The spectrum of nasal involvement in systemic lupus erythematosus and its association with the disease activity.

The purpose of this study was to determine the spectrum of nasal involvement in systemic lupus erythematosus (SLE) and its association with the disease activity of SLE based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). This was a cross-sectional and observational study involving 73 stable SLE patients. All subjects were evaluated for the SLEDAI scores and had nasal endoscopic examination. The most commonly reported symptom was nasal congestion (31.5%) followed by nasal itchiness (26.0%), runny nose (20.5%) and nasal dryness (19.2%). Almost half (42.9%) of the subjects had nasal mucosal abnormalities, which included mucositis, crusting, ulceration, bifid middle turbinate, septal spur, Jacobson's organ, deviated nasal septum, bilateral inferior turbinate hypertrophy, everted uncinate process, nasopharynx cleft and torus palatinus. The median SLEDAI score for subjects with nasal symptoms was significantly higher than subjects without nasal symptoms (p < 0.05). Similarly, subjects with moderate to high activity (SLEDAI scores of 6-19) had a significantly higher frequency of both nasal symptoms and nasal mucosal abnormalities (p < 0.05) compared to subjects with no to mild activity (SLEDAI scores of 0-5).

Role of schools of public health on maternal and child health programmes in the Asia-Pacific region.

This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.

The drug abuse problem in Peninsular Malaysia: parent and child differences in knowledge, attitudes and perceptions.

A survey was carried out to gather information on knowledge, attitudes and perception of parents and their children in relation to drug abuse matters. Significantly more teenagers knew more of the cause of drug addiction, as well as places for treatment and rehabilitation. Both teenagers and parents were also aware of reasons why drug addicts find it difficult to change their habits, mainly lacking motivation to stop taking drugs and that drug addicts do not have the power to control themselves. Teenagers were significantly more aware of effects of negative parental attitudes contributing to drug abuse, apart from school factors. Personal experiences before abusing drugs such as knowledge of pleasurable effects of drugs and where to obtain them has also a role to play in leading to drug abuse. There was also agreement that unfulfilled needs such as 'not being respected recognised for ones capabilities' and 'not being loved or treated fairly by parents', were causes of drug abuse. Significantly more teenagers knew of the ways of abusing drugs, mainly by injection, smoking and sniffing, and also sources of information via the mass media, social clubs, rehabilitation centres and schools. However, both the parents and teenagers were relatively ignorant of the long term effects of abusing drugs.

Sexual activities of Malaysian adolescents.

This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.

PIP: The authors examined data on the sexual activities of 1200 Malaysian adolescents aged 15-21 years (mean age, 17.6 years). 792 respondents were male and 408 were female. 748 were students. Of the 1181 unmarried respondents, 9% reported having had sexual intercourse, with males being significantly more experienced than females. Older age groups were more sexually active than younger ones. Among the 521 who had experienced dating, 20% had experienced sexual intercourse, 44% have kissed and necked, 35% experienced petting, and 24% had not been physically intimate. Condoms, oral contraception, and withdrawal were the most commonly employed contraceptive methods among those who were sexually experienced, although the level of contraceptive prevalence was low; only 37% of the sexually active respondents used any form of contraception. The condom was the most common method used. Males began masturbating at the mean age of 14.4 years, compared to girls who began at mean age 15.5. Almost half of those who masturbate are worried by that behavior, especially the females.

Knowledge, attitudes and perceptions related to drug abuse in peninsula Malaysia: a survey report.

Given the magnitude of drug addiction in Malaysia, the government has given top priority to this issue. It is timely that an assessment of knowledge, attitudes and perceptions related to drug abuse and drug dependents among the general public be carried out. Thus, a nationwide survey was undertaken. A representative sample of 2,591 respondents aged 13 years and above from households were surveyed throughout the 11 states and the Federal Territory of Kuala Lumpur in Peninsula Malaysia. The results revealed that the respondents are moderately knowledgeable on drug abuse, especially information pertaining to treatment, rehabilitation and aftercare services, including education to families against drug abuse. The public possess a negative attitude towards drug dependents. Majority felt that drug addicts do not have the will power to rid themselves of drugs and they also lack a supportive family network system. Many believe that the most vulnerable group are the adolescents. Respondents were aware of the type of drugs commonly abused, although they failed to realise their long-term effects. Respondents do not attribute low education, large family and marginal income to the background of drug dependents. The findings showed gaps and misconceptions in terms of knowledge, attitudes and perceptions of the public. Accurate knowledge on, and right attitudes and perceptions towards drug related issues would certainly benefit the public in timely prevention of drug abuse.

Development and evaluation of a computer expert system for the management of fetal distress.

The general lack of specialist obstetricians in a developing country such as Malaysia prompted us to develop a computer expert system for the management of fetal distress in rural hospitals. It was based on accepted production rules and implemented on a microcomputer. The clinical prototype was evaluated by 8 specialist obstetricians and 21 non-specialist doctors involved in obstetric care. The initial impression was that this type of expert system may help in diagnosis, decision-making and teaching.

Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants.

This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.

PIP: Findings from this study conducted in urban Sabah, Malaysia, support the view that migrants, as opposed to natives, are at a disadvantage with regard to education and income and are more exposed to negative environments in Malaysia compared to their home countries. Migrants are found to have less contraceptive use and higher proportions of women who never had prenatal care. Crude birth intervals are found to be similar in both the native population and the migrant population. Migrant women who breast feed are a larger proportion. The comparison of women who used prenatal care suggests that some migrant women use prenatal care late in pregnancy and only register at child health clinics as a means of obtaining citizenship. Pregnancy wastage is similar in both groups of migrant and native women. Infant mortality is higher among births to migrant women, but the differences are not statistically significant. It is suggested that poor living conditions contribute to the higher infant mortality. Logistic models reveal that maternal educational level is a statistically significant predictor of pregnancy wastage and infant mortality. Risk of pregnancy wastage is also significantly affected by household income. Piped water supply and sanitary facilities are insignificant predictors. The lack of a relationship is interpreted as potentially a function of disparity in the time frame of variables. The authors recommend an improvement in access to health care and in living conditions. The study area is primarily rural and the population is scattered, which makes for more difficult delivery and distribution of services. Voluntary use of health care services by migrants needs to be encouraged. Government policy should shift to improving local government capacity to provide health care, improving the responsiveness of relevant public agencies, lowering health care costs, increasing service demand among the poor, promoting private sector cooperation, and encouraging migrant movement to small and intermediate sized cities.

Utilization of maternal and child health facilities by the urban poor of Kuala Lumpur.

A survey conducted to assess the extent which the urban poor in rapidly expanding Kuala Lumpur utilize maternal and child health services available to them. The sample consisted of 1,380 households with children below 6 years and yielded 1,233 children below 6 years of age. 74% of the children had been delivered in government hospitals and 86% of the pregnancies had antenatal care in governmental establishments. 89.2% had BCG immunization before they were 1 year old but 13.3% had not received DPT by that age. Immunization was mainly done in government clinics. The overall immunization coverage for the whole of Kuala Lumpur is expected to be higher than these figures limited to the urban poor. Health planners should increase health facilities in the city to accommodate the expanding population. There is a need to continually campaign for immunization to improve coverage among the urban poor.

Services for urban poor families in Kuala Lumpur, Malaysia: a case study.

With 25% of its population living in over 148 squatter settlements, with a high incidence of communicable diseases, teenage pregnancies, and psychological and familial stress, the city of Kuala Lumpur has sought ways to improve conditions. This article describes one particularly promising approach: community-based centers integrating three socioeconomic components--preschool education, maternal and child health clinics, and income-generating activities.

PIP: The accomplishments of the Sang Kancil Intervention program, a project designed to improve the living conditions of squatter communities in Kuala Lumpur, Malaysia are described. 25% of Kuala Lumpur's population lives in 148 squatter settlements, where life is especially difficult for women and children. Hoping to improve the living conditions of the urban poor, Kuala Lumpur's City hall initiated the Sang Kancil Intervention program. This program contains 3 components: preschool education, maternal and child health, and income generation. The preschool component provides education, food supplements, and medical checkups and treatment to children in the squatter settlements. In order to foster community participation, the teachers of the preschool program are chosen from among the squatter community, and mothers are encouraged to become involved. Evaluations of the preschools reveal positive attitudes from mothers and teachers, high attendance rates, and higher IQ test scores among children attending the preschool than among children not in the program. Sang Kancil has also provided maternal and health services to the squatter communities. Once a week, nurse practitioners set up a clinic providing the following services: immunization, prenatal and postnatal care, health education, nutrition, family planning, and treatment of minor illnesses. Sang Kancil's income-generation program seeks to raise the living standards of poor families by creating employment opportunities for women. Sang Kancil has established companies staffed, owned, and managed entirely by women. Among other things, these companies manufacture toys, batik items, and ceramics. The success of the companies has pushed shareholders above the poverty line.

Illegal abortion: an attempt to assess its cost to the health services and its incidence in the community.

This article describes a study designed to test a method for assessing the cost to the health services of illegally induced abortion and the feasibility of estimating the incidence of induced abortion by a field interviewing approach. The participating centers included three hospitals in Ankara, Turkey; three hospitals in Ibadan, Nigeria; one hospital in Caracas and one in Valencia, Venezuela; and two hospitals in Kuala Lumpur, Malaysia. Hospitalized abortion cases were classified as induced or spontaneous or as "probably induced," "possibly induced," or "unknown" according to a classification scheme comprising certain medical criteria. The sociodemographic characteristics of induced and spontaneous abortion cases were subjected to discriminant function analysis and the discriminating variables best characterizing the induced versus the spontaneous abortion groups were identified for each center. On the basis of this analysis, the "probably" and "possibly" induced and "unknown" categories were further classified as induced or spontaneous abortion, with stated probabilities. Thus an overall estimate is made of the proportion of all hospitalized abortions that can be considered illegally induced outside the hospital. Selected results on costs of induced and spontaneous abortion are shown. The method further tested the feasibility of obtaining valid survey data on abortion from the communities studied by re-interviewing the women hospitalized for induced and spontaneous abortion six months later in their homes. This exercise showed a degree of under-reporting of abortion that varied widely among centers, even among women who had admitted illegal induction at the time of hospitalization. The feasibility of estimating the incidence of illegal abortion by field studies is discussed in the light of these findings.

Population 70 million: a consideration of health aspects.

PIP: A 70 million population for Malaysia by the year 2010 has been officially targeted 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; infant mortality rates are used as the health indicators. In recognition of the relevance of the medical, economic, and education factors to health, trends in Malaysia's population ratio, per capita gross national product (GNP), and rates of school enrollment are also drawn. The characteristics associated with low mortality and high life expectancy are identified as low population growth, high literacy, and high per capita GNP. Whatever the ideology--Malthusian or Marxist--there is no doubt that population is closely linked to development variables, of which health is a part. Linear regressions on West Malaysian trends show a very high correlation between percent school enrollment and number of medical doctors. Selected cross-country comparisons show that the real issue is not the size of the population but its pace of growth and the social and economic climate at the time. The most dramatic reduction in mortalities from 1957-1980 has been for infant mortality rates (IMR), which have fallen from 76 to 25/1000 live births. Significant control over IMRs has been achieved by effective treatment of malaria, smallpox, tuberculosis, whooping cough, and diarrheal diseases. Attempting a prediction on health outcome at population 70 million, various health statistics from selected countries near that population size were compiled. It is apparent that certain relevant features are associated with low infant mortalities and high life expectancy at birth: 1) low population growth rates, crude birth rates, and fertility; 2) high literacy rates; and 3) high per capita GNP. Overall, health improved for the nation as a whole, and this is highly correlated with school enrollment and health service ratios.^ieng