Over a five year period, 184 patients were treated for acute renal failure. Uraemia was usually treated by peritoneal dialysis, and haemodialysis was reserved for post surgical and hypercatabolic patients. The overall mortality was 33.2% and was highest among surgical patients. These results were similar to previous reports. Peritoneal dialysis was usually effective in controlling uraemia. Uncontrolled sepsis remains a major problem, and septicaemia and gastrointestinal bleeding were adverse factors affecting the outcome. The combination of septicaemia and gastrointestinal bleeding commonly led to a fatal outcome.
Mortality in the early phase of acute myocardial infarction occurs both during the pre-hospital period and after admission to the Coronary Care Unit. This report is an analysis of deaths that occurred in the Coronary Care Unit within a 3 year period. Forty percent of 304 patients (13 percent) unth. acute myocardial infarction died in the Coronary Care Unit, Fifty percent of the deaths were due to cardiac arrhythmias and 45 percent attributable to myocardial pump failure. Mean delay in hospital admission from onset of symptoms was 15 hours. Factors affecting early mortality and their prevention are discussed.
Health, including nuirition is not independent but is closely associated with the social and economic environment. Malnutrition itself can cause death, but more commonly, it can cause considerable ill-health, physical retardation, impaired mental performance, loss in productivity and a decline in the quality of life. The effects of malnutrition as obstacles to socio-economic development are now well recognised. In a rapidly developing country like Malaysia, the nutritional and nutritionally-related problems present themselves with contrasting features. While population indicators such as toddler mortality, incidence of low birthweight and food balance sheet studies suggest an improving nutritional situation, methods of direct assessment have shown that chronic protein-energy malnutrition and anaemia are sWI common amongst pre-school children in both the rural and urban disadvantaged sectors. Moderate anaemia also affects a significant proportion of older children and women of childbearing age. Intestinal parasites, another indicator of under development at the local level, are ubiquitous in the rural setting and urban slums owing to unsatisfactory waste disposal. In striking contrast, diseases associated with dietary excesses and increasing affluence have now emerged as the major killers. This changing pattern of mortality and morbidity along the lines encountered by the industrialised societies is now dramatised by the fact that road accidents are now claiming a large number of victims. It is clear that while continued efforts should be given to the improvement of the nutritional health of both rural and urban poverty communities, little time should be wasted in considering the adoption of public health measures aimed at stemming the rising number of deaths associated with our increasing affluence, particularly those diseases that are nutritionally linked, such as coronary heart disease, hypertension and diabetes mellitus, not forgetting the increasing road toll afflicted by the motor vehicle.
Maternal deaths in Kerian district during a 5 year period (1976-1980) is described. There were 35 maternal deaths in all and Malays constituted the majority 32 (91.4 percent). Most of the women were of low socio-economic status and only 20 percent had some formal education. The women were mainly multigravida and majority of them 20 (57.2 percent) were between 31-40 years of age. The main cause of death being PPH and PPH with retained placenta. Most of them died at home and were attended to by TBAs. The need to identify, train and utilise TBAs has been realised as they delivered about 41.4 percent of the deliveries in Kerian in 1976.
Over the six-veer periodfrom. 1976 to 1981, there were 241 neonates referred to the U.K.M. Paediatric Surgical Unit, General Hospital, Kuala Lumpur for alimentary tract obstruction and 207 were operated on. The three commonest conditions were anorectal anomalies (91 cases), Hirschsprung's disease (31 cases) and oesophageal atresia (30 cases). Overall operatioe mortality was 28.0 percent. This was high when preoperative complications lihe gut perforation (88.9 percent) or pneumonia (61.9 percent) and associated severe anomalies (90.9 percent) or chromosomal abnormalities (66.7 percent) were present. Emphasis is placed on the establishment of early diagnosis and the significance of the green vomit and maternal hydramnios is highlighted, The need is felt for more specialised nurses and the creation of a separate neonatal ICU in this hospital.
Malaria is a major public health problem in Malaysia, particularly in peninsular Malaysia and the state of Sabah. An eradication program started in the states of Sabah and Sarawak in 1961 initially was remarkably successful. A similar but staged program was started in peninsular Malaysia in 1967 and was also quite successful. However, a marked upsurge in incidence in Sabah in 1975-1978 showed that malaria is still a major hazard. The disease leads to great economic losses in terms of the productivity of the labor force and the learning capacity of schoolchildren. The topography, the climate, and the migrations of the people due to increased economic activity are similar in peninsular Malaysia, Sabah, and Sarawak. However, the epidemiologic picture differs strikingly from area to area in terms of species of vectors, distribution of parasitic species, and resistance of Plasmodium falciparum to chloroquine. Likewise, the problems faced by the eradication or control programs in the three regions are dissimilar. Because solutions to only some of these problems are possible, the eradication of malaria in Malaysia is not likely in the near future. However, the situation offers an excellent opportunity for further studies of antimalaria measures.
Fifty-six living related renal transplants were performed between December 1975 and December 1980. All except eight of the recipients were male. The mean age was 29.5 years. Patient and graft survival were 86 percent and 73 percent at 1 year and 83 percent and 68 percent at 2 years respectively. Infection was the main cause of death and acute and chronic rejection were the main causes of graft failure. The donors were aged between 18 and 72 years old. There were 21 parent and 35 sibling donors. Donor nephrectomies were performed without mortality and our experience so far with the transplantation of kidneys from elderly donors has been encouraging.
Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.
Over a 28 month period in the Sarawak General Hospital, Kuching, there were 100 'confirmed' septic induced abortions and 75 'suspect' cases. Socio-demographic characteristics are studied. Seventy-five percent of induced abortions used some kind of foreign body per vaginam. Forty-one percent are in the age group of 20-25 years and the housewife together with the unemployed form 57 percent of the whole group. There were 2 maternal mortalities.
Considerable attention has been paid to the correlation between high infant morbidity and mortality rates and the increased incidence of bottle feeding. The shift from prolonged breast feeding to a mixed regime or the exclusive use of sweetened condensed milk or infant formula has been related to the promotional activities of milk companies, and typically has been presented as a relatively recent development in Third World countries. However, the marketing of tinned and powdered milk only partially explains the increased use of these products. In colonial Malaya, condensed milk was marketed from the late 19th century. Infant formula was available from the turn of the century and was widely advertised, first in the English-language press and later also in the vernacular presses. At the same time, other social and cultural factors served to discourage breast feeding. There were changes in ideas regarding ideal body weight for both women and infants, and regarding infant care and diet; these ideas were presented in the mass media. In addition, maternal and child health clinics, established in the 1920s to reduce the high infant mortality rate, both propagated popular beliefs about infant weight and supplied milk and educated women to artificially feed their infants. Industry, the media, and health services all promoted, if not always intentionally, bottle feeding rather than breast feeding. Bottle feeding as an ideal, if not a reality, was thus well established before the intensive promotion of milk products by multinational corporations that followed the political independence of the colony.