Pregnancy is perceived by many pregnant mothers as a period of happiness in anticipation of motherhood. Not all pregnant mothers experience cheerfulness as some may experience a high anxiety and depression level for unknown reasons. The purpose of this study was to determine the level of anxiety and depression among high risk pregnant women and the factors that contribute to their level of anxiety and depression. A descriptive cross-sectional study was conducted on 38 high risk mothers whose stay in hospital exceeded more than three days in the obstetric ward of Hospital Universiti Kebangsaan Malaysia. A self assessment questionnaire “Hospital Anxiety Depression scale” was used to measure the level of anxiety and depression among high risk pregnant women. Of the 38 participants, 16 (42.1%) women experienced a mild level of anxiety and 22 (57.9%) experienced a severe level of anxiety. Seventeen (44.7%) women was classified as having mild depression and 21 (55.3%) severe depression. The factors contributing to the level of anxiety and depression, include those related with “lack of information on disease”, “family matters” and “finance”. High risk pregnant women in this study experienced a significant level of anxiety and depression during their stay in hospital. It is therefore important for nurses and doctors to be aware and sensitive to the influencing factors that cause anxiety and depression as to enable high risk pregnant mothers to enjoy their pregnancy and childbirth.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The estimation of age of human foetal remains is of great medico-legal importance. When the remains are intact and fresh, various morphological features such as crown-heel length, weight, appearance of ossification centres particularly around the ankles and knees and other parameters could be used to make a reasonable estimation of the period of gestation. In cases of criminal abortion, infanticide and child murder the question of age of the foetus, viability, live birth and a separate existence become very important. In practice, often at the time of detection, the remains are decomposed or skeletonised. In such a situation the examination of developing teeth will provide a reliable answer pertaining to the foetal age, the possibility of a separate existence and even the period of survival after birth. The.age determination from dental examination is possible from approximately 10 weeks intrauterine up to old age. The presence of neonatal line (birth line) in both dentine and enamel indicates live birth and a separate existence. It is possible that the time period of survival can be estimated by measuring postnatal deposition of these hard tissues. An intact human foetus that has undergone mild to moderate putrefaction was studied. The study of the morphological features and the ossification centres suggested that its approximate age was around nine months intrauterine. It was not possible to decide whether it was a live birth and had a separate existence. The examination of the developing first deciduous molar of the mandible suggested the approximate age was around 30-32 weeks intrauterine. The importance of examination of developing teeth in foetal remains (including neonates), particularly associated with putrefaction or skeletonisation is emphasized.
Adequate nutrition is important for mothers and their offspring during and after birth. This cross sectional study was conducted to determine nutritional status and nutritional knowledge of pregnant women from two selected private hospitals in Klang Valley, Malaysia. A total of 236 Malay pregnant women aged between 20 to 45 years old (mean age 31+5 years) were recruited through convenient sampling method. Socio-demographic data, nutritional knowledge and a 24-hours diet recall were obtained through a self-administered questionnaire. Anthropometric and haemoglobin data were obtained from the antenatal records in the respective hospitals. The percentages of participants who were underweight, normal, overweight and obese before pregnancy were 12.7%, 55.1%, 25.0% and 7.2% respectively. Among those who were obese before pregnancy, a total of 59.7% had inadequate weight gain, 24.6% gained adequate weight and 15.7% gained excessive gestational weight. About 33.5% of subjects were anaemic (Hb < 11.0g/dL). The mean daily energy intake of the participants was 1748 ± 526 kcal which was 76% of RNI. Calcium (73% of RNI), folic acid (36% of RNI), niacin (89% of RNI) and vitamin D (40% of RNI). The nutritional knowledge level of subjects was moderate (51.9 ± 13.8%). Lower monthly household income (p < 0.001), educational level (p < 0.001) and gestational stage (p < 0.05) of participants were associated with a lower nutritional knowledge level. Nutritional knowledge score was positively correlated with gestational weight gain (r = 0.166, p < 0.05) and haemoglobin level (r = 0.200, p < 0.05). Subjects who claimed practising food taboos had higher nutritional knowledge score (54.9 ± 12.5%) than those who did not (49.9 ± 14.4%)(p < 0.05). A comprehensive nutrition education should be integrated in the antenatal classes to improve nutritional status of pregnant women.
Incidence patterns indicated the prominent role of genetic factors in this type of cancer. A histocompatibility leukocyte antigen (HLA) profile of A2 and B-locus antigen, Singapore 2 (Sin 2), was identified. An association between these genes and increased risk for nasopharyngeal carcinoma (NPC), was confirmed. The risk was restricted to the "co-occurrence" of A2, B-Sin 2, suggesting that the genotype predisposing to the development of NPC was the A, B-Sin 2 haplotype. Similar associations were found to exist in Malaysian and Hong Kong Chinese so the A2, B-Sin 2 phenotype is a feature common to Asian Chinese in at least three locations. Preliminary HLA studies of medium NPC incidence in Tunisians and Malays indicated that patients with NPC of both ethnic types have altered HLA antigen profiles. If the findings of a locus-B antigen deficit in Tunisians and the role of A9 with B-locus antigens in Malays can be confirmed and clarified, the histocompatibility genetic hypothesis of NPC predisposition would be substantially strengthened.
In a previous study, it was noted that "a strong desire to be held or cuddled correlated with a general leaning toward openness in emotional expression." As is well known, some cultures foster openness, while others do not. This project was designed to assess the influence of cultural attitudes on the wish to be held. To do so, questionnaires were given to five groups of Asian women living in Kuala Lumpur, Malaysia. The most striking differences found were between two groups of Chinese women, one Chinese-educated, and the other, English-educated. The Chinese-educated group inhibited the expression of sensual needs. An English education overturned the traditional mode of response; women in this group scored highest in their wish to be held and lowest in their inclination to keep their body-contact desires secret. This study demonstrates that cultural as well as psychological forces exert a profound influence on the wish to be held.
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.
We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus.
The prevalence of cleft lip and palate in human is 1 in 500 live births worldwide. Non·syndromic clefts are a complex trait with both genetic and environmental etiology. The aim ofthe study was to assess the association between maternal exposure to second-hand smoke during pregnancy and ruk of having cleft child. Unmatched case-control study was carried out among Malays in Kelantan.
1 Case and control subjects were denned as mothers of cleft children and mothers of normal children respectively. The cleft children were recruited from the Combined Cleft Clinic at Kota Bharu Dental Clinic. Normal chiMren were selected at Orthodontic Clinic, Kota Bharu. A total of 184 cases and controb with age range from 17 to 50 years were interviewed using the standard craniofacial
registration form. Multiple Logistic Regression modeling was used to estimate adjusted odds ratio of factors associated with non-syndromic oral cleft. Signijicant factors include history of miscarriage (OR: 3.40; 95% C1:1.05, 11 .08) p=0.042; duration of exposure to second-hand smoke for 15-30 minutes (OR: 2.41; 95% C1:1.42, 4.09) p 30 minutes (OR: 5.16; 95% C1:Z.87, 9.28) p
National Antenatal HIV Screening Programme has been integrated as a routine screening in antenatal care in early 1998 and in Terengganu since May 1998 involving all health centers in the state. As of December 2001, a total number of 57,882 antenatal mothers were screened (97.5% of all new antenatal mothers). The HIV prevalence rate among antenatal mothers was found to be 0.052%. All HIV positive mothers were married and majority were Malays (93 .3%). Ninety percents of them revealed that the only risk factorfor HIV was through sexual contact. HIV positive status was confirmed in 66 .7% ofthe husbands. All twenty eight mothers that managed to be followed up delivered to live birth babies. All newborns reported to have good Apgar score (9 at 5 minutes of life). Mean birth weight was 3 .08 kilograms 1- 0.45 and only 8% were premature babies. The observed rate of HIV vertical transmission was 6.25% and this is lower than the expected mother to child transmission rate of 30% without intervention.
Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.
According to Malinowski there are no peoples, however primitive, without religion and magic; nor are there any societies lacking either in the scientific attitude or in science (Blumberg 1963). Magic and taboo are resorted to when through the normal use of science, or rational techniques, man is unable to control unpredictable events important to him. Where there is difficulty in predicting the outcome of behaviour, where the results of action are not consonant with effort, where there are great limitions on man's knowledge of vital issues, magical techniques are employed--in short, where circumstances of life are uncertain, uncontrolled and unknown. Magic and animism are systems of thought which give not only the explanation of a single phenomenon, but make it possible to comprehend the totality of the world from one point, as a continuity. Of the three systems of thought--animistic, religious and scientific--animism is perhaps the most consistent and the most exhaustive, the one which explains the world in its entirety.
A cross-sectional study was undertaken to evaluate if outpatient administration of in-travenous iron sucrose complex (Venofer) was a sensible option in treating iron defi-ciency anaemia during pregnancy and puerperium. A total of 120 patients with iron deficiency anaemia were recruited from the Obstetric Day Care Clinic at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over 18 months from March 2003 to August 2004. The main outcome measures were haemoglobin increment, patients’ compliance, adverse effects and saving from hospitalization fees. The pre-treatment haemoglobin (Hb) level was 8.5+0.85g/dl for the antenatal patient and 7.6+0.80 g/dl in the post-partum group. The mean post-treatment haemoglobin increment at day four-teenth was 3.52+0.75g/dl. One patient developed skin rash while another had low-grade pyrexia. Seven patients experienced mild metallic taste. There were no serious side effects or anaphylactic reactions. Ten patients (8.3%) did not complete their ther-apy - eight delivered before completion of treatment; another two defaulted following delivery. The average number of Venofer used was seven ampoules i.e. 700mg per person, most of them required three sessions to complete the course. Outpatient treatment allows each patient to save hospitalization fees of RM45 per day, which to-talled up to RM135 for a 3-days ward stay. An estimation of RM16,200 hospitalization fees for the 120 patients was avoided during the study period. In conclusion, outpatient treatment of anaemia in pregnancy and post-partum period using Venofer was safe and feasible, with high patient compliant and cost-savings from hospitalization fees.
Study site: Obstetric Day Care Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia