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The developmental niche: a theoretical framework for analyzing the household production of health

Harkness S, Super CM

Soc Sci Med, 1994 Jan;38(2):217-26.
PMID: 8140448

Recent efforts to promote child survival and development internationally have focused new attention on the importance of the household as a mediator of both environmental risks and programmatic interventions to promote better health. In this paper, we introduce a theoretical framework, the 'developmental niche,' derived from studies of children's behavior and development in different cultural contexts, as a tool for analyzing the household production of health. The developmental niche is conceptualized in terms of three basic components: (1) the physical and social settings of the child's everyday life; (2) culturally regulated customs of child care and child rearing; and (3) the psychology of the caretakers. The relevance of each of these components to the household production of health is illustrated through examples from research in several cultures, including Malaysia, Kenya, Bangladesh, India, and the U.S. Further discussion centers on three corollaries of the developmental niche framework that point to the interactive relationships among the three components, between the niche and the larger environment, and between the niche and the child (or any individual seen from a developmental perspective). It is suggested that this approach is useful for identifying and collecting relevant information on household-level factors that affect health outcomes, and thus for organizing more effective interventions. At a theoretical level, the developmental niche framework also facilitates understanding processes of mutual adaptation between the individual and the environment as they are filtered through the constraints of household settings, customs and caretaker psychologies.

Matched MeSH terms: Family Health*
Using tracers to link health services to training through evaluation

Bandaranayake RC, Singh PJ

Med Educ, 1993 Nov;27(6):509-17.
PMID: 8208159

The tracer concept was applied to evaluate the delivery of family health care and the training of family health workers. A retrospective evaluation permitted linking the products of care to process, input and context, by isolating and analysing potential factors contributing to a limited number of representative concerns. Contributory learning deficiencies identified in health workers, one input to health care as well as a product of training, enabled the evaluation of training programmes to be focused on related segments of the courses. The latter were evaluated through a pathway analysis which followed the same deficiency model as the evaluation of health care. Links were thus established between the traditionally compartmentalized training and service sectors in health.

Matched MeSH terms: Family Health*
Fulltext A qualitative study on the implementation of family health team: the perspectives of providers and patients

Mohd Hanafiah AN, Johari MZ, Azam S

BMC Fam Pract, 2020 08 09;21(1):162.
PMID: 32772931 DOI: 10.1186/s12875-020-01217-7

BACKGROUND: Malaysia has committed to the global call to achieve universal health coverage, and with the adoption of Sustainable Development Goals, is further strengthening the health system through the primary health care services, particularly the family doctor concept. The Enhanced Primary Health Care (EnPHC) initiative was implemented to address the worrying upward trend of non-communicable disease prevalence, and incorporates the Family Health Team (FHT) concept. The aim of this paper is to describe the implementation of the FHT as part of the EnPHC intervention.
METHODS: In-depth interviews and focus group discussions were conducted with the intervention design team, healthcare providers and patients in two rounds during the implementation period. A total of 121 individuals in the two rounds, split into different groups, where some of the participants of the FGD were also interviewed individually. Data were analysed using a thematic analysis, with codes being organised into larger themes.
RESULTS: Themes that emerged from the data were around the process of FHT implementation and the advantages of the FHT, which included continuity of health care and improved quality of care. Patients and health care providers were receptive to the FHT concept, and took the effort to adapt the concept in the local settings.
CONCLUSIONS: The FHT concept implemented at 20 public primary health clinics has benefits appreciated by health care providers and patients. Addressing the viable shortcomings would better prepare the current primary healthcare system to scale up the FHT concept nationwide and enhance its feasibility and sustainability.
TRIAL REGISTRATION: The study is registered with the National Medical Research Register, Ministry of Health Malaysia ( NMRR-17-295-34711 ).

Matched MeSH terms: Family Health*
Fulltext A Review of Primary Health Care in Malaysia. A Report for the World Health Organization Western Pacific Region

Awin N

Citation: Awin N. A Review of Primary Health Care in Malaysia. A Report for the World Health Organization Western Pacific Region. Manila: World Health Organization Western Pacific Region; 2001

Matched MeSH terms: Family Health
The 4-item family resilience scale: psychometric evaluation and measurement invariance of the malay version in adolescents and young adults

Hamzah H, Tan CS, Ramlee F, Zulkifli SS

BMC Psychol, 2023 Nov 13;11(1):392.
PMID: 37957763 DOI: 10.1186/s40359-023-01435-5

BACKGROUND: The original Family Resilience Scale (FRS) is a reliable tool to assess family resilience. However, the FRS is based on the United States and parental context. Thus, the usefulness of the FRS for the adolescent and young adult population in Asian countries, particularly Malaysia remains unknown. This study translated the FRS into the Malay language and validated it on Malaysian adolescents and young adults to identify its potential as a self-report tool to assess the resilience level of their family.
METHODS: A total of 351 participants (Mage = 19.75, SDage = 3.29) were recruited in the study using purposive sampling. Confirmatory factor analysis was conducted to examine the factorial structure of the Family Resilience Scale-Malay (FRS-Malay) and measurement invariance between adolescents and young adults. Then, the scale's reliability was investigated using Cronbach's alpha, McDonald's omega coefficients, and composite reliability index. Finally, we examined the discriminant validity of the FRS-Malay by correlating its score with individual resilience score and examined the incremental validity of the scale using hierarchical multiple regression analysis to test if family resilience can explain individual well-being levels beyond and above individual resilience.
RESULTS: The findings of the confirmatory factor analysis suggest that a single-factor model is supported for both age groups. Furthermore, the scale exhibited scalar invariance between adolescents and young adults. The scale also exhibited good reliability, as the value of Cronbach's alpha, McDonald omega coefficients, and composite reliability index were above 0.80. Additionally, the Pearson correlation analysis showed a positive correlation between the FRS-Malay and individual resilience scores, which supports the discriminant validity of the scale. Similarly, the incremental validity of the scale is also supported. Specifically, family resilience had a positive correlation with well-being, even after controlling for individual resilience in the regression analysis.
CONCLUSIONS: The FRS-Malay has demonstrated good reliability and validity. The scale measures the same construct of family resilience across adolescents and young adults, making it suitable for comparisons. Therefore, this unidimensional tool is appropriate for self-reporting their perceived level of family resilience. It is also useful for studying the development and fluctuation of family resilience in the Malaysian context.

Matched MeSH terms: Family Health*
Traumatic brain injury: caregivers' problems and needs

Hassan ST, Khaw WF, Rosna AR, Husna J

JNMA J Nepal Med Assoc, 2011 Jan-Mar;51(181):53-5.
PMID: 22335097

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.

Matched MeSH terms: Family Health
Aggregation and predisposition to Ascaris lumbricoides and Trichuris trichiura at the familial level

Chan L, Bundy DA, Kan SP

Trans R Soc Trop Med Hyg, 1994 1 1;88(1):46-8.
PMID: 8153999 DOI: 10.1016/0035-9203(94)90492-8

This study examines the persistence of familial aggregation and familial predisposition to Ascaris lumbricoides and Trichuris trichiura infection over 2 periods of treatment and reinfection, in an urban community in Kuala Lumpur, Malaysia. Both parasite species were shown to be aggregated (assessed by the variance to mean ratio) within families at all 3 interventions, although no consistent trend in aggregation was observed over the period of the study. Associations between mean A. lumbricoides and T. trichiura infection levels of families, at all 3 interventions, were highly significant (P < 0.0001), suggesting persistent predisposition at the family level.

Matched MeSH terms: Family Health*
Fulltext Family characteristics of suicides in Cameron Highlands: a controlled study

Maniam T

Med J Malaysia, 1994 Sep;49(3):247-51.
PMID: 7845274

Cameron Highlands has one of the highest suicide rates in the world, especially among Indians. Forty Indian families (19 suicides; 21 controls) were studied to compare family characteristics such as income, overcrowding, birth order of index cases of suicide, family history of suicidal behaviour or mental illness, marital disharmony, presence of alcohol abuse, availability of, and knowledge about, weedicides/insecticides, talk/threat of suicide among family members and experience of significant losses in the past year. Controls were matched for age, sex and educational level with the index cases of suicide. A significant difference was only found for one of the above factors, namely increased experience of significant losses in the past year in the family of index cases of suicide. More than 75% in both groups had alcohol related problems. About equal proportions in each group had a family history of suicidal behaviour and mental illness. There was more marital disharmony in families of suicides but this failed to reach significance. These results and methodological limitations of this study are discussed.

Matched MeSH terms: Family Health/ethnology*
Ethnic variation of genetic (idiopathic) generalized epilepsy in Malaysia

Lim KS, Ng CC, Chan CK, Foo WS, Low JS, Tan CT

Seizure, 2017 Feb;45:24-27.
PMID: 27912112 DOI: 10.1016/j.seizure.2016.11.011

PURPOSE: Ethnic variation in epilepsy classification was reported in the Epilepsy Phenome/Genome Project. This study aimed to determine the ethnic variation in the prevalence of genetic (idiopathic) generalized epilepsy (GGE) and GGE with family history in a multi-ethnic Asian population in Malaysia.

METHOD: In this cross-sectional study, 392 patients with a clinical diagnosis of GGE were recruited in the neurology outpatient clinic, University of Malaya Medical Centre (UMMC), from January 2011 till April 2016.

RESULTS: In our epilepsy cohort (n=2100), 18.7% were diagnosed to have GGE. Of those, 28.6% >(N=112) had family history of epilepsy with a mean age of seizure onset of 16.5 years old, and 42.0% had myoclonic seizures (N=47). The lifetime prevalence of epilepsy among first-degree relative of those with GGE and positive family history was 15.0%. Analysis according to ethnicity showed that Malaysian Chinese had the lowest percentage of GGE among those with epilepsy (12.3%), as compared with Indian and Malay (25.3% and 21.3%, p<0.001). In addition, 32.1% of these Indian patients with GGE had positive family history, which is more than the Malay (26.4%) and Chinese (27.5%) ethnic groups. Consanguineous marriage was noted in 5 Indian families with positive family history (9.6%).

CONCLUSION: There was ethnic variation in the prevalence of GGE, whereby the Malaysian Chinese had the lowest percentage of GGE as compared with Indian and Malay. A substantial proportion of GGE had positive family history among the three ethnics groups.

Study site: neurology outpatient clinic, University of Malaya Medical Centre (UMMC)

Matched MeSH terms: Family Health*
Fulltext Psychiatric morbidity in schizophrenic relatives--use of Self-Reporting Questionnaires (SRQ)

Salleh MR

Singapore Med J, 1990 Oct;31(5):457-62.
PMID: 2259943

A validated study of the Self-Reporting Questionnaire (SRQ-20) of the World Health Organization against ICD-9 was found to have good validation indices at the cut-off point of 5/6. The sensitivity was 84.8% and specificity 83.7%. However, SRQ-24 had poor validation indices and are too sensitive to detect psychotic illness. Twenty-three per cent of 264 schizophrenic relatives who had been staying together with them and or actively involved in their care for at least one year had neurotic disorders compared with 1% who had latent schizophrenia. The prevalence of psychiatric morbidity was higher in the first-degree relatives compared with non-first degree relatives.

Matched MeSH terms: Family Health*
Fulltext Parental body mass index is associated with adolescent overweight and obesity in Mashhad, Iran

Shafaghi K, Shariff ZM, Taib MN, Rahman HA, Mobarhan MG, Jabbari H

Asia Pac J Clin Nutr, 2014;23(2):225-31.
PMID: 24901091 DOI: 10.6133/apjcn.2014.23.2.11

OBJECTIVE: This cross-sectional study was carried out to determine the prevalence of overweight and obesity among secondary school children aged 12 to 14 years in the city of Mashhad, Iran and its association with parental body mass index.
METHODS: A total of 1189 secondary school children (579 males and 610 females) aged 12- 14 years old were selected through a stratified multistage random sampling. All adolescents were measured for weight and height. Household socio-demographic information and parental weight and height were self-reported by parents. Adolescents were classified as overweight or obese based on BMI-for age Z-score. Multivariable logistic Regression (MLR) determined the relationship between parental BMI and adolescent overweight and obesity.
RESULTS: The overall prevalence of overweight and obesity among secondary school children in Mashhad was 17.2% and 11.9%, respectively. A higher proportion of male (30.7%) than female (27.4%) children were overweight or obese. BMI of the children was significantly related to parental BMI (p<0.001), gender (p= 0.02), birth order (p<0.01), parents' education level (p<0.001), father's employment status (p<0.001), and family income (p<0.001). MLR showed that the father's BMI was significantly associated with male BMI (OR: 2.02) and female BMI (OR: 1.59), whereas the mother's BMI was significantly associated with female BMI only (OR: 0.514).
CONCLUSION: The high prevalence of overweight/obesity among the research population compared with previous studies in Iran could be related to the changing lifestyle of the population. The strong relationship with parental BMI was probably related to a combination of genetic and lifestyle factors. Strategies to address childhood obesity should consider the interaction of these factors.

Matched MeSH terms: Family Health/statistics & numerical data*
Fulltext Acute glomerulonephritis in Kelantan--a prospective study

D'Cruz F, Samsudin AT, Hamid MS, Abraham T

Med J Malaysia, 1990 Jun;45(2):123-30.
PMID: 2152016

A prospective study of acute nephritis in children was conducted at the Universiti Sains Malaysia Hospital, Kubang Kerian between July 1987 and June 1988. One hundred and twenty four children were admitted with acute glomerulonephritis. The aim of the study was to determine the clinical pattern of the nephritis as well as its aetiology. The majority of our patients came from the lower socio-economic group and 54% of the families had incomes below the poverty line. Preceding skin infection was much more common than throat infection. The children showed a high incidence of complications: severe hypertension (43.6%), hypertensive encephalopathy (11.3%), clinical pulmonary oedema (36.3%), severe azotaemia (10.5%), and prolonged gross haematuria (13.7%). By using immunologic indices such as ASOT, anti-DNase B and complement 3, it was concluded that 121 of the 124 patients had post-streptococcal nephritis.

Matched MeSH terms: Family Health
The analyze toddler growth and development according to family's economic status in Village Limau Manis, Districts Tanjung Morawa

Pangaribuan IK, Simanullang E, Poddar S

Enferm Clin, 2020 06;30 Suppl 5:92-95.
PMID: 32713594 DOI: 10.1016/j.enfcli.2019.11.029

The toddler stage is a golden period and at the same time a critical period for a child, since he / she will experience rapid brain growth and development so that he/ she need sufficient nutrition intake. Toddler's abnormal growth and development are usually found in low economic community because they cannot afford to provide their need for basic food for their toddler's growth and development. The objective of the research was to analyze toddler's growth and development according to family's economic status. The research used descriptive analytic method with cross-sectional design. It was conducted at Limau Manis Village, Tanjung Morawa Subdistrict, Deli Serdang Regency, from January to June 2016. The population was 1899 toddlers, and 113 of them were used as the samples, taken by using simple random sampling technique. The data were gathered by using questionnaires to find out toddler's growth and development according to family's economic status. The result of univariate analysis showed that 57 toddlers (50.4%) had abnormal growth and development. The result of bivariate analysis with chi-square test showed that there was the correlation of toddler's growth and development with economic status (p value=0.004), women's care pattern (p value=0.028), and environmental sanitation (p value=0.01). Therefore, empowerment of family's economy through the development of family's nutrition portfolio is necessary.

Matched MeSH terms: Family Health
Fulltext The relationship of socio-demographic characteristics and knowledge of breast cancer on stage of behavioral adoption of breast self-examination

Moey SF, Mutalib AMA, Mohamed NC, Saidin N

AIMS Public Health, 2020;7(3):620-633.
PMID: 32968682 DOI: 10.3934/publichealth.2020049

Background/aim: In Malaysia, breast cancer is the most common cancer among women. As such, early diagnosis and screening practices are important to increase the survival rate. Breast self-examination (BSE) is one of the main screening methods for breast cancer. Socio-demographic characteristics and knowledge of breast cancer are amongst the crucial roles in determining women's behavioral adoption in performing BSE. This study aims to assess the relationship of socio-demographic factors and knowledge of breast cancer on the stage of behavioral adoption of BSE among Malaysian women in Kuantan, Pahang.
Materials and methods: A cross-sectional study was conducted on 520 women from three different government health clinics in Kuantan and IIUM Family Health Clinic from February to April 2018. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of breast cancer and its effect on the behavioral adoption of BSE.
Results: Significant difference was found between socio-demographic characteristics and behavioral adoption of BSE. However, only breast screening and the best time for screening were found to be significant with the behavioral adoption of BSE and knowledge of breast cancer.
Conclusion: It is found that most women in Kuantan, Pahang perform BSE but were still unaware of the importance of performing BSE for early breast cancer detection. This study was expected to enhance women's awareness of the benefits of performing BSE.

Matched MeSH terms: Family Health
Fulltext Psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients

Varma SL, Sharma I, Chugh S

Singapore Med J, 1992 Feb;33(1):67-9.
PMID: 1598611

A total of 1018 and 812 first degree relatives (FDR) of schizoprencies and controls respectively, were studied to find out the psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients. The risk of schizophrenia and affective disorders was found to be independent of the probands subtype diagnosis. The risk for schizoid-schizotypal and paranoid personality disorders was found to be increased in the first degree relatives of paranoid schizophrenic, as compared to non-paranoid schizophrenic, thus suggesting that the psychopathology in the FDR may differ with the subtype diagnosis of the proband.

Matched MeSH terms: Family Health
An initial look at the quality of life of Malaysian families that include children with disabilities

Clark M, Brown R, Karrapaya R

J Intellect Disabil Res, 2012 Jan;56(1):45-60.
PMID: 21435066 DOI: 10.1111/j.1365-2788.2011.01408.x

While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual disabilities. Dynamics characterising Malaysian society are described as developments in social policy and service delivery that support persons with disabilities and their families.

Matched MeSH terms: Family Health/statistics & numerical data*
Validation of the medical outcomes study family and marital functioning measures in SLE patients in Singapore

Thumboo J, Fong KY, Chan SP, Leong KH, Feng PH, Thio ST, et al.

Lupus, 1999;8(7):514-20.
PMID: 10483028 DOI: 10.1191/096120399678840747

OBJECTIVE: To validate the Medical Outcomes Study Family and Marital Functioning Measures (FMM and MFM) in a multi-ethnic, urban Asian population in Singapore.
METHODS: English speaking Chinese, Malay or Indian SLE patients (n=120) completed a self-administered questionnaire containing the FFM and MFM at baseline, after 2 weeks and after 6 months. Lupus activity, disease-related damage and quality of life were assessed using the British Isles Lupus Assessment Group (BILAG), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and SF-36 Health Survey respectively. Scale psychometric properties were assessed through factor analysis, Cronbach's alpha, quantifying test-retest differences and known-groups construct validity.
RESULTS: Factor analysis of scores obtained at baseline and after 6 months identified 3 factors corresponding to the FFM (1 factor) and the MFM (2 factors). Both scales showed acceptable internal consistency, with Cronbach's alpha of 0.95 for the FFM and 0.70 for the MFM. Mean (s.d.) test-retest differences were -0.31 (3.82) points for the FFM and -0.70 (4.26) points for the MFM. Eleven out of 13 a priori hypotheses relating both the FFM and MFM to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales.
CONCLUSION: The FFM and MFM are valid and reliable measures of family and marital functioning in a multi-ethnic cohort of Asian SLE patients in Singapore.

Matched MeSH terms: Family Health*
Fulltext Homozygous familial hypercholesterolemia

Alicezah MK, Razali R, Rahman T, Hoh BP, Suhana NH, Muid S, et al.

Malays J Pathol, 2014 Aug;36(2):131-7.
PMID: 25194536 MyJurnal

We report a rare case of homozygous familial hypercholesterolemia (HoFH), a 22-year-old Malay woman who presented initially with minor soft tissue injury due to a cycling accident. She was then incidentally found to have severe xanthelasma and hypercholesterolemia (serum TC 15.3 mmol/L and LDL-C 13.9 mmol/L). She was referred to the Specialized Lipid Clinic and was diagnosed with familial hypercholesterolemia (FH) based on the Simon Broome (SB) diagnostic criteria. There was a family history of premature coronary heart disease (CHD) in that three siblings had sudden cardiac death, and of consanguineous marriage in that her parents are cousins. DNA screening of LDLR and APOB genes was done by Polymerase Chain Reaction (PCR), followed by Denaturing High Performance Liquid Chromatography (DHPLC). Homozygous mutation C255S in Exon 5 of her LDLR gene was found. There was no mutation was found in Exon 26 and Exon 29 of the APOB gene. This report is to emphasize the importance of identifying patients with FH and cascade screening through established diagnostic criteria and genetic studies in order to ensure early detection and early treatment intervention to minimize the risk of developing CHD and related complications.

Matched MeSH terms: Family Health
Darkroom prone provocative test in primary angle closure glaucoma relatives

Zahari M, Ong YM, Taharin R, Ramli N

Optom Vis Sci, 2014 Apr;91(4):459-63.
PMID: 24637481 DOI: 10.1097/OPX.0000000000000220

To evaluate ocular biometric parameters and darkroom prone provocative test (DPPT) in family members of primary angle closure (PAC) glaucoma (PACG) patients and to establish any correlation between these biometric parameters and the DPPT response.

Matched MeSH terms: Family Health
Fulltext Does a positive family history influence the presentation of breast cancer?

Yip CH, bt Mohd Taib NA, Lau PC

Asian Pac J Cancer Prev, 2008 Jan-Mar;9(1):63-5.
PMID: 18439076

INTRODUCTION: An important risk factor for developing breast cancer is a positive family history of breast cancer. In Malaysia, there is no population-based breast screening programme, but the clinical practice guidelines suggest increased surveillance for those with a positive family history ie mammography for those 40 years old and above, breast self-examination and clinical breast examination yearly.
OBJECTIVE: To determine if women with a family history of breast cancer present with earlier stages of disease.
METHODOLOGY: From Jan 2001 to Dec 2006, 1553 women with breast cancer presenting to the University Malaya, where family history was recorded, were eligible for this study. Women with a first or second degree relative with breast cancer were compared with those who have no family history with regard to their race, age, stage, size and duration of symptoms. The Chi Square test of significance was used for analysis.
RESULTS: Out of 1553 patients, 252 (16.2%) were found to have a relative with breast cancer out of which 174 (11.2%) had at least one affected first degree relative. There were no significant difference in the incidence of positive family history between the Malays, Chinese and Indians. 20% below the age of 40 years old had a positive family history compared with 12.6% in women with no family history. (p<0.05). There was no significant difference in stage at diagnosis between those with and without family history, ie 24.2% late stages (Stage 3 and 4) in the group with no family history compared with 21.8% in the group with family history. (p>0.05). The mean size in the group with no family history was 4.4 cm compared to 4.1 cm in the group with family history. There was a significant difference in screen-detected cancers in the women with family history, 10.7% compared with 5.1% of screen-detected cancers in the group without a family history. However there was no difference in the duration of symptoms between the 2 groups--25.8% in the women without a family history presented after 1 year of symptoms compared with 22.4% in the group with a family history (p>0.05).
CONCLUSION: Having a family history of breast cancer does not appear to have much impact on the health-seeking behavior of women. Even though there were more screen detected cancers, these comprised only 10% of the group with family history. Public education should target women at risk ie with family history to encourage these women to present earlier and to undergo screening for breast cancer.

Matched MeSH terms: Family Health

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