The hemoglobinopathies include all genetic diseases of hemoglobin (Hb) and fall into two main groups: the thalassemias and structural hemoglobin variants (abnormal hemoglobins). Thalassemia is a public health problem in Malaysia. About 4.5% of the Malays and Chinese are β-thalassemia carriers. We performed hemoglobin analysis on a total of 499 patients from a Government Hospital and Health Clinics in the state of Perlis, Malaysia. About 91.4% of the patients were Malays. All patients had microcytic hypochromic anemia except for a few who went for thalassemia screening. Female patients outnumbered male patients in the ratio of 3.5:1. About 75.7% of the female patients were of childbearing age (17 - 40 years) and a majority of them were there for their antenatal checkup. Using our screen tests (full blood count, high performance liquid chromatography (HPLC), and agarose gel electrophoresis), the common hemoglobinopathies detected were HbE trait (19.3%), β-thalassemia trait (14.6%), HbH disease (1.8%), Hb Constant Spring (1.6%), Homozygous HbE (1.4%), and HbE- β-thalassemia (1.4%). Thalassemia is preventable through screening and education programmes, and prenatal diagnosis. Thalassemia screening is provided free of charge at various government hospitals and health clinics throughout the country.
Key words: Hemoglobinopathies screening, β-thalassemia trait, HbE trait, Thalassemic diseases
The compulsive behaviour of observing an unsuspecting person undressing or being naked in voyeurism may be related to Obsessive-Compulsive spectrum disorder. The aim of this paper is to report a case that reiterates a unique psychopathology of a Malaysian male voyeur with an obsession on female body parts. This 35 year-old voyeur man who attended psychiatric outpatient clinic in an academic medical centre presented to a psychiatrist for taking photos of his sisters' naked bodies and collected nails and hairs from their body, coded them with intend for masturbation. His voyeuristic thoughts and urges which came repeatedly and intrusively, involving attempts to resist them and was associated with an inner tension for the urges to be fulfilled. He responded both to Paroxetine and behaviour therapy. The possibility that voyeurism, a paraphilia can manifest itself as a subtype of OCD is discussed. Keywords: Malaysian voyeur, obsession-compulsive spectrum disorder, body parts
1829 school-boys of Singapore comprised of 849 Chinese, 469 Malays and 511 Indians were investigated for the incidence of red-green colour-blindness with Ishihara's plates. The incidence of red-green colour-blindness was found to be 3.8%, 4.5% and 4.5%, respectively in Chinese, Malay and Indian boys. The incidence among the different dialect groups was variable with the highest incidence of red-green colour-blindness among Mandarin speaking group (14.3%), followed by Hainanese speaking (6.7%) and other dialect groups of Chinese (2.8% to 4.5%). The incidence of red-green colour-blindness was higher in the older boys compared with the younger boys when all the three ethnic groups are combined.
Body image plays an important role in the management of body weight, especially among female adolescents. This study examined the differences in body image perception, weight management knowledge, eating behaviour and physical activity between overweight and normal weight Malaysian female adolescents. Body mass index screening was done on 588 secondary school students to identify overweight (OW) and normal weight (NW) subjects. A BMI-for-age of => 85th percentile and between => 5th and <85th percentile were used as cut-offs for identifying suitable subjects of overweight and normal weight, respectively. Fifty girls identified as being OW were matched for age and ethnicity with 50 NW students. Subjects completed a self-administered questionnaire on demographics, eating behaviour and physical activity, a weight management knowledge inventory (WMKI) and the Body Silhouette Chart. The study sample comprised Malays (40%), Chinese (30%) and Indians (30%) with a mean age of 14.76 ± 1.15 years. The majority of them were from families with a monthly household income of less than RM1,000. Significantly more NW subjects (χ2=6.112, p=0.013) than OW subjects had incorrect perception of their current body weight status. The WMKI revealed that more OW subjects (64%) than NW subjects (52%) had a low level of weight management knowledge. Eating behaviour patterns were not significantly different between OW and NW subjects, but more OW subjects skipped one or more daily meals as compared to their NW counterparts (χ2=0.174, p=0.010). Physical activity patterns were similar in both groups. Healthy eating and physical activity promotion programmes in schools should include sound weight management practices.
Questionnaire: Figure Rating Scale of Stunkard; Weight Management Knowledge Inventory (WMKI)
The objective of this paper is to assess the perception of bodyweight status among the office workers in two government departments in Kuala Lumpur. A total of 385 Malay workers aged between 18 to 55 years were randomly selected from the Prime Minister’s Department and the Ministry of National Unity and Community Development. The weights and heights of all subjects were measured and their Body Mass Index (BMI) determined. In this study, obesity is defined as individuals having ï‚³ï€ 25 kg/rn 2 . A questionnaire was prepared to obtained information on socioeconomic status, health aspects, dietary intakes, activity levels and perception on bodyweight status. The study revealed a high prevalence of obesity (38.1 %) and among the obese subjects, 21.7 % perceived themselves as having normal weight. The normal weight and underweight subjects perceived themselves as obese (33.5 % and 6.3 % respectively). A small percentage (5.7 %) of the obese individuals who perceived themselves as obese did not wish to lose weight. In contrast, 9.7 % of the normal weight subjects who perceived themselves as having normal weight wanted to lose weight. A third person’s perception on the subjects’ bodyweight status is significantly associated with the subjects’ bodyweight status (P
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.
Introduction : Johor Bahru has one of the highest rates of dengue disease in this country in spite of the implementation of COMBI (Communication for Behavioural Impact) in 2001.
Methods : To identify factors contributing to this problem, a case control study was conducted, focusing on risk factors such as the weather (rainfall and temperature), environment and sociodemography. Cases were selected from confirmed dengue cases from January to June, 2006. Controls were selected from patients who had no past history of having dengue illness from Health Clinics in Johore Bahru. Both case group and control group were matched by age and sex. All risk factors were analysed using SPSS version 11.5.
Results : Results from time-series analysis indicated that the cases of dengue illness were related to changes in the minimum temperature (r =-0.149; p
Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia.
Bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.
Leisure participation in old age is often a continuation of their participation at younger age. This study aims to explore the association between current and former leisure participation of the elderly. Methods: A cross-sectional survey was conducted among 268 persons aged 60 years and above, purposively selected from eight health clinics in Selangor. Current leisure participation was measured using a validated Leisure Participation Questionnaire (LPQ), specific for Malaysian elderly. The LPQ consists of 25 activities, categorized into recreational (physical), cognitive, social and productive activity. Frequency of participation in each activity was measured on a 6-point scale. Leisure participation at younger age only involved their general participation in leisure. The most common daily leisure activities were having conversations while relaxing (78.7%) and watching television (74.6%), while the least were from playing golf (0.01±0.12) and performing musical instruments (0.04±0.36). More than half (64.9%) reported being actively involved in any leisure
activity at younger age. Results: The study found there was a significant association between former and current leisure participation, especially for cognitive (t=-2.45, p=0.015), social (t=-2.68, p=0.008) and productive (t=-2.89, p=0.004) activities. However, only productive activity involvement was predicted by their leisure participation while younger (B=1.304, p=0.027). Conclusion: The findings suggest the importance of considering active intervention programmes at younger age to ensure better leisure participation of the elderly, especially in recreational physical activity.
Objective: Truancy is a disciplinary problem, which frequently occurs among school students and it has many contributory as well as inter-related factors. It is a growing problem in this country and it often becomes a prelude to other delinquent behaviours. The study objective is to determine the prevalence of truancy as well as factors related to it including psycho-behavioural factors. Methods: A cross-sectional study involving 556 Malay student’s selected using multi-stage sampling was conducted. Results: The overall prevalence of truancy is 30.2%. The predictors to truancy are age, students who frequenting entertainment centre, students who have not completed Quran recital, coping strategies using problems solving methods and time spent watching television/video. There is a significant association between truancy and psycho-behaviour such as watching video/internet pornography, frequenting entertainment centre, smoking, motorcycle racing and dating a special friend. Conclusion: Truancy is a social issue, which must be given serious attention by all concerned components of the society.
Introduction: Anemia in pregnancy is still a public health problem in developing countries including Malaysia. Early screening of pregnant mothers who have risk factors of anemia could help identifying these potential anemic mothers and hence targeted for intervention.
Methodology: A cross sectional study IN 2008 was conducted among pregnant women who attended government health clinics in Johor Bahru district to assess the prevalence of anemia in pregnancy and factors associated with it using a structured questionnaire.
Result: Prevalence of anemia in pregnancy (Hb<11.0 g/dl) was 36.6% and majority in mild category (Hb 9-<11 g/dl). The associated factors of anemia in pregnancy were birth spacing, dietary intake with high iron content and iron pill consumption. Multivariate analyses revealed that iron pill intake was the most important factor influencing anemia in pregnancy.
Discussion and conclusion: Even though Johor Bahru is a big town with good health facilities, the prevalence of anemia in pregnancy was quite high. Results were compared with previous studies. Emphasis on compliance to iron pills is very important in prevention and treating anemia in pregnancy
Key Words: anemia in pregnancy, birth spacing and iron pill intake
Study site: Four urban and two rural klinik kesihatan, Johor, Malaysia
Background: Circumcision though not mentioned in the Quran is believed to be a compulsory practice among the Muslims. In Malaysia, although there are several methods of circumcision available and traditional circumcision is still popular.
Methods: A cross-sectional survey was carried out in a small fishing village of Kedah to study the methods of circumcision available to the villagers. This was followed with an in-depth interview conducted with ‘Tok Mudim’, a practitioner of traditional method of circumcision.
Results: Forty three of the eligible 71 subjects participated in the study giving the response rate as 60.5%. The most common age for circumcision was 9 years old. Despite private clinics being the most common place of circumcisions, there was an increasing number of boys going to the ‘Tok Mudim’ for circumcision. A Mass Circumcision Ceremony is traditionally practiced. The ‘Tok Mudim’ described the procedure in detail and was of the opinion that the reason traditional method is still popular was because of the fear of injections and impotency among the parents. Most common complication faced by the ‘Tok Mudim’ was bleeding and infection.
Discussion and Conclusion: Till the community shifts entirely to using modern medicine, there is a need to integrate traditional practitioners into the system. Training the ‘Tok Mudim’ to use modern instruments and aseptic techniques should be considered.
Background: All healthcare services are moving towards quality management system including ISO 9000 due to pressure from various stakeholders involves and also to improve healthcare quality. The objective of this study was to measure the satisfaction level among the outpatients in ISO Certified Klinik Kesihatan Bandar Baru Bangi, Selangor. Also to identify the relations of patient’s satisfaction with the sociodemographic factors and service dimensions such as general satisfactions, technical quality of clinic staffs, interpersonal aspect of clinic staffs, time with doctors, communications with clinic staffs and availability/accessibility of clinic.
Methodology: A cross sectional study was carried out from February 2008 to Jun 2008 and a total of 240 respondents in the clinic were selected using universal sampling. Only those who are Malaysians aged 18 and above and complied with the inclusions criteria’s were selected as the respondents to fill up the Patient’s Satisfaction Questionnaire III.
Results: The study found that the satisfaction level of the respondents in Klinik Kesihatan Bandar Baru Bangi, Selangor were remarkable with 78.8%.It has been shown that the predictor factors of total patient’s satisfaction were general satisfaction (AOR=5.06, CI= 1.51-16.96), technical quality of clinic staff (AOR = 3.09, CI= 1.13-8.43), interpersonal aspect of clinic staff (AOR = 2.96,CI= 1.04-8.42), availability/accessibility of clinic (AOR = 9.38, CI= 9.37-87.95) and communication of clinic staff ( AOR=17.90, CI=3.74-85.73) with the R2 = 67.7%.
Conclusion: The satisfaction level among the respondents in Klinik Kesihatan Bandar Baru Bangi, Selangor were remarkable with percentages of 78.8%. The study has shown that service dimensions factor influenced the patient’s satisfaction such as general satisfaction, interpersonal aspect of staff, communication of staff, technical quality of clinic staff and availability/accessibility of clinic. It could have also been contributed by the implementation of ISO and it can only be confirmed by carrying out a comparison study of patient’s satisfaction in clinics with and without ISO certification.
Study site: Klinik Kesihatan Bandar Baru Bangi, Selangor, Malaysia
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Improvement in the service quality system of health clinics in Malaysia had increase with the increase of national development. However, customer dissatisfaction towards regular service still has become an issue in the provision of health service in clinics throughout this country. This study aims to identify factors that influence customer satisfaction such as sociodemographic factors of patients, the location of clinic (rural or urban) and the most important SERVQUAL dimensions in determining customer satisfaction. This study conducted in October and November 2008 in Hulu Langat District. SERVQUAL questionnaires were used. Probabilistic sampling was used for the selection of respondents and the number of samples for each clinic was based on the workload of the clinic. Overall, the results showed that there are differences in levels of customer satisfaction between urban clinic (25.8%) and rural (30.7%). The most critical service quality dimensions for urban clinics are the responsiveness and reliability dimensions with a mean value of -0.7018 and -0.7434. Responsiveness, existence and reliability are the weakest quality service dimensions (mean -0.6317, -0.6718 and -0.6028) in rural clinics. It was found that customers’ ethnicity and education affect customer satisfaction in both the urban and rural clinics. Gender and type of work are factors that affect customer satisfaction only in urban clinics. Overall customer satisfaction at health clinics in Hulu Langat District is low. The difference between urban and rural clinics show the customers' needs in the area is different.
Key words: Customer satisfaction, SERVQUAL, health clinics, services.
Misuse of alcohol among adolescents, particularly schoolchildren has become one of the public health concerns in Malaysia due to its serious effects and an increased risk of alcohol related injuries, especially motor vehicle injuries. This is the most common type of youthful fatal injury in Malaysia. However the availability of data on the extent of alcohol abuse particularly among school children in this country is limited. Therefore, we conducted this study with the objectives of identifying the prevalence of alcohol drinking among school children in Kuala Lumpur, factors rekited to alcohol drinking among the adolescents and to assess health status of their parents through the presence of any related alcohol diseases and the habits of alcohol drinking among their parents.
In this baseline study a two stage stratified sampling design was used to recruit 8532 eligible students from the selected secondary schools in Kuala Lumpur. The prevalence of alcohol drinking was 9.0% (771 / 8532) . Significant factors identihed related to alcohol consumption were akoholic father (OR=1.29), akoholic mother (1 .55) ; elder siblings consume alcohol (2 .49) and the Chinese ethnic group (1 .55) . The study revealed that factors which signihcantly contributed to the habit of alcohol drinking were related to whether their parents consumed alcohol or not or either their eMer siblings were ako taking alcohol. Therefore, the, results from this study could be used as a baseline data to describe the level of alcohol consumption among adolescents particularly school children. Ehfective public health interventions that focus on the familial context of adolescents' drinking habits may be developed.