total of 199 apparently healthy adolescents comprising 94 male and 105 female subjects were purposively selected for the study. The mean age of the subjects was 15.2 f 2.2 years with female subjects having a higher mean age of 15.7 f 2.4 years compared to the males (14.6 k1.8 years). The mean BMI of the subjects was 18.4 f 2.9 kg/m2 with females having a significantly higher BMI (18.9 f 2.8 kg/m2) than the males (17.8 f 3.0 kg/m2). Based on the WHO classification (WHO, 1995), 19.6% of the subjects could be classified as thin while 4.5% were at risk of overweight. Overall for both sexes, intake of energy and most nutrients were below the Malaysian recommended nutrient intake (RNI) levels for adolescents, with the exception of vitamin C and niacin. The male subjects showed higher mean intake for vitamin A, thiamine, niacin and vitamin C than the females. Calcium and iron intake ranked among the lowest levels, at 33.4% and 47.2% respectively of the RNI values for both sexes. The main sources of energy were rice, flour products and tubers while fish and seafood were the chief sources of protein. Majority of the subjects (84%) reported taking breakfast daily, which often consisted of fried noodles, fried banana, doughnuts and coffee. Consumption of snacks was popular and commonly consumed snacks were bread, biscuits, and fried banana. The present study revealed that 25.5% and 14.3% of the male and female adolescents respectively were thin, with majority of them consuming inadequate levels of energy and several key nutrients. The results underscore the need for adolescents to be targeted for nutrition and health education as they go through a period of marked physical, physiological and psychological changes.
The high morbidity and mortality caused by smoking is a major public health problem today. Smoking prevention has been acknowledged and identified as a long-term measure to overcome this problem. This is a longitudinal knowledge; attitude and practice (KAP) study among form five students over l year. The response rate at follow‘up was 251/337 (74.5 %). The smoking prevalence changed after 1 year (from 29.7% to 26. 7%) after one year. The male to female smoking rates were 52.1% to 3.1% respectively. Students who smoke were found to have a positive attitude as well as poor knowledge of the risks of smoking. The initiation risk factors identified were being male and having a friend who smokes Positive peer influence also contributed to smoking cessation after a period of one year. Holistic measures that stress on micro macro and approaches such as health education programe to enhance knowledge of smoking hazards and community participation ( cooperation of school, family and community member) should be fomtulated in order to reduce initiation of smoking among the adolescents. Quit smoking programmes must also be readily available.