This article examines the numerous problems faced by primary health care in Malaysia, care that traditionally has been a private sector activity. While general practitioners have adapted, and are continually adapting, to the needs of a multiracial society with diverse cultural patterns, it is hoped that with the emergence of a dynamic discipline of family practice, family doctors will be able to provide a sophisticated form of primary health care that will serve the needs of the people.
Matched MeSH terms: Health Services Needs and Demand*; Health Services Research*
Citation: Kasah A. Country report on nutrition communication activities in Malaysia. Kuala Lumpur: United Nations University; 1988
The primary health-care approach in Malaysia is an integral part of the government community development movement, or Gerakan Pembaharuan (Operation Renewal), launched in 1972. Nutrition communication activities form a major component of the existing basic health services. The activities are channelled through various health and nutrition services. Group talks, cooking demonstrations with group discussions, individual advice in clinics, and home visits are provided through maternal and child health services. The health education unit is responsible for producing educational materials such as posters and leaflets at both national and state levels. Health education mobile units, fully equipped with audio-visual aids, provide films and slide shows, arrange talks and dialogue sessions, and distribute leaflets. A mass media programme using radio and television was introduced in July 1983 as a joint effort of the ministries of Health and Information. The messages include a wide range of health and nutrition information. Health education materials are used extensively and local radio broadcasts will be utilized to overcome dialect problems. The applied nutrition programme started in 1969 uses an intersectoral approach towards PHC. Four main ministries are involved, namely, Health, Agriculture and Rural Development, Education, and Information. Health and nutrition education is one of the main tasks. Nutrition surveillance is also used as a channel for nutrition communications. In addition, both formal education, such as that provided in nursing schools, and in-service training for health personnel are being conducted by various training schools. The present trend of the health service is shifting from a clinic-based to a community-based approach, in which health staff work closely with community leaders. Attempts to encourage more active community participation in health activities are being made through committee meetings on development at the village and district levels.
The present study analysed the records of 342 elderly subjects aged 55 years and above of different ethnic groups to ascertain the types and level of their unperceived dental needs. The overall percentage of unperceived needs was highest among the Malays (96.1% or 74/77 subjects) and among the men (88.5% or 139/157 subjects). The unperceived need for prosthetic treatment was highest among the Malays and Chinese as well as among women, whereas the unperceived need for treatment for periodontal disease was highest among the Indians. The data for unperceived needs for prosthetic treatment as well as for treatment for caries and periodontal disease were somewhat similar among men. Within each ethnic group, variations among sex in the unperceived needs for the various dental symptoms were also noticeable. Further research is indicated to ascertain the role of traditional and cultural concepts and dogmas in determining the importance attached to the various dental health symptoms within each ethnic group.
Matched MeSH terms: Health Services Needs and Demand*; Health Services Research*
A study based on the WHO model of community-based rehabilitation in Guangzhou City, China, is described. Preliminary epidemiological data are reported, and compared with analogous data from Korea, Vietnam, Malaysia, Mexico, Indonesia, and Pakistan. Confidence levels for estimates of the prevalence of limb dysfunction, visual dysfunction, hearing and/or speech dysfunction, and mental retardation are also reported.
Matched MeSH terms: Community Health Services/organization & administration
A survey of 303 six- to fifteen-year-old Proto-Malay children was carried out in Selangor, West Malaysia. The examinations were carried out using a chair-table and natural daylight. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN). The findings revealed a generally low prevalence of periodontal disease affecting only 25.08% of the sample examined. Of these, 15.72% were found to have a score of 1 (bleeding of the gingiva), while 9.36% had calculus on the tooth surface. In terms of treatment needs, 24.75% required dental health education. The relationship between these findings and the possible causes are discussed.
Matched MeSH terms: Health Services Needs and Demand*; Health Services Research*
Rosalind Benster and Judith Stanton went to Sarawak to study child health care. Their aim was to highlight areas of most need so that the tiny health budget could be channelled in the relevant directions. They found cultural and environmental differences to account for significant differences in the nutritional status of children from different tribes. They suggest remedies to this situation.
Matched MeSH terms: Child Health Services/standards*; Health Services Research*
Like dental caries, epidemiological assessment of periodontal disease is important for purposes of recognizing the extent of the disease in the population as well as a basis for planning and evaluating preventive and treatment programmes. while present day measurement methods for dental caries are excellent such is not true for periodontal diseases. This paper reviews the development and usefulness of different indices for the assessment of periodontal disease and treatment needs in epidemiological investigations.
Matched MeSH terms: Health Services Needs and Demand
This study compares the knowledge, attitudes and practice of mothers in two ethnic groups with regard to acute respiratory infections (ARI) in their child. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Most mothers were aware of the effect of frequent attacks of ARI on the health status of their child and of the importance of early treatment. Reasons for their becoming worried during an episode of ARI in their child indicated that problems of distance, transportation and arrangements for care of their other children predominate. A large proportion of the respondents felt that their present knowledge of ARI was inadequate and were thus interested in obtaining more information.
From the start of the school milk feeding programme in February 1985 to October 1986, a total of 2,766 children aged six to nine years from 12 primary schools in Ulu Selangor were followed-up for about two years. The children's weight and height were monitored at the beginning, in the middle and at the end of the study. The study shows that there is a reduction in the prevalence of protein-energy malnutrition in terms of underweight (15.3% to 8.6%), stunting (16.3% to 8.3%) and wasting (2.6% to 1.7%) from the start of the school feeding programme to two years later. Associated with this there was an improvement in the attendance rate of the children during the same period. As there was no major developmental change in Ulu Selangor during that period, it is likely that the reduction in the prevalence of protein-energy malnutrition and the improvement of the attendance rate among the children are due to the impact of the school milk feeding programme.
The mortality pattern of a subpopulation of Semai Senoi of Malaysia is studied by using a two-census method. The method yields abridged life tables for both sexes as well as an estimate of the birth rate. The life tables show that Semai mortality is reduced compared to estimates based on stable population methods for the population prior to 1969. Increased health care availability seems to account for this lower mortality.
Matched MeSH terms: Health Services; Health Services Accessibility
Citation: Manderson L. Political economy and politics of gender: maternal and child health in colonial Malaya. In: Cohen P, Purcall J (editors). The Political Economy of Primary Health Care in Southeast Asia. Canberra: Australian Development Studies Network an ASEAN Training Centre for Primary Health Care Development; 1989, p79-100
Matched MeSH terms: Child Health Services; Maternal Health Services
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.
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.
Matched MeSH terms: Health Services Needs and Demand
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.
An excess of male over female deaths is characteristic of modern national populations, whereas in some high-mortality societies female mortality exceeds that of males. Among the Semai Senoi, a Malaysian Orang Asli ("aboriginal") population, women experienced higher mortality than males in the decades before 1969. This differential occurred in all age classes older than 15 years so that the sex ratio progressively increased with age. A recent (1987) restudy of the Semai population found that sex-specific differential mortality is much reduced. A comparison of the 1969 and 1987 life tables shows a sharp shift in the sex ratios of mortality for the post-15-year-old age classes (the geometric means of age classes 15-44 were 0.768 in 1969 and 0.997 in 1987) so that male and female expectations of further life at age 15 are now nearly identical. In contrast to the best-known cases of high female mortality (mostly in South Asia), Semai sex differential mortality does not include the childhood ages. The Semai have traditionally been relatively sexually egalitarian, and sex bias in care has not occurred. Analysis of sex-specific causes of death for the pre-1969 population suggests that maternal mortality is the major cause of the excess female deaths. The reduced number of maternal deaths seems largely due to better health care, particularly the availability of hospital services. Interestingly, the reduction in female mortality has occurred simultaneously with increased fertility, and overall mortality has continued at relatively high levels (eO less than 36). Thus, rather than forming a component of a unitary demographic transition, declining sex differences in mortality can be accounted for by a specific factor, better maternal care.
Matched MeSH terms: Maternal Health Services/standards; Maternal Health Services/trends
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.