Malaysia enjoys a comprehensive range of health services, the government being committed to the principles of universal access to high quality health care, which the Ministry of Health provides through a wide variety of nation wide network of clinics and hospitals. One of the major problems is the availability of comprehensiveness and quality of health care in remote health centres. When patients are transferred from the health centres to the hospitals for further treatment, this not only incurs inconvenience to the patients and their family but also increases the cost to the health care system. Teleprimary care is one of the tools to overcome this problem. The doctors in the remote clinics are able to discuss the problem cases through teleconsultation with the doctors and specialist in the hospitals using an audiovisual system to provide better care in the health centers without transferring the patients to the hospitals. Only the essential and needy patients are referred to the hospitals. This has not only reduced the number of patients referred to the hospitals but it has reduced the cost to the health care system. It has also provided a more comprehensive care to the patients in the health centres. The doctors in the health centers are also provided training and are also updated on the latest in medicine. This method of training has made doctors in the health centers more efficient and satisfied.
Matched MeSH terms: Rural Health Services/manpower; Rural Health Services/standards
Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, et al.
ISBN: 0-7326-0959-3
Citation: Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, Rosenblatt R, Rourke J, Strasser R, Wainer J. WONCA Policy on Rural Practice and Rural Health. Traralgon, Victoria, Australia: Monash University School of Rural Health; World Organisation of Family Doctors (WONCA), 2001
Citation: Awin N. A Review of Primary Health Care in Malaysia. A Report for the World Health Organization Western Pacific Region. Manila: World Health Organization Western Pacific Region; 2001
The concept of primary health care (PHC) according to WHO has been implemented in Malaysia since 1978. The rural health centres which provide the primary health care have developed from about 47 in 1970 to about 772 in 1998. Since the implementation of the health centres there has been significant reduction in morbidity and mortality rates. However due to the emerging issues like changing demographic 'patterns, changing pattern of disease, and increasing demand from the public, the delivery of PHC is being reviewed. Newer programmes and review of the older programmes are being done to address the provision of PHC in the 21st century. The functions and roles of the existing staff in the health centres are being reviewed. This new concept is known as expanded scope of primary health care. The purpose of this paper is to explain the achievements in primary health care and the components of primary health care in the expanded scope.
People in 5 Orang Ulu villages in Sarawak, Malaysia were tested for rickettsial infection by Weil-Felix reaction and by indirect immunoperoxidase reaction. Of those surveyed 9.6% were positive for typhus. Of the positives, 3.8% were positive for tick typhus (7/11), scrub typhus (4/11) or endemic typhus (1/11). The incidence of typhus was higher among semi-nomadic Penans compared with the settled Kayans.
A serosurvey was conducted in 1995-97 among 1596 febrile patients from 8 health centres in Malaysia for antibodies against Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) by using an indirect immunoperoxidase assay. A total of 51.4% patients had antibody against at least 1 of those rickettsiae. Antibody to SFGR was most prevalent (42.5%), followed by RT (28.1%) and OT (24.9%). The seroprevalences of antibodies to SFGR, RT or OT alone were 12.4, 3.6 and 4.3%, respectively. Antibodies against more than 1 species of rickettsiae were presence in 31.1% of the patients, suggesting the possibility of co-infection, previous exposures or serological cross-reactivities. Seroprevalence of the various rickettsiae varied according to locality, with SFGR antibodies being the most prevalent in most areas. There was no significant association of prevalence of rickettsial antibody with gender. The seroprevalence of OT, SFGR and RT increased with patient age but an increase of antibody titre with age was not significant. Those working in the agricultural sectors had significantly higher seroprevalence of OT, SFGR and RT than those not related with agricultural activities. Scrub typhus remains a public health problem with an estimated annual attack rate of 18.5%. Tick typhus and murine typhus as shown in this serosurvey appear much more widespread than scrub typhus in this country.
Matched MeSH terms: Rural Health/statistics & numerical data
A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.
A study of the prevalence and intensity of soil-transmitted helminthiasis among pre-school children aged 0 to 7 years from an Orang Asli village resettlement scheme in Gua Musang, Kelantan was undertaken. The overall prevalence of soil transmitted helminthic (STH) infections was 56.0%. The predominant helminth found was Ascaris lumbricoides while the commonest type of infection was a mixed infection with Ascaris lumbricoides and Trichuris trichiura. The prevalence rates of Ascaris, Trichuris and hookworm infections were 47.5%, 33.9% and 6.2% respectively. The intensity of Ascaris infections were 64.5% light, 27.3% moderate and 8.3% heavy whilst the intensity of Trichuris infections were 80.5% light, 18.3% moderate and 1.2% heavy. However, the intensity of hookworm infections were 86.7% light, 13.3% moderate and no heavy infection. The prevalence of helminthiasis (STH) shows an-age dependent relationship, with the lowest prevalence in 0-< 1 year age group and highest in the 6-< 7 year age group.
Seven members of a 15-man U.S. military team that had operated in rural Malaysia developed an acute illness consisting of fever, myalgias, bronchospasm, fleeting pruritic rashes, transient lymphadenopathy, and subcutaneous nodules associated with eosinophilia, elevated erythrocyte sedimentation rate, and elevated levels of muscle creatinine kinase. Sarcocysts of an unidentified Sarcocystis species were found in skeletal muscle biopsies of the index case. Albendazole ameliorated symptoms in the index case; however, his symptoms persisted for more than 5 years. Symptoms in 5 other men were mild to moderate and self-limited, and 1 team member with laboratory abnormalities was asymptomatic. Of 8 team members tested for antibody to Sarcocystis, 6 were positive; of 4 with the eosinophilic myositis syndrome who were tested, all were positive. We attribute this outbreak of eosinophilic myositis to accidental tissue parasitism by Sarcocystis.
Anopheles mosquitos were surveyed using three trapping technics in four longhouse settlements and their respectively farming zone in western Sarawak, Malaysia. The study area was mountainous with tropical rain forest. An. leucosphyrus and An. donaldi were predominant in the farm huts. An. tessellatus and An. subpictus were more abundant in the village settlements. In both ecotypes, human baited traps yielded a significantly greater proportion of Anopheles mosquito than CDC light traps and landing biting catches. Circumsporozoite antigen positively rate, mosquito survival rate and parasite rate showed that malaria transmission is more intense in farm huts than in longhouse settlements. The entomological inoculation rate of An. donaldi and An. leucosphyrus in farm huts was 0.035 and 0.023, respectively. No sporozoite infections were observed in the main settlements.
A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the East Coast of Malaysia. The findings indicated that the mean intakes of energy and all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, excepts for protein and vitamin C. Nutrients most likely to be inadequate were vitamin A, thiamine, riboflavin, niacin and calcium, with more than 50% of the subjects having estimated intakes of below 2/3 of the recommendations. However, vitamin A status was adequate, with only 2 subjects being biochemically deficient (plasma retinol < or = 0.7 mmol/l). Approximately a third of the subjects had hypoalbuminaemia (plasma albumin < 3.3 g/dl) and anaemia (Haemoglobin < 12 g/dl for men; < 13 g/dl for women). Riboflavin deficiency, as assessed by an erythrocyte glutathione reductase activation coefficient (EGRAC) of more than 1.35 was identified in 77% of the subjects. The prevalence of vitamin E deficiency (plasma a-tocopherol < or = 12 mmol/l) was 27%, with men being at a greater risk. In conclusion, the dietary intakes of these rural elderly Malays was inadequate. Over three quarters of the sample were biochemically deficient in riboflavin, the functional consequences of which need to be further investigated.
The Obstetric Flying Squad (OFS) has been operating in Peninsular Malaysia for over three decades. In the light of current controversies regarding its role in modern day obstetric practice, its status in Malaysia over the last 12 years is reviewed.
Matched MeSH terms: Rural Health Services/organization & administration*
A community study was carried out to evaluate the efficacy of a 3-day course of 400 mg albendazole daily in the treatment of Trichuris trichiura and Giardia intestinalis infection. This treatment regimen was effective in the treatment of Trichuris trichiura and Giardia intestinalis infection with cure rates of 91.5% and 96.6% respectively. Uses of a 3-day course of 400 mg albendazole daily should be considered in mass or targeted soil-transmitted helminths chemotherapy particularly in areas where the prevalence of Trichuris trichiura is high and polyparasitism is common.
The intestinal parasites of schoolchildren from an urban and a rural area on Penang island, Malaysia were compared. Examination of stool samples for helminth eggs showed that helminths found were Trichuris, Ascaris and hookworms. The results indicate that there is no significant difference (p<0.05) between rural and urban schoolchildren as regards to the prevalence of the three species of helminths. An extensive control program targetted at schoolchildren to monitor the helminth problem on the island is suggested.
The present study aims to compare the family's social environment, social supports and mental health of Malay women from rural and urban areas. Equal number (n-184) of Malay women from similar socio-economic back grounds were chosen from the rural areas of Kedah and urban areas of Pulau Pinang using the stratified random sampling method. The results indicated significantly higher level of mental health problems among the rural respondents when compared with the urban subjects. Among the family related variables included in the present study, cohesiveness, moral religious emphasis and organization and intellectual and cultural orientation were found to be significantly associated with the mental health problems of rural respondents. Whereas, only one variable, namely, active recreational orientation was found to be having an impact on the mental health of urban respondents. Similarly, deficiencies in the social support perceived from family and other members of the community were found to be significantly associated with the mental health problems of rural samples when compared to the social support perceived from the others for the urban subjects. The implications of these observations are discussed.