Breast feeding has been actively encouraged in Malaysia in the last few years in all public hospitals. This study proposes to find out the prevalence of breast feeding in three villages in a rural community in Kedah, Malaysia. This was a cross sectional study on breastfeeding practices in Kubang Pasu, a district of Kedah. Majority of the mothers initiated breast feeding but exclusive breastfeeding was only 21% for four months and predominant breastfeeding was about 12.6%. The breastfeeding practice was more prevalent among women from the higher educational strata and higher income than those from the lower strata and lower income (p
Rural health training is an important element in the training of medical students in the University of Malaya. There is a need for the undergraduates to be familiar with the rural health infrastructure and to understand the social and economic aspects of the rural poor. The objective of the training is to make the students understand the problems faced by the poor in the rural areas so that when they practice in rural health areas, after graduation, they will understand the problems of the rural poor. They will have the knowledge of the diseases in the rural areas and also understand the community and the environmental factors that contribute to the disease. The training lasts' for 4 weeks, one week for lectures on health survey, two weeks for the field trip and one week of data analysis and presentation of their findings to an expert panel. During the field trip the students are divided into groups and they go to different parts of the country. Each group will do a field survey to find out the socio-demography, environmental, economic, nutritional and health problems in the village. In addition to the survey they also do a research project on any topic. The students also do social work, visit places of public health interest like the water treatment plant, sewage disposal, factory visits and others. Apart from technical skills in statistics and epidemiology, various other managerial skills like leadership, teamwork, communications and public relations are also learnt during the training. In conclusion this rural health training is an important aspect of the medical students training as it imparts several skills to them that are needed as a doctor.
The overall mean birth weight of the total deliveries (1986-1988) in Lundu Hospital was 2.96 kg. The mean birth weight for the male babies was 2.94 kg. The Chinese babies had a significantly higher mean birth weight (3.12 kg) than the other ethnic groups (p < 0.05). The overall incidence of low birth weight (LBW) in this study was 11.84 per cent. The Chinese again had a lower incidence of LBW of 6.73 per cent compared to Ibans who had the highest incidence of LBW, 13.59 per cent, with the Bidayuhs 12.97 per cent and Malays, 12.45 per cent. It was also noticed that of the 14.9 per cent preterm deliveries, 37.5 per cent were LBW. The very young mothers (15-19 years) and older mothers (> 40 years) seem to have a higher incidence of LBW. Mothers who had medical conditions like anaemia, hypertension, pre-eclampsia also had a higher incidence of LBW when compared to mothers who did not have a medical condition. Special emphasis should be given to mothers who have medical conditions, and to very young and very old mothers during antenatal care, to prevent incidence of LBW.
Comment in: Chia CP. Low birth weight babies. Med J Malaysia. 1995 Mar;50(1):120
The findings of a cholera epidemic in Krian district is reported. There were 77 cases and 92 carriers in the epidemic. Although the three main ethnic groups of Malays, Chinese and Indians were involved in the epidemic, the Malays constituted majority of the cases and carriers. The overall infection rate and case attack rate was higher among the younger population. The case: carrier ratio was also higher among the younger population especially among Indians. Various reasons and probable causes of the epidemic have been described briefly.
The birth weight distribution, mean birth weight and incidence of LBW amongst the various ethnic groups in Malaysia is described briefly. The data collected and analysed is hospital data where all deliveries in 1980 were analysed. The mean birth weight showed that the Chinese had the highest Mean Birth Weight amongst the three ethnic groups and the Indians had the lowest mean birth weights. The overall incidence of LBW was 11.8% and the Malay and Indian babies constituted the high
incidence of LBW whereas the Chinese had a low incidence of LBW babies in the study. Amongst the various ethnic groups the Indians had a higher incidence of LBW compared to the Chinese and Malays.
The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.
Maternal deaths in Kerian district during a 5 year period (1976-1980) is described. There were 35 maternal deaths in all and Malays constituted the majority 32 (91.4 percent). Most of the women were of low socio-economic status and only 20 percent had some formal education. The women were mainly multigravida and majority of them 20 (57.2 percent) were between 31-40 years of age. The main cause of death being PPH and PPH with retained placenta. Most of them died at home and were attended to by TBAs. The need to identify, train and utilise TBAs has been realised as they delivered about 41.4 percent of the deliveries in Kerian in 1976.
The International Medical University has a Community and Family Case Study (CFCS) programme as part of the training for medical students. The aim of the programme is to emphasize the family and community perspective of patient care in the home environment. A cross-sectional descriptive study was done among 66 final year medical students using a questionnaire. The students were in the 10th Semester and had completed their Community and Family Case Studies (CFCS) programme. Majority (54.5%) of the students who were interviewed were Malays, 34.8% Chinese and 9.1% Indians. Majority of the students (87.9%) liked the programme because it was a good opportunity to understand the patient in their home environment; it improved their commination skills and made them understand the patient better in the community setting. The perceived problem in this programme by the students were mainly choosing an index patient initially (32.8%), patient cooperation (19.0%) and transportation to the patients' house (13.8%). They said that this programme was useful because they learnt more about the disease (45%) and understood the patient management better (15%). The programme also provided the students a wider exposure to medicine (37.9%) and the opportunity to practice clinical skills. Overall the CFCS programme in IMU was well liked by the students as it gave them an opportunity to practice some of the clinical skills in the patients' home environment and it provided an opportunity to manage the patient better. The major problem the students faced was in selecting the index patient.
There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
This study examines the association between maternal factors and low birth weight among newborns at a tertiary hospital in Malaysia. This was a cross-sectional study where mothers were followed through from first booking till delivery. There were 666 mothers who delivered from May 2007 to March 2008. Infants' birth weight were compared with maternal age, pre-pregnancy BMI, fathers BMI, parity, ethnicity, per capita monthly income, and maternal blood pressure during pregnancy. A multiple logistic regressions was used to determine the relationship of maternal factors and low birth weight, while the ROC curve was constructed to assess the sensitivity and specificity of the predictive model. Among the significant risk factors of low birth weight were older age (35 years and above), low pre-pregnancy BMI (<20 kg/m2), parity of 4 and above, Indian origin, economically under privileged, and low and high blood pressure. Blood pressure during pregnancy was an important risk factor for LBW, by using this parameter alone the risk of LBW could be predicted with a sensitivity rate of 70% and a specificity rate of 70%. The sensitivity and specificity was further improved to 80% and 75% percent respectively when other factors like maternal factors such as maternal age, pre-pregnancy BMI, ethnicity, and per capita monthly income were included in the analysis.
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.
Telemedicine is fast becoming popular in many countries in the world. It has several advantages such as being cost saving and providing better access to health care in the remote areas in many parts of the world. However, it has some disadvantages as well. One of the major problems is the problem of patients' rights and confidentiality in the use of telemedicine. There are no standard guidelines and procedures in the practice of telemedicine as yet. Both the patient and the physician are unsure of the standard of practice and how to maintain confidentiality. The patient is uncertain as to how to protect her/his rights in the use of telemedicine. The issue of litigation is also unclear as to where the physician is practicing when he/she uses telemedicine. Is she/he practicing in the country where the patient is or is the physician practicing in the country of her/his origin? These issues need to be addressed urgently so that telemedicine will have standards of ethical practice and the patient's rights and confidentiality will be protected.
A cross sectional descriptive study on breast feeding practices in an urban clinic was conducted among 136 mothers aged between 21-49 years who were interviewed using a questionnaire. Malays constituted 61% of the respondents, Chinese 22.8% and Indians 16.2%. Mojority of these were working mothers and although the initiation of breastfeeding was high (99.3%), exclusive breastfeeding was only 12.5%. A large proportion (33.8%) dtopped prior to 3 months. Majority of the Chinese mothers (61.3%) stipped before 3 months as compared to the Indian (40.9%) and Malay (21.7%) mothers (p<0.001). Mean age of introducing complementary foods at 3 months is below the accepted age of 4 to 6 months for weaning. Ever-breast feeding rate is high in this urban setting but more efforts are needed to effect a higher rate of exclusive breastfeeding and longer duration of breastfeeding.