Dental fear is a hindrance to the effective provision of oral health care and causes patients to delay, or even avoid necessary care altogether. The aim of this study was to determine the prevalence and level of dental fear, to identify specific fear provoking stimuli and also to explore the avoidance behaviour among the respondents. A cross-sectional study was conducted on a sample of 407 antenatal mothers utilizing the Kleinknecht's Dental Fear Survey Questionnaire. The overall prevalence of dental fear was 94.1% of which 67.6% of the subjects reported low fear levels, 26.5% were moderately fearful while none were highly fearful. Only 5.9% of the subjects reported no fear. The drill and anaesthetic needle were identified as the most fear provoking objects. Subjects with moderate fear were about 6.4 times (OR=6.39; 95%CI 3.81-10.75) more likely to avoid making appointments and 6 times (OR=6.05; 95% CI 3.20-11.50) more likely to cancel appointments compared to subjects with lower levels of fear. This. study indicates that dental fear is a common problem among antenatal mothers contributing to poor dental attendance.
This is a cross-sectional study on 218 pregnant mothers in an urban government Hospital.The study aimed to assess knowledge, attitudes and sources of information on breastfeeding. The results could be utilised to promote breastfeeding. Almost all the respondents (96.8%) intended to breastfeed their newborns. Most of them (74.8%) were knowledgeable about breastfeeding i.e. colostrum and breast milk was the best food, good for resistance against disease and allergy, filling up stomach easily, helpful in teeth development and maternal recovery after birth, increased bonding, was easy and economical. The two main misconceptions were mothers would stop breastfeeding when infant or mother was sick, and giving clear fluid to the exclusively breastfed infants to prevent dehydration. Most mothers (83.9%) responded positively towards breastfeeding i.e. it was easier than infant formula, had no negative effect on marital relationship or family care, would commence breastfeeding straight after delivery, agreeable to the banning of bottles and teats in hospital and they would not stop breastfeeding even if husband discouraged them. Only 56.9% of the mothers believed they could breastfeed their babies with modesty anywhere. The main sources of information were attained from the mass media (34.9%), antenatal class (32.1%) and other mothers with breastfeeding experiences.
This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented.
This qualitative study used focus group discussions (FGDs) to evaluate information needed in order to make informed human papillomavirus (HPV) vaccination decision, opinion on the most acceptable public education messages, and channel of delivery in a multiethnic, multicultural and multireligion country. A total of 19 FGDs were conducted among mothers of eligible vaccinees, young women eligible for the vaccine, and men. Messages that carry accurate information about HPV-cervical cancer link, the HPV preventive vaccines and at the same time minimize the stigma of a sexually transmitted infection (STI) vaccine were preferred. Educational messages for future HPV educational intervention were developed and methods to effectively convey to the public the need for HPV vaccination were identified. The findings serve as a basis for future intervention to develop research-based communication materials and strategies.
OBJECTIVE: It has been a little more than a year ago since the prophylactic vaccine against human papillomavirus (HPV) was released in Malaysia. Little is known about parental knowledge and acceptability of the vaccine. The objective of this study is to assess the mother's knowledge and attitudes toward HPV vaccination. The results are aimed to provide insights into the provision of appropriate educational and promotional program for effective immunization uptake.
MATERIALS AND METHODS: Purposive sampling method was adopted for recruitment of participants. A total of 47 mothers participated across 8 focus group discussions carried out between October and November 2007. The transcribed group discussions were analyzed using open-, axial-, and selective-coding procedures.
RESULTS: Respondents have low awareness about the newly released vaccine and the link between HPV and cervical cancer. When provided with information about HPV and cervical cancer, most mothers were in favor of protecting their daughters from cervical cancer using the vaccine. As with any new vaccine, efficacy and safety were the major concern, particularly when the vaccine is recommended to preadolescent. Many expressed concern about the high cost of the vaccine and hope that the inoculation could be at least partially subsidized by the government. A minority were concerned that the sexually transmitted disease-related vaccine would promote sexual activities, and some opposed making vaccination mandatory. For Muslim respondents, the kosher issue of HPV vaccine was an important factor for acceptance.
CONCLUSIONS: Developing public health messages that focus on the susceptibility of HPV infection and its link to cervical cancer to educate parents may have the greatest impact on improving the uptake of the vaccine. Apart from the major concern about safety and efficacy, affordability, and acceptability of vaccinating young children, religious and ethnic backgrounds were important considerations when recommending the HPV vaccine. To foster broad acceptance, these issues need to be addressed before mass vaccination is pushed forward to the Malaysian public.insights into the provision of appropriate educational and promotional program for effective immunization uptake.
OBJECTIVES:
Postpartum depression (PPD), a major health concern, produces insidious effects on new mothers, their infant, and family. This literature review aims to explore risk factors for postpartum depression among women in Asian cultures, which has not been fully elaborated.
DATA SOURCES:
A literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they (a) examined risk factors for PPD, (b) were conducted in Asian countries using quantitative or qualitative methodologies, and (c) were published in English in peer-reviewed journals between 1998 and 2008. A total of 64 studies from 17 countries were reviewed, summarised, and synthesised.
RESULTS:
The prevalence of postpartum depression in Asian countries ranged from 3.5% to 63.3% where Malaysia and Pakistan had the lowest and highest, respectively. Risk factors for postpartum depression were clustered into five major groups: biological/physical (e.g., riboflavin consumption), psychological (e.g., antenatal depression), obstetric/paediatric (e.g., unwanted pregnancy), socio-demographic (e.g., poverty), and cultural factors (e.g., preference of infants' gender). Traditional postpartum rituals were not found to provide substantial psychological benefits for the new mothers.
CONCLUSIONS:
This review informs a current state of knowledge regarding risk factors for postpartum depression and has implications for clinical practice. Health care professionals should be aware that the phenomenon is as prevalent in Asian cultures as in European cultures. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions, if needed, can be initiated in a timely fashion.
Objective. This study aims to highlight the subjective experience of an immigrant Pakistani woman during postnatal depression (PND), with a special emphasis on the husband's knowledge and behaviour towards PND.
Methods. A face-to-face interview was conducted with a woman reporting symptoms of depression on the fourth day after delivery. She was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV)(1) and the Edinburgh Postnatal Depression Rating Scale (EPDRS).(2) The evaluations were completed by a qualified psychiatrist. The demographic information, personal and family medical history and attitude towards the child were the principal issues recorded. In addition, five items were used to evaluate the husband's knowledge about PND. The EPDRS differences before and after counselling were evaluated using a student t-test.
Results. The patient was 32 years old and this was her first experience of delivery by Caesarean section. The evaluation for depression confirmed the diagnosis of PND and she scored 16 on the EPDRS. The husband's knowledge of PND was poor.
Conclusion. This case study suggests that lack of social support and understanding appear to play a vital role in the persistence of symptoms of PND among new mothers. Therefore, counselling of couples may be an effective additional tool in treating PND.
Introduction : Human displacement during disaster would cause women and their dependent children to be particularly vulnerable. Yet, women failed to make their voices heard. Thus their needs, priorities and perceptions would not be identified which in turn could hinder an effective emergency response and a full recovery process.
Objective : This paper provides a general overview of problems and issues experienced by women and their dependent children during the Johore flood disaster. With this information, relevant agencies shall focus, among other considerations, on the special needs of women and children in planning and carrying out emergency responses in the future.
Methodology : This paper was written based on data and information obtained from the Johore Flood Disaster Report and observations made by the health teams on the flood victims throughout the flood period.
Findings and Discussions : Pregnant mothers with 36 weeks of gestation or more were evacuated from their homes to the health centres or hospitals when the Johore flood disaster struck. Regular maternal and child health (MCH) services were conducted at the flood relief centres. Despite the efforts by health care providers, we observed women facing some unique issues and problems. These include: 1) Effects of loss of security and protection; 2) Disruption of social relations and privacy; 3) Inadequate supply of basic items and; and 4) Economic disruption. Recommendations for future relief work are: i) Predisaster planning for emergency response must engage and involve women representatives. Women must also be recruited as emergency and relief workers; ii) Assessment of predetermined capacity of identified relief centres with gender consideration for evacuees must be done; iii) All relief centres shall have physical partition between families. Breast feeding room with access to clean water should also be provided; iv) Gender, cultural and religious sensitivity with regards to social protection and relations shall be observed at all times; v) Women should engage and be made occupied with suitable activities to encourage healthy social interaction thus avoiding feelings of boredom and helplessness; vi) Basic personal items for women and adolescent girls, such as sanitary towel and undergarments, and places to wash and hang them in privacy must be provided; vii) Elderly women may have to temporarily stay at unaffected relatives’ or old folk homes throughout the disaster period, and; viii) No smoking policy shall be enforced at all times in flood relief centres.
Conclusion : Women and their dependent children have been recognised as one of the vulnerable groups during disasters. Thus, women shall be empowered as partners in formulating any emergency response plan so that together they would be able to complement all disaster mitigation, relief and recovery efforts in amore effective manner.
Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired.
Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis.
Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p
Gestational breast cancer (GBC) or pregnancy-associated breast cancer was defined as breast cancer diagnosed during pregnancy and within 1 year of delivery. Breast cancer is the second commonest cancer after cervical seen in pregnancy and lactation. Nevertheless, the incidence is low and accounts for approximately 1 in 3000 of pregnancies. A delay in diagnosis is common and 70% to 89% of patients with operable primary lesions already have positive axillary lymph nodes. Breast cancer identified during pregnancy can be extremely distressing for the mother despite it has similar course of disease and prognosis seen in non-pregnant women of the same age and stage of disease. Diagnostic and treatment options should be carefully decided to prevent further harm to the mother or any potential risk to the developing fetus.
Postnatal depression is common and affects 10-15% of postpartum women. While there are many studies on the depressive episode in the postnatal period, its association with the bipolar spectrum disorder is often go unrecognized and undiagnosed.
Objective: To study the rate of bipolar spectrum disorder in mothers presented with postpartum depression and its associated factors.
Method: This is a cross sectional study on the women who visited the postnatal clinic in University Malaya Medical Centre. Subjects who consented were asked to complete a short questionnaire looking at the socio-demographic details and asked to answer the Multidimensional Scale of Perceived Social Support (MSPSS), Mood Disorder questionnaire (MDQ) and Edinburgh Postnatal Depression Scale (EPDS) whish assess the perceived social support and mood disorder.
Result: A total of 93 women were recruited into the study. Independent t-test and stepwise regression analysis identified that unemployment and baby with health problem were the only associated factors for postnatal depression. 28.6% of the mother with possible postnatal depression (EPDS = 12) might have bipoar spectrum disorder (MDQ = 7).
Conclusion: Postnatal depression as part of bipolar spectrum disorder needed additional attention. Postnatal check with screening tools may help to identify mood disturbance in postpartum women
Study site: Postnatal clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The exclusive breastfeeding rate in Malaysia is very low. However in recent years the awareness of breastfeeding among mothers has increased. A preliminary qualitative research was carried out on these motivated mothers. The objective of this study was to understand the challenges encountered by breastfeeding mothers and to explore the support and motivation received by them. Information from the motivated mothers was obtained from focus group discussion. Some obstacles faced by the mothers were lack of knowledge on breastfeeding and lack of support from health professionals, parents and siblings. Facilities to express breast milk while at work were not readily available. The main motivation to breastfeed came from the mother herself and support from the husband. A holistic approach must be used to help mothers to continue breastfeeding. This includes breastfeeding promotion and education, setting up more Baby Friendly Hospitals, availability of breastfeeding support groups and provision of enough breastfeeding facilities at work and public places.
It is important to provide effective postoperative analgesia following a Caesarean section because mothers wish to be pain-free, mobile and alert while caring for their babies. The role of regular oral diclofenac as postoperative analgesia was evaluated in a randomized controlled study and it was compared to the established method of parenteral pethidine. Forty healthy women scheduled for elective Caesarean section under spinal anaesthesia with 2-2.5 mg of heavy bupivacaine 0.5% were randomized to receive either 75 mg of oral diclofenac twice daily or 1 mg/kg of subcutaneous pethidine every 8 hourly. Efficacy of pain relief (visual analogue score), patients' satisfaction and side effects such as sedation, nausea and vomiting were recorded for three days. The demographic variables were similar in both groups. Pain relief was adequate and comparable in both groups with similar mean visual analogue score during the second and third day of the study period. However, on the first postoperative day, 60% of the diclofenac group population required rescuemedication consisting of subcutaneous pethidine in order to achieve the same pain scores as those in the pethidine group who did not require any rescue medications. Women who received oral diclofenac reported lower sedation and higher overall satisfaction. The incidence of nausea and vomiting was similar in both groups. This concluded that although oral diclofenac 75mg twice daily may not be superior to the traditional method of subcutaneous pethidine for pain relief following caesarean section, it can still be used alone as an alternative, as it has other benefits of a non-opioid analgesia.
Introduction: The aims of this study were to assess the differences in the percentages of abnormal morphology between the epididymal and testicular spermatozoa of mature male offspring mice whose mothers were injected with various doses of lead acetate during gestation. Materials and Methods: Seventy two healthy female mice were divided into three major groups according to the number of injections involving 1, 2 or 3 injections at 8th day; 8th and 13th days; and 8th, 13th and 18th days of gestation period, respectively. Each major group was subdivided into four minor groups according to the dosage of lead administered (0, 25, 50 and 100) mg/Kg. Results: The percentages of abnormal morphology of epididymal and testicular spermatozoa were studied and the data were statistically analyzed. The results of this study proved that an increased number of injections and/or dose of lead acetate injected to the mothers during gestation cause an elevation in the percentage of abnormal morphology of both epididymal and testicular spermatozoa of the male mice offspring. Conclusion: In conclusion this study demonstrated that lead acetate when exposed prenatally have toxic effects on the sperm in the offspring male mice resulting in abnormal morphology of spermatozoa. The most likely causative factor is disturbances in the phase(s) of spermatogenesis and/or spermiogenesis.
The advantages of breastfeeding have been well established. The objective of this study was to determine the practice and knowledge of breastfeeding in an urban com-munity and identify the influencing factors. This is a cross-sectional study. All mothers attending the Maternal and Child Health Clinic during the study period, who fulfilled the selection criteria, were included in the study. The mothers were interviewed using a self administered questionnaire. A total of 162 mothers participated in the study. The prevalence of initiating breastfeeding during the first week after childbirth was 93.8%. Breastfeeding was found to be higher among Malay mothers (p value
Study site: a Child Health Clinic in Cheras Baru, Kuala Lumpur
To determine why HPV vaccination uptake is low in Asia, we surveyed attitudes, knowledge and communication about cervical cancer and HPV vaccination amongst 480 physicians and 1617 randomly selected urban mothers who could afford HPV vaccines in Korea, Malaysia, Taiwan and Thailand. HPV vaccine rejection by mothers was linked with poor knowledge and low perceptions of self-relevance. Physicians' likelihood of raising the subject and/or recommending vaccination was linked to how proactively they advocate preventive health, their attitude to the subject's sensitivity and their knowledge levels. Because most Asian mothers seek doctors' advice and prefer them to take the initiative, physicians should be more proactive in discussing and recommending HPV vaccination.
We describe a chromosome 6 uniparental disomy (UPD6) in a boy, discovered during a screening for the genetic cause of cleft lip and palate. In the medical literature, almost all documented cases of UPD6 are paternal in origin, and only four were maternal. We present here a report of complete maternal chromosome 6 uniparental heterodisomy. Haplotype analysis was performed using highly polymorphic short tandem repeat (STR) markers that span both arms of chromosome 6. Analysis of these markers revealed the presence of two maternal alleles but no paternal allele, indicating an instance of maternal uniparental heterodisomy. Chromosome analysis of peripheral blood lymphocytes confirmed a normal male karyotype. Advanced maternal age at the time of the infant's birth and heterodisomy of markers around the centromere favors a meiosis-I error. No specific phenotype has been reported for maternal UPD6. Therefore, the cleft lip and palate in the present case probably occurred due to other risk factors. This report provides further evidence that maternal UPD6 has no specific clinical consequences and adds to the collective knowledge of this rare chromosomal finding.
There is a need to identify the knowledge that mothers have about breastfeeding to help promote it. Therefore, it is important to develop a valid and reliable questionnaire to provide useful and comparable data about breastfeeding knowledge. The objectives of this study were to determine the reliability and validity of a Malay version of a questionnaire assessing breastfeeding knowledge and describe the breastfeeding knowledge level among respondents.
In Malaysia, the National Breastfeeding Policy recommends exclusive breastfeeding for the first six months of life and continued up to two years. Since the 1990s, several breastfeeding promotion programmes had been implemented in the country. This article reports the findings on the prevalence of breastfeeding practice from The Third National Health and Morbidity Survey (NHMS III) which was conducted in 2006. A total of 2167 mothers or carers of children below two years old were interviewed representing 804,480 of the estimated population of children aged below 2 years in Malaysia. Respondents were asked whether various types of liquid or solid food were given to the child at any time during the preceding 24-hour period. The overall prevalence of ever breastfed among children aged less than 12 months was 94.7% (CI: 93.0 - 95.9). The overall prevalence of exclusive breastfeeding below 6 months was 14.5% (CI: 11.7 - 17.9). Prevalence of timely initiation was 63.7% (CI: 61.4 - 65.9) and the continued prevalence of breastfeeding up to two years was 37.4% (CI: 32.9 - 42.2). The findings suggest that the programmes implemented in the last ten years were effective in improving the prevalence of ever breastfeeding, timely initiation of breastfeeding and continued breastfeeding up to two years. However, the challenge is to improve exclusive breastfeeding practice. Longterm community-based interventions need to be carried out in partnership with the existing health care system, focusing on discouraging the use of water and infant formula, especially in the first few months of life.
Study name: National Health and Morbidity Survey (NHMS-2006)