Factors contributing to poor compliance with anti-TB treatment among tuberculosis patients.

Tuberculosis (TB) has made a comeback. It has become a resurgent public health problem in developing countries in the tropics and is the leading cause of death from any single infectious agent. Non-compliance to anti-tuberculosis treatment is the most serious problem in TB control. A cross-sectional study was conducted to investigate the determinants of poor compliance with anti-tuberculosis treatment among tuberculosis patients in Kota Bharu, Kelantan, Malaysia in 1999. A total of 390 patients were included in the study of which 130 were tuberculosis patients who defaulted treatment and 260 were those compliant to treatment. Data collection was done by interviewing the patients and collecting clinical and laboratory data from their medical records. Using multiple logistic regression analysis, patients who were not on direct observed therapy (DOT) lived distant to the health facility, were non-intravenous drug users (IVDU) and were HIV positive had statistically significant higher odds of being non-compliant. Patients should be given treatment under direct supervision with special attention to IVDU and HIV positive groups. Anti-TB treatment should be accessible to patients at the nearest health center from their residence. Interventions with health education programs emphasizing the benefits of treatment compliance should be implemented by further large-scale multicentered studies.

Malaysian antenatal risk coding and the outcome of pregnancy.

OBJECTIVE: Measure the effectiveness of the colour coding system in Malaysia for the prediction of risk in pregnancy. METHOD: Cohort study of records and interviews of 253/279 women examined at first antenatal visit. RESULTS: Nurses' final coding showed poor concordance with guidelines; recoding produced a predictive value of high risk of 48%; 25% of those with low risk had 50% of complications. Complication rates were moderate and intervention rates low. The mothers had little appreciation of risk and preferred home delivery. Home deliveries gave excellent results except for the 17% requiring transfer to hospital during labour or delivery. CONCLUSION: The coding system is ineffective with Malaysia's relatively low reproductive risk. Women require more personalised counseling about risk to make appropriate choices. Better results depend on simpler but consistent selection for hospital delivery using reproductive history, combined with better communication and transport systems for home deliveries and a reorientation within hospitals to rapid emergency care.

Prevalence of sexually transmitted diseases among female drug abusers in Malaysia.

The prevalence of sexually transmitted diseases (STD) among female drug abusers was determined by screening 130 new inmates of a rehabilitation centre. The majority of the subjects (77.7%) were self-confessed sex workers. A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%) and trichomoniasis (19.2%) were noted. Gonorrhoea vaginitis was seen in 8.5%, which was low compared to previous studies. Six subjects were seropositive for human immunodeficiency virus (HIV), with 5 of them admitting to needle sharing and working as prostitutes. More than half of them harboured 2 or more STD. A rich reservoir of STD was seen among the drug abusers. With more evidence now available concerning the ease of HIV transmission associated with ulcerative STD, a stage could be set for greater heterosexual HIV transmission. As part of the rehabilitation process, female drug abusers need a thorough screening for STD followed by aggressive treatment regimens.

PIP: Drug users may be considered to be at high risk for having sexually transmitted diseases (STD). The government of Malaysia has therefore established facilities in which they incarcerate and attempt to rehabilitate such individuals. 5472 drug users had been imprisoned in the country's fourteen facilities by the end of 1991. Since 97.8% of drug users in Malaysia are male, only on facility exists for female users. The authors determined and report the prevalence of STDs among 130 new female resident drug users at the facility. The women were admitted over the period May 1989-July 1991, and 104 were IV-drug users. They were aged 18-44 years, with 87.7% in the 20-40-year range. Further, 77.7% were sex workers and 13.1% were salaried workers in other fields. 50.8% had syphilis, 52.2% hepatitis B, 23.8% moniliasis, 19.2% trichomoniasis, and 8.5% gonorrhea vaginitis. 6 were HIV-seropositive, of whom 5 admitted to needle sharing and prostitution. More than half of the women were infected with 2 or more STDs. STDs were not found in 14.6% of subjects, however, even though 10 acknowledged being sex workers. Given the high prevalence of STDs in this population and the ease of HIV transmission with ulcerative STDs, the authors recommend that incarcerated female drug users be routinely screened and treated for STDs as part of their rehabilitation program.

An evaluation of the hydrogen sulphide water screening test and coliform counts for water quality assessment in rural Malaysia.

The H2S water screening test and the membrane filtration faecal coliform count were compared with Escherichia coli counts for water samples collected from household water sources and domestic drinking water in rural Malaysia. Water samples were taken from 151 wells, 44 taps supplying water from the treated municipal supply and 192 domestic stored water supplies. E. coli were detected in 20% of the samples (42% of wells, 7% of tap water and 6% of drinking water). Excellent correlation (Spearman's rank correlation rs = 0.93) was found between the faecal coliform and E. coli counts for all sample types. The H2S method was poorly correlated whether read at 18 or 30 h. False positive rates were highest for well water, and false negative rates were highest for both well and drinking water samples, with low E. coli counts. The faecal coliform test was an excellent predictor of the presence of E. coli in these water samples, while the H2S test was very inadequate.

Fireworks related injuries during Hari Raya festival in Hospital Universiti Sains Malaysia--1986 to 1990.

A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.

Non-ionizing radiation exposure causing ill-health and alopecia areata.

Three cases of occupational exposure to radio-frequency and microwave radiation were seen at the out-patient clinic, Hospital Universiti Sains Malaysia. They presented with run-down symptoms of neck strain associated with throbbing headache, irritability, loss of appetite, fatigue, memory difficulties, and numbness of extremities. They also presented with alopecia areata which is felt to be causally linked to the radiation exposure.

Knowledge and use of oral rehydration therapy for childhood diarrhoea in Tumpat District.

A community based study was conducted on the understanding and knowledge of childhood diarrhoea and use of oral rehydration therapy (ORT), in four selected villages in Tumpat District, Kelantan. The calculated annual incidence of diarrhoeal disease in children aged 0 to four years in all study villages was 1.38 episodes for each child. The main care-givers of children aged 0 to four years were interviewed and asked to demonstrate how to mix a standard ORS (oral rehydration solution) sachet if they had previously used ORT. Forty percent of care-givers had heard of the locally available ORT and 30% had actually used ORT. Of those who had heard of or used ORT, 10% had good knowledge of what it was and what it was used for, 51% had some knowledge and 39% had either no knowledge or inaccurate knowledge. Of care-givers who had previously used ORT only 20.5% demonstrated the correct volume of water to add to one sachet of ORT, but 82% would discard an unused solution within 24 hours. Significantly more literate women had used ORT than those not literate (p = 0.002). Mothers, particularly those literate, are the primary target group for ORT intervention strategies. Components of health education should include advice on what ORS is, what it is used for, and how to correctly mix a standard sachet.

PIP: In May-June 1988, community medicine professors oversaw interviews of 265 primary caregivers of 0-4 year old children living in 4 villages in Tumpat District in Kelantan State, Thailand, and collected secondary data from the health centers and district hospital serving these villages to identify epidemiological features of childhood diarrhea and knowledge and use of oral rehydration therapy. The annual incidence of diarrhea stood at 1.38 episodes/child. 21 children (5.3%) had diarrhea in the 2 weeks before the interview. Literate mothers were considerably more likely to use oral rehydration solution (ORS) than were illiterate mothers (38.7% vs. 22.6%; p = .002). 40% of all mothers were familiar with ORS, but only 30% had used ORS. 10% of mothers who knew about our used ORS demonstrated strong knowledge of ORS and 39% had no knowledge. ORS usage was highest in village C (55.2% vs. 32.6% for the village with the next highest usage rate) which had the lowest proportion of houses with latrines (8.7% vs. 21.9% for the village with the next lowest proportion) and the second lowest proportion of houses with safe water (3.3% vs. 3.7% and 12.3%). 94.9% of mothers said they could correctly prepare ORS, yet only 20.5% could actually do so (31% in the village with the highest maternal educational level [49.5% vs. 19.2% for the village with the lowest educational level]). Nevertheless, 82.1% of the mothers stating they knew how to prepare ORS knew that they had to throw out the unused prepared solution in less than 24 hours. The study population used 5 different ORS sachets, the most commonly used sachet being that of the Ministry of Health (250 ml). Other ORS sachets included the 200-ml sachet (Eltolit) from the Universiti Sains Malaysia Hospital, an orange flavored Eltolit, and 2 sachets with instructions in English (240 ml and 250 ml). The abbreviation ml confused many of the literate women.

Cholera outbreak in Tumpat, Kelantan-1990.

Two episodes of El Tor cholera outbreak occurred in Tumpat, Kelantan between the 13th of January and the 16th of May 1990. Every case and carrier reported were investigated to determine the source and mode of transmission and to identify specific preventive measures to break the chain of transmission. There were 109 cases and 85 carriers involved in this study. The first episode of one case only was of Inaba serotype while the second episode was caused by the imported Ogawa serotype. Two foci of spread were identified from cluster occurrence but the majority of infection had no discernible link between them. The outbreak became both explosive and protracted indicating poor basic sanitation and personal hygiene. Person-to-person transmission via food and water was the main mode of spread. The Kelantan river water and river clams were confirmed sources of reservoir during the outbreak. Recommendations for prevention are intensified surveillance throughout the year,urgent upgrading of potable water supply and concerted effort in public health education especially against the use of river water and the consumption of raw food.

Cause-specific mortality among Koreans, Chinese and Americans in Japan, 1973-1982.

Mortalities from selected causes from 1973 to 1982 among Koreans, Chinese, and Americans residing in Japan were compared with those of Japanese. In the Korean population, besides the well-documented excess in mortalities from liver cancer, lung cancer, liver cirrhosis and male tuberculosis, a rather prominent elevation was observed for mortalities from female tuberculosis and diabetes mellitus in both sexes. Distinctive features in the Chinese population were increased mortalities from liver cancer and female lung cancer and lowered mortality from stomach cancer, and these findings are consistent with the observations among Chinese in other areas. Mortalities from diabetes mellitus and liver cirrhosis was moderately increased in this population as well. Americans in Japan by and large showed a mortality pattern similar to that in the US although mortality from stroke among female Americans was rather elevated during the period 1973-1977. Epidemiological studies on Koreans and Chinese in Japan with reference to their lifestyle are strongly required.