PIP: Marvelon, a monophasic oral contraceptive (OC) containing 30 mcg of ethinyl estradiol and 150 mcg of desogestrel, has been available to Malaysian women through the national family planning program since 1982. To assess the safety, effectiveness, and side effects associated with this OC, 247 women who requested the pill were enrolled in a multicenter prospective study that included follow-up after the first, third, and sixth cycles of use. 81% of participants had never used any form of contraception before Marvelon. 194 women (79%) completed the 6-month study. There were no pregnancies recorded. Although women reported a slightly increased incidence of nausea, breast tenderness, and headache in the first treatment cycle, these side effects had abated by the end of the third cycle. After six cycles, mean body weight had decreased by an average of 0.4 kg. Both systolic and diastolic blood pressure were unaffected. An unexpected finding was a decrease in the severity of acne with continuous use of Marvelon. Although both spotting and breakthrough bleeding increased slightly in the first two cycles, irregular bleeding returned to pretreatment levels by the third cycle. The length of the withdrawal bleed in the pill-free week was reduced. The incidence of irregular bleeding and other side effects was substantially lower in this sample of Malaysian women than in Asian and Caucasian Marvelon users surveyed in other studies.
PIP: To identify the maternal risk factors associated with low birth weight in Malaysia, the records of the 2613 infants delivered at North Okkalapa General Hospital from January to September 1990 were reviewed. The incidence of low birth weight during the 9-month study period was 21.1%; 18.1% of these cases were attributable to intrauterine growth retardation and 3% were associated with preterm births. Univariate analysis identified the following risk factors as significant: age under 20 years (.001), parity 1 (.001), maternal height of 145 cm or under (.01), maternal cigarette smoking (.01), maternal education of 8 years or less (.001), parity 5 or above (.05), and maternal age of 35 years and above (.05). A last birth interval of 1 year or less and more than 3 years was associated with an odds ratio exceeding 1, but the correlation with low birth weight was not significant. These risk factors should be used to design maternal health programs aimed at reducing the incidence of low birth weight.
PIP: Data from 297 interviews among married patients attending prenatal clinics in Malaysia in 1993 are used to determine the number, spacing, and timing of pregnancies. Only live born children are included. Findings indicate that 92.2% of women were 18-35 years old, 4.2% were under 18 years of age, and 3.6% were over 35 years old. 86.2% had 4 or fewer children and 13.8% had 4 or more children. 69.7% spaced children 2 or more years apart and 30.3% had birth spacing of under 2 years. Over 90% of women had their pregnancies during the ages of 18 and 35 years.
An increase in the use of health services and contraception is usually associated with a decrease in breastfeeding. This study seeks to establish the relationship between maternal use of health services and breastfeeding practice. Data was obtained from the Sarawak Population and Family Survey of 1989. The breastfeeding pattern of 1583 children born to 1047 women aged between 15-49 years in the five years preceding the study were analyzed and compared among the various groups using maternal health services and contraception. Results showed that Sarawak has a very short mean duration of about 6 months for breastfeeding. Women attending antenatal and postnatal clinics had shorter breastfeeding durations but higher initiation rates compared to those who did not. Those whose delivered by doctors and those delivering in private hospitals were least likely to breastfeed. Contraceptive use was also negatively associated with breastfeeding duration. Whilst it is commendable that the use of maternal health facilities is high in Sarawak, the inverse relationship to breastfeeding can offset its health benefits. Health policies can play a part to arrest this decline which is also related to socioeconoic development.
Health workers in Malaysia randomly assigned either a low-dose triphasic or a low-dose monophasic oral contraceptive (Triquilar and Marvelon, respectively) to 198 women to examine discontinuation rates and reasons for discontinuation. 15.3% of Triquilar women and 9.1% of Marvelon women forgot to take 1 pill at some time during the study while 6.1% and 3% forgot to take at least 3 consecutive pills. There were more complaints and/or complications among Triquilar women than among Marvelon women. The most serious complication was severe headaches (only 1 woman from each group). 2 women in the Marvelon group complained of either generalized itchiness or digestion impairment. Complaints of women in the Triquilar group included localized and generalized itchiness, weight gain, digestion impairment, dryness of vagina, and numbness of extremities. Women in the Triquilar group were more likely to have menstrual complaints than those in the Marvelon group (14.3% vs. 9.1%). The leading menstrual complaint in both groups was spotting (6.1% vs. 4%). No Marvelon women reported menorrhagia, scanty menses, or intermenstrual pelvic pain or discomfort while at least 1 woman did from the Triquilar group. The percentage of women with changes in complaints since admission were the same for both groups. Total discontinuation rates which included lost to follow ups were 46.9% and 40%, respectively. The most common reason for discontinuation for both groups was desired method change (11.2% Triquilar and 14.1% Marvelon). Method unrelated reasons (unable to return to clinic, moving/travel, and not interested in the study) were the next most common reason for discontinuation. 3 women conceived while taking Triquilar. These pregnancies were attributed to method failure, perhaps due to incomplete pituitary suppression. There were no accidental pregnancies in the Marvelon group.
PIP: Long term use of low doses of combination oral contraceptives appears to increase plasminogen level, thereby increasing fibrinolytic activity and reducing the risk of thromboembolism. Blood levels of plasminogen, tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI), were measured before and after stress (5 minutes of stair climbing) in a group of 30 women, 23-40 years old, who had taken 30 mcg of ethinyl estradiol with 150 mcg of desogestrel or levonorgestrel for at least 1 year. Similar measurements were taken from a control group of 30 women matched for age, height, and weight. Plasminogen and tPA levels in both groups increased significantly after exercise. The level of PAI did not change significantly with stress in either group. The level of plasminogen was significantly higher in the group taking contraceptives, whether before or after exercise, when compared to the control group. Levels of tPA and PAI, although slightly increased in the oral contraceptive group, were not significantly different between the two groups. The increase in plasminogen may be due to the estrogen component of the contraceptives. Stress seems to increase fibrinolytic response.
PIP: Between December 1990 and May 1991 in Malaysia, clinicians at the Sultanah Aminah Hospital in Johor Bahru screened 200 women with a diagnosis of threatened miscarriage with ultrasound to determine whether ultrasound could evaluate the viability of the fetus and thus the outcome of pregnancy in cases of threatened abortion. A fetal heartbeat was absent in 65% of cases with the remaining 35% of cases having a fetal heartbeat. Nonviability of the fetus or an abnormal or very early pregnancy may have accounted for an absent fetal heartbeat. The pregnancy of 46% of cases continued while 41% experienced spontaneous abortion. Just 6.2% of cases with a fetal heartbeat suffered from spontaneous abortion compared with 69.7% of those without a fetal heartbeat. 93.8% of cases with a fetal heartbeat continued their pregnancies compared with 30.3% of those without a fetal heartbeat. Inability of ultrasound to detect fetal heartbeats during early pregnancy probably accounted for the somewhat high percentage of those without a fetal heartbeat who continued their pregnancies. Among patients with a fetal heartbeat, the number of pregnancies that continued. Ultrasound detected 13% abnormal pregnancies (i.e., molar pregnancy or ectopic pregnancy). Surgery on these cases confirmed the ultrasound findings. These results showed that ultrasound should be used in every case of threatened miscarriage and that a fetal heartbeat does indicate the viability of the fetus.
A study of knowledge, attitude and practice was carried out among sixty nine married Orang Asli women in the district of Kuaia Langat. The study showed that oniy a smail proportion of the women were using family planning methods. About half of the study women were stiil uncertain with regards to their attitude towards family planning. The findings aiso showed that there was no diversity of the methods with oral contraceptive being the major choice. Majority of the husbands had indeed positive feeling towards family planning. The women also considered breastfeeding as a major method of contraception.
PIP: A knowledge-attitude-practice (KAP) study of 69 married Orang Asli women from Kuala Langat district, Malaysia is reported. The Orang Asli comprise 2744 people in 412 households served by rural health services and a few private practitioners. The median age of the sample was 16.3 years, of whom 18.8% were married before age 15. 47.8% knew of family planning methods. 53.6% of the women said that they and their husbands approved of family planning, 2.9% disapproved, and the rest were undecided. Only 30.4% had discussed family planning with their husbands. 21.7% stated that they would use contraception, either the pill or sterilization, after their family was completed.
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.
A cross-sectional study looking at the coagulation system was carried out involving 175 women attending the National Population and Family Development Board's Clinic at the Maternity Clinic, General Hospital, Kuala Lumpur. Study subjects comprise of 50 combined low-dose estrogen/progestrogen oral contraceptive (DC) pill users and 75 non-DC users, acting as controls. The subjects were on the pill for a period of one year or more. There were significant shortening of the prothrombin time (PT) and partial thromboplastin time (PIT) in the DC group as compared to the control group. However, the activities of factors II, Vand VIII assayed were not significantly different between the two groups, suggesting that the changes in the PT and PIT were not significant clinically. The effect of long term usage of combined 10w..cJose DC pills does not seem to indicate changes in the coagulation profile of the women in our study.
PIP: The effect of low dose combined oral contraceptives containing 30 mcg ethinyl estradiol and either 150 mcg levonorgestrel or 150 mcg desogestrel on coagulation indices in Malaysian women was examined. 50 women who had been using the pills for 1 year or more, were compared to 75 non-users. All were attending the Maternity Clinic of the General Hospital, Kuala Lumpur. Pill users registered shorter prothrombin time, 11.5 vs. 11.1 seconds (p=0.016), and partial thromboplastin time, 40.1 vs 35.1 seconds (p=0.000). Since there were no significant differences in Factors II, V, VII, or VIII, the overall effects of low-dose pills on coagulation is probably not clinically significant.
A study was conducted on a total of 100 women attending the Family Planning Clinic in Kuala Lumpur. 50 took combined low-dose estrogen and progesterone pills for a year or more and the other 50 used different methods of birth control. Platelet aggregation, ATP release, Thromboxane B2, and 6-keto-prostaglandin F1alpha estimations were made to evaluate the effect of oral contraceptives (OCs) on platelet function and prostanoid production. The results showed no significant differences in the parameters measured in the 2 groups investigated. These findings are comparable to those reported by other studies, suggesting relatively low risk, if any, of thrombosis in OC users.
PIP: Previous studies have shown the users of intrauterine devices have a 4.4 times greater risk of pelvic inflammatory disease. This present study intends to categorize the distribution of microbes in cultures from different types of extracted copper intrauterine devices (IUCDs). Bacteriological studies of aerobic and anaerobic organisms were performed on the extracted IUCDs of 522 IUCD users; 480 wearing a Multiload Cu 250, 15 wearing a Copper T, 22 Lippes Loop and 5 a Copper 7. Cultures were negative in 46 (8.8%) IUCD cultures where 43 were Multiloads, Copper T (1) and Lippes Loop (2). 91.2% yielded bacterial growth and the commonest organisms isolated were Staphylococcus species, (23%), E.coli (9.6%) and Staphylococcus aureus (4.0%. Candida albicans, E.coli and Staphylococcus sp. were commonly isolated from Multiload, Copper T, Lippes Loop and Copper 7. Beta-hemolytic streptococci, Staphylococcus aureus and Candida sp. were frequently recovered from Multiload, Copper T and Lippes Loop. Only Multiload cultures yielded Bacillus, Streptococcus viridans, Klebsiella, Proteus, Enterobacter, Citrobacter diversus, Citrobacter freundii, Moraxella, Pseudomonas and Acinetobacter. One woman with complaint of PID yielded E.coli in her IUCD culture.
The efficacy of a recently marketed posttesticular male oral contraceptive, Contrasperm, was assessed in a clinical trial involving 32 Malaysian volunteers ages 21-39 years. Contrasperm is claimed to be a pure botanical extract free of toxic chemicals, steroids, and hormones. The drug is believed to cause cells surrounding the sperm in the seminiferous tubules to secrete carbon dioxide, producing a weakly acidic environment that greatly increases the sperms' metabolism and reduces the pH of semen from its normal level of 7.5 to 1.5. The manufacturer claims that this drop in pH decreases motility from 95% to 0%. Semen samples were collected by masturbation from subjects to provide baseline data. 3 days after the initial sperm analysis, subjects were given 1 capsule of Contrasperm containing 10 mcg of the active ingredient. Additional semen analyses were conducted 30 minutes, 6 hours, and 24 hours after ingestion. Sperm count and sperm motility were greatly reduced in most subjects 30 minutes after ingestion. However, 6 subjects had increased sperm counts and 4 subjects demonstrated increased sperm motility, indicating an enhancing effect. At 6 hours after ingestion, 20 subjects had lowered sperm motility and 12 subjects showed normal sperm motility, contradicting the manufacturer's claim that motility is reduced to 0%. Although Contrasperm is claimed to be effective for 6-8 hours after ingestion, its effect wore off in less than 6 hours in 37% of subjects. Both sperm count and sperm motility returned to normal levels 24 hours after ingestion, confirming the reversibility of this drug. Most subjects reported mild side effects such as muscle weakness, blurred vision, dizziness, perspiration, urgency, abnormal muscle tension, and dry throat which persisted longer than 24 hours. Further studies, with proper controls, are needed to assess the reliability and toxicity of this preparation.
This preliminary report details our experience and also serves to evaluate the risk benefits of office laparoscopy for female fertility assessment in 183 subjects. The patients were admitted at about 8.00 in the morning and discharged at 3.00 to 4.00 in the afternoon after laparoscopy has been performed. Only 7. 7 percent of the subjects required inhalational anesthetic gases along with a combination of intravenous sedation and local anesthetic infiltration. The pick-up rate for pelvic abnormality is fairly high, approximately 22.4 percent. Difficulties and complications encountered during laparoscopy were minimal and easily overcome. The benefits of laparoscopy overrules the risk of complications. It is suggested that all family planning clinics involved in fertility assessment and sterilization feature laparoscopy on an but patient basis as one of its main activities.