Enhancing diabetic care in the community in Malaysia: need for a paradigm shift

Efforts towards improving the management of diabetes mellitus has grown and progressed. Clinical studies and new drug discoveries have led to better treatment for patients. Most healthcare budgets devote an enormous amount of expenditure for the treatment of diabetes. However, despite all these efforts, the disease continues to grow and has been predicted to be unmanageable in the near future. Thus, there is a dire need to relook the current approaches and policies. “Prevention is better than cure” is definitely the precise solution to this catastrophe. A paradigm shift in strategies for the prevention of diabetes and treatment of its risk factors is an imperative

A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live. Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence. Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire. Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%. Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001)

A population-based study on the prevalence and factors associated with obesity in Selangor

Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity

A national study on the prevalence and factors associated with smoking amongst Malaysians aged 18 years and above

A cross-sectional study was conducted in Malaysia with the objectives of determining the prevalence of smoking in Malaysia, reasons for starting to smoke, age first started to smoke, duration of smoking and to determine the relationship between smoking and age, sex, race, education level, peer influence and parental smoking status. Methods: All residents aged 18 years and above from selected households were included in this study. A standardised pre-tested structured questionnaire was used in this study. Results: The results showed that the overall mean age of the 17, 246 respondents was 38.8 (95% CI= 38.5 - 39.2) years with a range of 18 - 100 years. The majority were Malays (55.5%) followed by Chinese (21.2%) and Indians (11.2%). The age, sex and ethnicity adjusted prevalence of ever and current smokers were 32.0% and 24.9% respectively. The prevalence of ever and current smokers for males was 59.3% and 47.2% respectively. For the females, the prevalence of ever and CUlTentsmokers was 4.8% and 2.7% respectively. The highest ethnicity adjusted prevalence of current smokers was in Malays (28.9%), followed by the Chinese (18.7%). The lowest prevalence was amongst the Indians (16.8%). The highest prevalence of current smokers was found in Kelantan (30.2%), Terengganu (29.7%), Pahang (28.7%) and Kedah (26.9%); the lowest prevalence was in Kuala Lumpur, Federal Teritory (20.4%). The overall mean initiation age of current smokers was 19.2 years (95% CI = 19.1, 19.4 years). The mean initiation age of male current smokers was significantly lower (18.9 years) compared to female current smokers (24.1 years). The mean duration of smoking amongst the current smokers was 18.6 years. Males smoked significantly more cigarettes than the females ( p < 0.00 I). D isc u ssio n : Multivariate logistic regression analysis showed that smoking was significantly associated with age, sex, ethnicity, educational level and peer and family influence

Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects.

Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure 4140 mmHg, diastolic blood pressure490 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of o0.05 was considered to be statistically significant. Results: The overall prevalence of hypertension for subjects aged X15 years was 27.8% (95% confidence interval (CI) 26.9–28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3–31.0) compared with females (26.0%, 95% CI 25.0–27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged X30 years has increased from 32.9% in 1996 to 40.5% in 2004. Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians

A national study on the prevalence of obesity among 16,127 Malaysians

A population-based cross-sectional study was conducted in all states of Malaysia with the aim to determine the prevalence of obesity among Malaysians aged fifteen years and above and factors associated. A stratified two stage cluster sampling design with proportional allocation was used. Trained interviewers using a standardized protocol obtained the weight and height measurements and other relevant information. Subjects with a body mass index ≥ 30 kg/m2 were labelled as obese. The results show that the overall national prevalence of obesity among Malaysians aged 15 years old and above was 11.7% (95% CI = 11.1 - 12.4%). The prevalence of obesity was significantly higher in females (13.8%) as compared to 9.6% in males (p< 0.0001). Prevalence of obesity was highest amongst the Malays (13.6%) and Indians (13.5%) followed by the indigenous group of "Sarawak Bumiputra" (10.8%) and the Chinese (8.5%). The indigenous group of "Sabah Bumiputra" had the lowest prevalence of 7.3%. These differences are statistically significant (p< 0.0001). Logistic regression analysis results show that there was a significant association between obesity and age, gender, ethnicity urban/rural status and smoking status. The prevalence of obesity amongst those aged ≥ 18 years old has markedly increased by 280% since the last National Health and Morbidity Survey in 1996. Conclusion: The overall prevalence of obesity in Malaysia is very high as compared to 1996. There is an urgent need for a comprehensive integrated population-based intervention program to ameliorate the growing problem of obesity in Malaysians

Anemia in pregnancy in Malaysia: a cross-sectional survey

Anemia is the most prevalent nutritional deficiency during pregnancy. Except for a study conducted 10 years ago in Kelantan, Malaysia's available statistics are based on isolated small urban maternity hospital studies from the 1980s. There was therefore, a need for a large study at national level to estimate the magnitude of the problem in the country as well as to understand its epidemiology. This multi-center, cross-sectional study was conducted from February to March 2005, to assess the prevalence of anemia. Multistage stratified random sampling technique was used and 59 Ministry of Health (MOH) primary health care clinics were selected. Our final dataset consisted of 1,072 antenatal mothers from 56 clinics. The overall prevalence of anemia in this population was 35 % (SE 0.02) if the cut off level is 11 g/dL and 11 % (SE 0.03) if the cut-off level is 10 g/dL. The majority was of the mild type. The prevalence was higher in the teenage group, Indians followed by Malays and Chinese being the least, grandmultiparas, the third trimester and from urban residence. After multiple linear regression analysis, only gestational age remained significant. These findings are useful for our Maternal Health program planners and implementers to target and evaluate interventions. Work is in progress for outcomes and cost-effectiveness studies to best tackle this problem. In conclusion, the prevalence of anemia is 35% and mostly of the mild type and more prevalent in the Indian and Malays

A profile study of 1016 drug addicts in Malaysia

Introduction: A cross-sectioned study was carried out on 1016 drug addicts from Johor state to better understand their profile. Methods: A structured questionnaire prepared in three languages was used to collect the data which was analysed using the Statistical Package for Social Sciences. Result& Discussion: The overall mean age of the respondents was 33.8 (95% CI=33.3-34.4) years and ranged from 16 to 61 years. ANOVA post hoc multiple comparison tests showed that was a significant different in the mean age between Malays and Chinese (p<0.0001) and Malays and Indians (p<0.0001). However, there was no significant different in the mean ages between Chinese and Indians (p<0.05). The majority of the respondents were Malay (79.6%) and had secondary education (72.1%) or primary education (21.7%). The majority (79%) was either semi-skilled or unskilled. More than 70% had more than five siblings. About 36% of the respondents had past a history of discipline problem at school. The majority (99.6%) of the drug addicts had smoke before and more than 90% were currently smoking. More than 80% had consumed alcoholic beverages. The majority did not used condom when they had sex. Only 24% stated that they did use a needle or syringe that had previously been used by someone else. Less than 4% had either bleached or boiled the needle or syringe that had previously been used someone else. About 17% were tested positive for HIV. The mean age at which the respondents first started injecting drugs was 21.5 (95% CI=20.7-22.2) years. ANOVA post hoc multiple comparison tests showed that there was no significant different in the mean age of the different ethnic groups at which the respondents first started injecting drugs. The majority (84.2%) of the drug addicts started injecting drugs between 10 and 20 years of age. Friends introduced 80% of drug addicts to drug. The common reasons given for first taking drugs was “I was curious about the feeling of taking drugs(43.6%)”, “ My friends asked me to try” (23.4%), “to release tension” (15.6%) and 5% stated “ to try for fun”, and 3% that they were “depressed”. The majority (64.2%) of drug addicts spend RM500 or more on drug and, more than 10% of them spend as much as RM1000 or more per month. Conclusion: These results indicate an urgent need for a more comprehensive program involving family, schools, communities and the media and aimed at reducing drug abuse

A case control study on risk factors associated with drug addiction amongst Malaysian males

Objectives: Drug addiction poses a significant threat to the health, social and economic fabric of families, communities and nations. The aim of this study was to determine factors associated with drug addiction amongst Malaysian males. Methods: A population-based case control study was carried out in Johor state. Cases were defined as confirmed male drug dependents aged 15 and above. Controls were defined as those aged 15 and above who had never used illegal drugs in their lifetime. A total of 1016 cases were selected at random from a list obtained from the state anti-drug agency and 1106 controls were sampled from a population-based sampling frame. After obtaining verbal consent, they were interviewed by trained graduates. Multiple logistic regression analysis was performed using Stata V8.2. The final model was adjusted for smoking, age, alcohol consumption, importance of religion, ethnicity, education level and self-esteem. Results: The final model had good fit (p>0.05) and good discrimination (AUC=0.94). Compared with those aged 15-19 years, the highest risk was amongst the 20-29 years age group (adjusted OR(aOR) 7.2; 95%CI=3.8,13.7) followed by the 30-39 year age group (aOR 5.4; 95%CI=2.9, 10.2) and 40-49 year age groups (aOR 5.0; 95 %CI=2.6, 9.8). Being an ever-smoker was highly associated with drug addiction (aOR 98.7; 95%CI=28.7, 339.5). Compared with the Chinese, Malays (aOR 7.4; 95%CI=4.9, 11.2) and Indians (aOR 3.8; 95%CI=2. 1,7.0) had a higher risk of drug addiction. Drug addiction was associated with disagreeing "that religion is important as guidance in their life" (aOR 16.2;95 %CI=8.3, 31.9), and a history of alcohol consumption (aOR 7.6; 95%CI=5.6, 10.4). Conclusion: In conclusion the important risk factors associated with drug addiction is smoking, ethnicity, age, education level, alcohol consumption and not giving importance to religion as guidance in their life. However an increased self-esteem (aOR 0.6; 95%CI=0.4,0.5) is protective against drug addiction

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd