An epidemiological survey of filariasis and malaria in Banggi Island and Upper Kinabatangan, Sabah, revealed microfilarial rates of 7.2% and 8.6% respectively and malaria prevalence of 9.7% and 16.9% respectively. Wuchereria bancrofti was a rural nocturnally periodic type with a periodicity index of 137.2 and average peak hour at 01.32 hrs; 9.2% of microfilaremic carriers as compared to 2.4% amicrofilaremic subjects had clinical filariasis. The Plasmodium falciparum: P. vivax: P. malariae ratios were 1:1:0.17 and 1.4:1:0.12 for Banggi and Upper Kinabatangan respectively. Anopheles flavirostris was incriminated as a new malaria vector in Banggi where the well-known primary malaria vector is An. balabacensis. The latter was also found for the first time to be a vector of rural W. bancrofti in Upper Kinabatangan. Experimental feeding also showed that L3 larvae of W. bancrofti were recovered at low rates from An. balabacensis. Aedes togoi appeared to be a suitable laboratory vector for W. bancrofti.
A 70 million population for Malaysia by the year 2010 has been officially targetted for in the Mid-Term Review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth. For this exercise, infant mortality rate was used as the health indicator. From trends seen vis-a-vis population growth, it appears that thus far, population growth has not been associated negatively with health (as measured by IMR). In recognition of the relevance of the medical, economic and education factors to health, trends in Malaysia's population ratio, per capita GNP and rates of school enrolment were also drawn; the selection of these as proxies being based on completeness of time-serial records. Although statistical regressions established the high correlation between medical doctors.population ratio and school enrolment rate with IMR, the limitations in this analysis did not permit any reliable inferences. In view of the difficulties in projections of trends, a comparison of health and related variables was carried out for several countries with high populations as near to 70 million as were available. The characteristics associated with low mortality and high life expectancy (health indices) were identified as low population growth, high literacy and high per capita GNP; this being stated with explicit qualifications. Other determinants of health were also discussed in brief, and the need for careful planning in the distribution of human and material resources was noted.
A random sample of 23 591 single livebirths was drawn from the Singapore Registry for 1967-1974, and information extracted from the birth certificates. The proportion of low birthweight infants (2500 g or less) fell markedly from 9.1% in 1967 to 5.7% in 1974, which has not been the finding in other studies. Variation in the proportions of low birthweight infants by sex, maternal age, parity, and social class, are broadly in agreement with other studies. Indians were found to have significantly smaller babies (mean weight of 3020 g) with a higher proportion of low birthweight ones (11.5%) than the Malays (3080 g and 8.1%) and the Chinese (3130 g and 6.1%). This is despite similar distributions of gestational age, and for term babies the differences in low birthweight proportions are highly significant with Chinese 5.0%, Malays 6.5%, and Indians 9.8%. The reasons for this are discussed with the implication that lower birthweights in Indians are to some extent of ethnic/genetic origin.
The transcutaneous (Tc) bilirubinometer was evaluated in 105 jaundiced neonates, comprising 38 Malays, 37 Chinese and 30 Indians, who had not been treated with phototherapy or exchange transfusion. Tc bilirubin index and serum bilirubin concentration correlated at statistically significant levels in all the three racial groups. Unlike the Chinese and Malay babies, the action levels, using Tc bilirubin index, in the Indian babies are not reliable due to the wide variation of skin pigmentation. Neonatal jaundice is conventionally monitored by estimation of serum bilirubin level. This involves blood sampling. The transcutaneous (Tc) bilirubinometer, however, is non-invasive, small and portable. In this study, the use of the Tc bilirubinometer in the management of neonatal jaundice' in the three racial groups was evaluated.
M-mode echocardiograms of six patients with a diagnosis of Ebstein's anomaly and confirmed by cardiac catheterization were reviewed. All the patients (5 females and 1 male) were Caucasians with their ages ranging from one day to twenty-six years. The tricuspid valve was easily located in all the echo cardiographic studies. There was a 45 to 100 msec delay in tricuspid valve closure as compared to the mitral valve closure, in all patients. The amplitude of the anterior tricuspid valve was found to be greater than the amplitude of the anterior mitral valve in all but one case. Paradoxical septal movement type A was observed in four cases. None of the cases had a right ventricular end diastolic diameter that was larger than the left ventricular end diastolic diameter. The study found that it was extremely difficult to specifically diagnose Ebstein's anomaly with M-mode echocardiography alone, as each case has not been able to meet with all the criteria for diagnosis, described by various investigators.
Despite being part of one of the few remaining primitive areas of the world, both Sabah and Sarawak are provided with adequate, though simple, urban and rural general medical services. At present no reliable data on the incidence of sexually transmitted diseases in these areas have been collected and no organised treatment services are available. Gonorrhoea appears to be the commonest notifiable infectious disease in Sarawak, and beta-lactamase-producing strains have been isolated. Because of the rapidly expanding economy and the encouragement of the tourist trade, sexually transmitted disease is likely to prove an increasing problem, for which a specialised service for diagnosis and treatment is badly needed.
In the University Hospital, Kuala Lumpur, from 1984 to 1990, 184 patients with acute conjunctivitis were examined for chlamydial infection by direct immunofluorescence. Overall, 52 (28.3%) were found to be positive for chlamydial antigen. There was no significant difference in the detection rate between men and women and among the 3 major ethnic groups. The detection rate was highest among sexually active adults. Epidemiological and clinical features suggest that most of the chlamydial ocular infections seen were inclusion conjunctivitis and not classical trachoma.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The obstetric performance of 240 elderly primigravida delivering at the University Hospital, Kuala Lumpur, Malaysia between January 1987 and February 1990 was compared with a random group of 250 young primigravida delivering during the same time period. The incidence of impaired glucose tolerance, diabetes mellitus, preterm delivery, antepartum haemorrhage and malpresentation was all increased in the elderly primigravida group. The incidence of caesarean section in the older group was 40.4% compared with 6.8% in the younger (p less than 0.001). Recent studies suggest that the perinatal mortality in women who delay having their first baby until after the age of 35 is not significantly different from the rest of the obstetric population. However, in our own population of elderly primigravida, although not quite reaching statistical significance the perinatal mortality rate of 46 per 1,000 is three times that of primigravida aged 20-25. This may reflect our low induction rate (7.5%) and assisted vaginal delivery rate (8.3%) in those women in this high risk group who are allowed to labour. The implications of these findings are discussed.
The clinical response and the histological changes in the mucosa of the small bowel in response to continued feeding with cows' milk protein were assessed over a period of 2-6 weeks in 24 infants who had shown histological changes without immediate clinical symptoms after challenge with a diet containing cows' milk protein. Twenty of the 24 infants (83%) thrived well on cows' milk protein. Jejunal biopsy specimens taken six to eight weeks after the initial biopsy showed histological improvement in all 20 infants compared with biopsy specimens taken soon after the challenge, which had shown mucosal damage. The mucosa had returned to normal in 12, was mildly abnormal in seven, and moderately abnormal in one. Corresponding improvements in the activities of mucosal enzymes were seen. In four of the 24 infants (17%) symptoms developed between three and six weeks. Histological examination of the jejunal biopsy specimens showed that mucosal damage had progressed in two, and remained the same in two; moreover, the disaccharidase activities remained depressed. The present study shows that most infants with enteropathy caused by sensitivity to cows' milk protein but without clinical symptoms develop tolerance to the protein and the mucosa returns to normal despite continued feeding with cows' milk protein.
Frontoethmoidal meningoencephaloceles (FEM) are exceedingly rare in the western hemisphere, Australia, and Europe with an estimated frequency of 1 in 40,000 live births. Among the inhabitants of Thailand, Burma, Malaysia, Indonesia, and parts of the Soviet Union, however, the frequency is as high as 1 in 5000, accounting for 15% of all neural tube defects (NTD). Normal maternal serum alpha-fetoprotein (MSAFP) values usually will be found in these cases since most encephaloceles are closed, skin covered defects. Correct interpretation of the sonographic findings is crucial in establishing a diagnosis as well as giving prognostic and recurrence risk information. To our knowledge, this is the first reported case of prenatally diagnosed FEM. Perinatal management, differential diagnosis for disorders associated with this malformation, and epidemiologic information regarding this rare condition are discussed. It is anticipated that the prenatal sonographic findings may be applied to establish this diagnosis in similarly affected fetuses.
A survey of 25,246 Malay, Chinese and Indian children and adults ranging from birth to over 60 years of age, of both sexes, from 4 types of communities with different conditions of environmental sanitation and socio-economic status revealed an overall incidence of infection with soil-transmitted helminths of 39.6 percent. The incidence of soil-transmitted helminthiasis was highest among rural rubber estates, followed closely by the urban slums or squatter areas and incidence of infection was low in the semi-rural new villages and the urban flats. The commonest helminth in all these areas was Trichuris trichiura and the commonest type of helminthic infection was mixed infections with Ascaris and Trichuris. Infection was most prevalent among Indians, followed closely by Malays. Chinese generally had lower incidences of infection. Soil-transmitted helminthiasis was also more prevalent among the younger age groups, starting from toddlers to 9 years and rising to a peak in the 10-19 years age group. Elderly people (60 years and above) from the squatter areas and some ofthe estates, new villages andflats also had a higher incidence of infection than the older adults (30-59 years). Malay and Indian children (under 15 years of age) having a higher overall incidence of injection also tended to have higher degrees of infection, as estimated by egg counts. There was no significant differences in the distribution of infection between males and females in most of the study areas. However, females in the squatter areas had a higher incidence of infection than males. Conversely, females in some of the flats (Sri Melati and Shaw Road) had a lower incidence of infection than males.
An anthropometric assessment was conducted on a sample of 309 children, aged twelve years and below, from an urban squatter community in Kuala Lumpur, Malaysia. The community consists mainly of Malays and Indians and is fairly established with a mean length of residence of about fifteen years. There was not much difference between the two ethnic groups with regard to educational status or income. Most of the residents were unskilled or semiskilled workers employed in factories and government agencies. About 40 percent of the infants and toddlers were found to be wasted, while about one-third of the older children were stunted. There appears to be some association between income per capita and nutritional status.
All singleton live births occurring in Singapore in the three years 1981-3 were computed, and birthweight was examined in the different ethnic groups (Chinese, Malay, and Indian). Overall the proportions of babies of very low birthweight (less than 1500 g) and low birthweight (less than 2500 g) were: Chinese 0.3% and 6.1%, Malays 0.4% and 8.5%, and Indians 0.5% and 10.0%. The important finding was that in all gestational periods and virtually all maternal age and live birth order groups Indians had the highest proportion of very low and low birthweight babies. However for prematurity Indians at 6.7% had a higher rate than Chinese (5.1%) but lower than Malays (9.9%). Likewise for neonatal mortality Indians at 8.7 per 1000 live births were between Chinese (7.1) and Malays (9.1). The evidence seems to indicate that the reason for Indians having a higher proportion of low birthweight babies is partly ethnic/genetic, and the cut-off point of 2500 g should perhaps be lowered for babies from the Indian subcontinent when international comparisons are being made.
A study was carried out at the University Hospital, Kuala Lumpur, Malaysia to determine the age-specific prevalence of measles infection by serology and the age specific - seroconversion rates following measles vaccination. The results show that the percentage of children with passively acquired measles antibodies decreased with increasing age fill three to five months of age. From 12 months of age, the percentage of positivity increased sharply due probably to natural infection. The geometric mean antibody titre was low at birth, but from six months it started to increase. These results indicate that measles infection is common in Malaysia and a small number of children began to acquire natural measles infection from six to eight months of age; however the peak age for the acquisition of measles infection was from 12 months to five years of age. Seroconversion rates following vaccination from nine months of age, ranged from 94-99%. However, the rates and the geometric mean titre were higher among those vaccinated at 11 months of age or older compared with those vaccinated at nine or ten months of age. Based on the above results, it is concluded that the optimum age for measles immunization in Malaysia should be 11 months.
A report is presented of seven patients with acute septicaemic melioidosis seen at the University Hospital, Kuala Lumpur, Malaysia, during 1976-1979. All had associated disorders which rendered them more susceptible to infection. As prognosis depends on early diagnosis it is important that this disease be considered in the differential diagnosis of a septicaemic illness in such patients from endemic areas. The treatment of choice is a combination of tetracyclines and chloramphenicol, initially used in massive doses, and continued for at least six month to prevent relapses.
Vomiting, drowsiness, metabolic acidosis, polymorphonuclear leucocytosis, and encephalopathy developed in thirteen infants within hours of ingestion of margosa oil. Liver biopsy of one infant and necropsy examination of ICR strain mice after experimentally induced margosa-oil poisoning demonstrated pronounced fatty infiltration of the liver and proximal renal tubules as well as cerebral oedema. Electron microscopy demonstrated mitochondrial damage. These findings indicate that margosa oil may be involved in the aetiology of Reye's syndrome among Indians in Malaysia.
Strict precautions were taken in our methodology to exclude any monocytes from being included in the total T and B cell estimation. There is a progressive drop in the percentage of T and B cells with age, but no significant differences between the races nor between the sexes of the same age group. Aberrancies of T and B cell percentages were noted in most infections, malignancies and even malnutrition.
Dengue hemorrhagic fever (DHF), though endemic in the sixties, emerged as a major public health problem in Malaysia from 1973 onwards. The incidence rate of DHF which was 10.1 per 100,000 in 1973 has fallen down to 1.9 per 100,000 in 1987 with a mean case fatality rate of 6.4 per 100 persons. The Chinese appear to be more prone to DHF with the highest mean morbidity rate of 5.5 per 100,000 and case fatality rate of 6.1%. The incidence of DHF is higher in the males with a higher case fatality rate in females. Male Chinese appear to be mainly affected. The overall age-specific incidence rate is highest in two age groups, viz. 5-9 years and 10-19 years of age with a mean morbidity rate of 4.9 cases per 100,000. The mean age-specific case fatality rate was highest in the 0-4 years age group. Dengue hemorrhagic fever is predominantly an urban disease in Malaysia with a mean incidence rate of 5.3 cases per 100,000 as opposed to 1.2 cases per 100,000 being reported from rural areas. The mean overall incidence of deaths in the urban area is 0.5 compared to 0.1 per 100,000 for rural areas. There is a marked seasonal correlation between DHF cases and rainfall, with a peak in August. While all four serotypes of dengue viruses are found in Malaysia, Den 2 appears to be isolated with greater frequency during all the epidemics.
Publication year=1992-1993