exudates and Anemia

Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population.. This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps.. A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.. This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence.. The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.

Topics: Anemia; Child; Ethnicity; Humans; Malaysia; Prevalence; Risk Factors

The haemoglobinopathies and thalassemias represent the most common inherited monogenic disorders in the world. Beta-thalassaemia major is an ongoing public health problem in Malaysia. Prior to 2004, the country had no national policy for screening and registry for thalassemia. In the absence of a national audit, the true figure of the extent of thalassemia in the Malaysian population was largely presumptive from micro-mapping studies from various research workers in the country. The estimated carrier rate for beta-thalassemia in Malaysia is 3.5-4%. There were 4768 transfusion dependent thalassemia major patients as of May 2010 (Data from National Thalassemia Registry).

Topics: Anemia; beta-Thalassemia; Genotype; Malaysia; Phenotype

Anemia in pregnancy is a public health concern. It has been diagnosed in 27% of pregnant women in Malaysia and up to 40% of pregnant women globally. This study aimed to develop and evaluate the effectiveness of an intervention initiative based on the health belief model. The MyPinkMom program was disseminated through a mobile messaging application to pregnant women to educate them on the prevention of anemia in pregnancy. We conducted a two-arm cluster-assignment, single-blinded, randomized control trial at two government antenatal clinics in Selangor. One clinic was randomly chosen as the intervention group, and the other was chosen as the control group. Sixty pregnant women with anemia from the intervention group received the MyPinkMom intervention program in the form of six infographic video clips, and 60 pregnant women with anemia from the control group received routine counseling on anemia in pregnancy. Pregnant women who had anemia secondary to hemoglobinopathy or other chronic diseases were excluded from this study. MANOVA showed significant increases in hemoglobin, knowledge, attitude, subjective norms, and perceived behavioral control scores for adherence to iron supplements, dietary iron, and dietary vitamin C intake (p < 0.001) in the intervention group at week 6. A significant reduction also occurred in dietary tannin intake (p < 0.001) in the intervention group at week 6. The intervention group at week 6 showed a large effect on hemoglobin level increments (partial eta squared, Ƞp2 0.268), dietary iron intake (Ƞp2 0.213), knowledge of anemia in pregnancy (Ƞp2 0.622), subjective norm scores for adherence to iron supplements (Ƞp2 0.167), and reduction in dietary tannin intake (Ƞp2 0.353). Similarly, repeated measures ANOVA showed that changes in hemoglobin levels were significantly different over time (i.e., at baseline, week 6, and week 12) between the intervention and control groups (p < 0.001). Hemoglobin increased rapidly over time among participants in the intervention group but gradually in the control group. To conclude, the newly developed MyPinkMom program that was delivered through a messaging application showed effectiveness in preventing anemia during pregnancy.

Topics: Anemia; Behavior Control; Female; Hemoglobins; Humans; Iron; Malaysia; Pregnancy

Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is ≥20%; however, it is unknown whether the inclusion of folic acid in weekly IFA supplements reduces anemia.. We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone.. In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18-45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome).. At baseline, 84% of women had low folate status (plasma folate < 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) μg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P > 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P < 0.001) were lower at 16 wk than at baseline.. Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.This trial was registered at www.anzctr.org.au as ACTRN12619000818134.

Topics: Anemia; Anemia, Iron-Deficiency; Dietary Supplements; Female; Folic Acid; Hemoglobins; Humans; Iron; Iron Deficiencies; Malaysia

Anemia is a major complication of vivax malaria. Antiphosphatidylserine (PS) antibodies generated during falciparum malaria mediate phagocytosis of uninfected red blood cells that expose PS and have been linked to late malarial anemia. However, their role in anemia from non-falciparum Plasmodium species is not known, nor their role in early anemia from falciparum malaria.. We measured PS immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in Malaysian patients with vivax, falciparum, knowlesi, and malariae malaria, and in healthy controls, and correlated antibody titres with hemoglobin. PS antibodies were also measured in volunteers experimentally infected with Plasmodium vivax and Plasmodium falciparum.. PS IgM and IgG antibodies were elevated in patients with vivax, falciparum, knowlesi, and malariae malaria (P < .0001 for all comparisons with controls) and were highest in vivax malaria. In vivax and falciparum malaria, PS IgM and IgG on admission correlated inversely with admission and nadir hemoglobin, controlling for parasitemia and fever duration. PS IgM and IgG were also increased in volunteers infected with blood-stage P. vivax and P. falciparum, and were higher in P. vivax infection.. PS antibodies are higher in vivax than falciparum malaria, correlate inversely with hemoglobin, and may contribute to the early loss of uninfected red blood cells found in malarial anemia from both species.

Topics: Adolescent; Adult; Anemia; Antibodies, Antiphospholipid; Female; Hemoglobins; Humans; Immunoglobulin G; Immunoglobulin M; Malaria, Falciparum; Malaria, Vivax; Malaysia; Male; Young Adult

Topics: Anemia; Anemia, Iron-Deficiency; Child; Humans; Inflammation; Iron Deficiencies; Malaysia; Malnutrition; Nutritional Status; Pediatric Obesity; Prevalence; Schools; Vitamin A; Vitamin A Deficiency

Older people with chronic kidney disease (CKD) may be anaemic due to various reasons, and they are vulnerable to various consequences. One of the most important causes of anaemia to be recognised in this population is gastrointestinal loss. The outcome can be improved by early detection, careful investigation, and suitable therapies. There is currently no standardised grading scale or reliable indicators to assist clinicians on handling gastrointestinal workup in elderly CKD patients who are anaemic.. A cross-sectional study of 171 people aged 60 and over who had CKD (stages 3-5), including those on Renal Replacement Therapy (RRT) and anaemia. Using oesophagogastroduodenoscopy, colonoscopy, and double balloon endoscopy, we analysed the endoscopic findings and calculated the prevalence of anaemia secondary to gastrointestinal disease. Haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), mean cell haemoglobin (MCH), iron panels, and immuno-faecal occult blood test (iFOBT) were evaluated to predict the diagnostic utility of each parameter in relation to gastrointestinal disorder in the elderly CKD population.. Abnormal endoscopic findings were obtained by upper and lower endoscopy in 98 individuals (57.3%). Upper endoscopy revealed the most prevalent lesions to be gastritis, gastric ulcer, and duodenal ulcer. The upper and lower endoscopies revealed a total of 14.0% malignant and pre-malignant lesions. T-test and receiver-operating characteristic (ROC) curve were performed on all haematological parameters and iron panels. Low ferritin level (less than 100 ng/mL) and combination with low transferrin saturation (less than 20%) have a significant p value less than 0.05. None of these variables had a significant area under the curve (AUC) of more than 0.75.. Positive endoscopic findings of anaemia are common in the older population at various stages of CKD, regardless of age, gender, or race. Malignant and premalignant lesions are not uncommon in older CKD patients. In the older CKD population, GI inflammation and ulceration are common lesions. Serum ferritin and TSAT levels are useful indicators of GI disorder in this population. Endoscopic evaluation as part of anaemia workup in the older people with CKD should not be ruled out.

Topics: Aged; Anemia; Cross-Sectional Studies; Ferritins; Hospitals, Teaching; Humans; Iron; Malaysia; Middle Aged; Renal Insufficiency, Chronic

With the establishment of the International Health Commission in 1913, the Rockefeller Foundation sought governmental partnerships overseas to combat hookworm disease and improve feces disposal practices. In the Madras Presidency in British India, the India Research Fund Association carried out hookworm surveys but failed in its educational efforts to improve feces disposal practices. In British Malaya, the Uncinariasis [Hookworm] Commission to the Orient discovered a syndemic of anemia among Tamil plantation laborers from the Madras Presidency and Chinese laborers from southern China who suffered from hookworm and malarial co-infections. Confronted with the apparent infeasibility of improving feces disposal practices and the obdurate fact of re-infection with hookworm after purgative treatment, the Rockefeller Foundation ended its hookworm initiative in British Malaya without advocating for programmatic intervention against syndemic anemia. The essay concludes with a reflection on the engagement of historians with the syndemic paradigm.

Topics: Ancylostomatoidea; Anemia; Animals; Coinfection; Global Health; Humans; India; Malaria; Malaysia; Syndemic

This study aimed to determine the prevalence of anemia and factors associated with anemia among men in Malaysia. The researchers used data from the 2019 National Health and Morbidity Survey (NHMS). The hemoglobin levels of men aged 15 years and above who gave their consent was measured using the HemoCue

Topics: Aged; Anemia; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Prevalence; Quality of Life; Risk Factors

This study compared the current nutritional status, hemoglobin levels and their associations with soil-transmitted helminth (STH) infections between two categories of Negritos (indigenous): (i) Inland Jungle Villages (IJV) (ii) and Resettlement Plan Scheme (RPS) near town peripheries, decades after redevelopment and demarginalization. A total of 416 Negritos (IJV: 149; RPS: 267) was included for nutritional profiling based on anthropometric analysis. However, only 196 (IJV: 64; RPS: 132) individuals consented to blood taking for the hemoglobin (Hb) measurements. Subsequently, the association of undernutrition and anemia with STH infections were determined based on univariate and multivariate logistic regression analyses. The overall prevalence of stunting, wasting, and underweight amongst children and adolescents (n = 343) were 45.8%, 42.3% and 59.1%, respectively. In adults (n = 73), the prevalence of underweight was low (6.8%) but overweight and obese was prominent (26.0%). For anemia (n = 196), an overall prevalence rate of 68.4% were observed with 80% and 70.4% of children aged 2-6 y/o and aged 7-12 y/o, respectively being anemic. Comparatively, the prevalence of underweight (WAZ) was significantly higher in the RPS versus the IJV (P = 0.03) In the IJV, children aged ≤ 6 y/o and having STH poly-parasitism were associated with underweight (P = 0.01) and moderate-severe T. trichiura infection was associated with anemia. Whilst in the RPS, underweight was highly associated with only T. trichiura infection (P = 0.04). Wasting was significantly associated with young children aged ≤10 in both IJV (P = 0.004) and RPS (P = 0.02). Despite efforts in improving provision of facilities and amenities among the indigenous, this study highlighted a high magnitude of nutritional issues among the Negritos especially those in the RPS and their likely association with STH infections and decades of demarginalization. Joint nutritional intervention strategies with mass anti-helminthic treatment are imperative and urgently needed to reduce the undernutrition problems especially among indigenous children.

Topics: Adolescent; Adult; Anemia; Animals; Child; Child, Preschool; Female; Growth Disorders; Helminthiasis; Helminths; Hemoglobins; Humans; Malaysia; Male; Malnutrition; Nutritional Status; Prevalence; Soil; Thinness; Young Adult

Serious disease outbreaks in cattle are usually associated with blood pathogens. This study aims to detect blood pathogens namely Theileria species, Anaplasma species, Candidatus Mycoplasma haemobos and Trypanosoma evansi, and determine their phylogenetic relationships and haemato-biochemical abnormalities in naturally infected cattle.. Molecular analysis was achieved by PCR amplification and sequencing of PCR amplicons of 18SrRNA gene of Theileria species, 16SrRNA genes of Anaplasma and Mycoplasma species, MPSP genes of T. orientalis and T. sinensis, MSP4 gene of A. marginale, 16SrRNA gene of Candidatus Mycoplasma haemobos, and RoTat1.2 VSG gene of Trypanosoma evansi, in sixty-one (61) clinically ill Kedah-Kelantan x Brahman cattle in Pahang, Malaysia.. A total of 44 (72.13%) cattle were infected with more than one blood pathogen. Theileria species was the blood pathogen with the highest molecular detection rate (72.13, 95% CI 59.83-81.81%). Nucleotide blast analyses of all sequences demonstrated high degree of molecular similarity (98-100%) in comparison with their respective reference sequences. Analysis of 18SrRNA gene sequences of Theileria species and 16SrRNA gene sequences of Anaplasma species revealed Theileria sinensis and Anaplasma platys respectively as additional species detected in these cattle. MPSP-PCR analysis was conducted for further confirmation of T. sinensis. The blood picture of eight infected cattle groups revealed poikilocytosis, anisocytosis, rouleaux formation and degenerative left shift. High mean erythrocyte fragility values were common in infected cattle groups. Anaemia of the macrocytic normochromic type and spherocytes were observed in the T. evansi and Anaplasma platys + Theileria sinensis double species co-infected cattle group. Normocytic normochromic anaemia was observed in the T. sinensis infected cattle group. Significant (p < 0.05) increases in serum liver and kidney parameters, total protein, globulin, total and unconjugated bilirubin and decreased albumin values were observed in the T. evansi infected cattle when compared to clinically healthy cattle.. We present the first evidence of Theileria sinensis-associated bovine anaemia (TSABA) in Malaysian cattle. Because of the high occurrence of bovine theileriosis and detection of A. platys, there is an urgent need for appropriate preventive and control measures against these blood pathogens.

Topics: Anaplasma; Anaplasmosis; Anemia; Animals; Cattle; Cattle Diseases; Female; Malaysia; Male; Mycoplasma; Mycoplasma Infections; Theileria; Theileriasis; Trypanosoma; Trypanosomiasis

Anaemia is a major consequence of malaria, caused by the removal of both infected and uninfected red blood cells (RBCs) from the circulation. Complement activation and reduced expression of complement regulatory proteins (CRPs) on RBCs are an important pathogenic mechanism in severe malarial anaemia in both Plasmodium falciparum and Plasmodium vivax infection. However, little is known about loss of CRPs on RBCs during mild malarial anaemia and in low-density infection.. The expression of CRP CR1, CD55, CD59, and the phagocytic regulator CD47, on uninfected normocytes and reticulocytes were assessed in individuals from two study populations: (1) P. falciparum and P. vivax-infected patients from a low transmission setting in Sabah, Malaysia; and, (2) malaria-naïve volunteers undergoing P. falciparum induced blood-stage malaria (IBSM). For clinical infections, individuals were categorized into anaemia severity categories based on haemoglobin levels. For IBSM, associations between CRPs and haemoglobin level were investigated.. CRP expression on RBC was lower in Malaysian individuals with P. falciparum and P. vivax mild malarial anaemia compared to healthy controls. CRP expression was also reduced on RBCs from volunteers during IBSM. Reduction occurred on normocytes and reticulocytes. However, there was no significant association between reduced CRPs and haemoglobin during IBSM.. Removal of CRPs occurs on both RBCs and reticulocytes during Plasmodium infection even in mild malarial anaemia and at low levels of parasitaemia.

Topics: Adult; Anemia; Complement System Proteins; Erythrocytes; Female; Humans; Malaria, Falciparum; Malaria, Vivax; Malaysia; Male; Middle Aged; Plasmodium falciparum; Plasmodium vivax; Young Adult

Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood.. We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia.. Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia.. EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40.. Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation.

Topics: Adult; Anemia; Biomarkers; Canada; Female; Ferritins; Hemoglobins; Humans; Malaysia; Middle Aged; Nutritional Status; Prevalence; Receptors, Transferrin; Riboflavin; Riboflavin Deficiency; Young Adult

Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water.. This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression.. Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3years old (aOR=7.16; 95% CI=1.07-47.94; p=0.042), anemia (aOR=10.12; 95% CI=1.12-91.35; p=0.039), thrombocytosis (aOR=11.21; 95% CI=2.06-64.33; p=0.005) and ultrasound findings of free fluid (aOR=9.39; 95% CI=1.62-54.38; p=0.012) and left-sided intussusception (aOR=8.18;95% CI=1.22-54.90, p=0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association.. USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study.. Treatment study LEVEL OF EVIDENCE: III.

Topics: Anemia; Child, Preschool; Enema; Female; Health Resources; Humans; Infant; Intussusception; Malaysia; Male; Retrospective Studies; Thrombocytosis; Treatment Outcome; Ultrasonography; Water

Anemia is common among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) and an independent risk factor for renal disease progression. Health economic evidence is important in Malaysia and yet cost and quality-of-life (QOL) data are scarce.. To investigate prevalence, factors associated with anemia, and cost and QOL among T2DM patients with CKD. Here, we present the estimated 1-year cost and QOL related to anemia in this group.. A cross-sectional, observational study was performed at 20 government clinics. Treatment cost was calculated on the basis of resource utilization ascertained through data extracted from medical records and patient recall. QOL was elicited using the short form 36 health survey version 2 questionnaire. Propensity score matching was performed and costs and QOL were analyzed by anemia status and CKD stage.. Data for 816 patients were obtained. The propensity score matching enabled a comparison of 257 patients with and without anemia. Annual treatment costs were significantly higher for patients with anemia (Ringgit Malaysia [RM] 4219 [US $983] vs. RM2705 [US $630]; P = 0.01). QOL scores were lower for patients with anemia but not statistically significant (physical component summary score: 44.8 vs. 46.2; P = 0.052; mental component summary score: 51.3 vs. 51.7; P = 0.562). Costs were higher and QOL lower among CKD stage 5 patients.. This study was the first to examine anemia in this group of patients. Costs were significantly higher among anemic patients compared with nonanemic patients; patients with higher CKD stage 5 fared less well than did those in lower stages. This information suggests the need to increase detection, prevention, and early treatment of anemia when managing T2DM patients, particularly those with CKD.

Topics: Anemia; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Health Care Costs; Humans; Malaysia; Male; Middle Aged; Prevalence; Quality of Life; Renal Insufficiency, Chronic; Risk Factors; Severity of Illness Index; Surveys and Questionnaires

Anaemia is common among the elderly, yet it remains an underresearched clinical condition. This study investigates ethnic differences in prevalence of anaemia and identifies potential factors associated with anaemia in the elderly.. Data from the National Health & Morbidity Survey (NHMS) 2015 conducted by Ministry of Health was analyzed. Haemoglobin levels were measured using point-of-care testing, HemoCue® Hb 201+ System©, from consenting individuals. Demographic information and other clinical information were obtained through a structured questionnaire. Descriptive and multivariate analyses were conducted and significant results were presented as adjusted odds ratio.. A total of 3794 participants aged 60 years and older responded to the anaemia module with a response rate of 93.7%. 64.0% of respondents were of Malay ethnicity, 21.6% were Chinese, 6.1% were Indians, and 8.3% were of other ethnicities. The overall prevalence of anaemia among older people was 35.3%. The highest prevalence of anaemia was found among respondents of Indian ethnicity (45.5%). The Indian (aOR: 1.72; 95% CI 1.26-2.34) and Malay (aOR: 1.25; 95% CI 1.04-1.49) ethnic groups were more likely to be anaemic in comparison to those of Chinese ethnicity. Anaemia in older people was also associated with increasing age, history of hospital admission, and the presence of diabetes mellitus.. Anaemia in the elderly is associated with Indian and Malay ethnicities, increasing age, hospitalization, and diabetes. Our study has identified important information on a common condition which will guide and assist future studies in reducing the burden of anaemia.

Topics: Aged; Aged, 80 and over; Anemia; Cross-Sectional Studies; Ethnicity; Female; Health Surveys; Humans; Malaysia; Male; Middle Aged; Prevalence; Risk Factors

Topics: Anemia; Anemia, Iron-Deficiency; Child; Female; Health Surveys; Humans; Inflammation; Malaysia; Male; Prevalence; Risk Factors

This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors.. This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing.. The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia.. Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.. NMRR-15-660-24324.

Topics: Aged; Anemia; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Humans; Logistic Models; Malaysia; Male; Middle Aged; Prevalence; Primary Health Care; Renal Insufficiency, Chronic; Risk Factors; Severity of Illness Index

Intestinal parasitic infections (IPIs) have been recognized as one of the most significant causes of illness among disadvantaged communities. Many studies have been conducted on the prevalence of IPIs in Malaysia. However, these studies mostly focused on the indigenous groups in Peninsular Malaysia. The present study was conducted to provide the current baseline data on prevalence of IPIs, anaemia, malnutrition and associated risk factors among the indigenous communities in Sarawak, situation at northwest Borneo island of Malaysia. A cross sectional study was conducted among the longhouses communities. Stool samples were obtained and examined for the presence of IPIs using microscopy technique. Haemoglobin measurement was done using a portable haemoglobin analyzer. Malnutrition (i.e., stunting, underweight and wasting) was assessed using the WHO Anthro software. Statistical analysis was carried out using SPSS software. A total of 341participants took part in this study. The overall prevalence of IPIs was 57.5%. Multivariate analysis indicated that the absence of toilets (OR = 1.6; 95% CI = 1.1-2.7; p = 0.002) and close contact with animals (OR = 1.8; 95% CI = 1.3-2.9; p = 0.027) as significant predictors for IPIs. The incidence of anaemia was 36.4%. The incidence of underweight, wasting and stunting were 22.2%, 5.6% and 35.4%, respectively. Multivariate analysis demonstrated that low level of parental education attainment (OR = 1.9; 95% CI = 1.2-3.0; p = 0.006) was identified as significant predictor for anaemia. The incidence of wasting was significantly associated with mild anaemia (OR = 1.2; 95% CI = 0.9-1.7; p = 0.024). Low household income was identified as significant predictor for stunting (OR = 2.1; 95% CI = 9.8-22.2; p = 0.001) and underweight (OR = 1.9; 95% CI = 5.6-18.7; p = 0.037), respectively. Essentially, the present study highlighted that intestinal parasitic infections, anaemia and malnutrition are still prevalent among rural indigenous community in Sarawak. Improvement of socioeconomic status, periodic mass deworming, iron supplementation and health education program should be included in the control and prevention of public health strategies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Animals; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Intestinal Diseases, Parasitic; Malaysia; Male; Malnutrition; Middle Aged; Neglected Diseases; Parasites; Population Groups; Prevalence; Risk Factors; Rural Population; Socioeconomic Factors; Young Adult

In the current study we explored the occurrence of adverse drug reactions (ADRs) to antiretroviral therapy among human immune-deficiency virus (HIV)/AIDS patients. We concluded an observational retrospective study in all patients who were diagnosed with HIV infection and were receiving highly active antiviral therapy from Jan. 2007 to Dec. 2012 at Hospital Pulau Pinang, Malaysia. Patient socio-demographic details along with clinical features and susceptible ADRs were observed during the study period. Out of 743 patients, 571 (76.9%) were men, and 172 (23.1%) were women. Overall 314 (42.2%) patients experienced ADRs. A total of 425 ADRs were reported, with 311 (73.1%) occurring in men and 114 (26.8%) in women, with a significant statistical relationship (P value (P) = 0.02, OR = 1.21). Overall 239 (56.2%) ADRs were recorded among Chinese, 94 (22.1%) in Malay, and 71 (16.7%) in Indian patients, which had a statistically significant association with ADRs (P = 0.05, OR = 1.50). Out of a total 425 among ADRs, lipodystrophy was recorded in 151 (35.5%) followed by skin rashes in 80 (18.8%), anemia in 74 (17.4%), and peripheral neuropathy in 27 (6.3%) patients. These findings suggest a need of intensive monitoring of ADRs in HIV treatment centres across Malaysia.

Topics: Adult; Aged; Anemia; Anti-Retroviral Agents; Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Exanthema; Female; HIV Infections; HIV-Associated Lipodystrophy Syndrome; Humans; Malaysia; Male; Middle Aged; Peripheral Nervous System Diseases; Retrospective Studies; Tertiary Care Centers; Young Adult

Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore.. A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.. Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.. Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.

Topics: Adolescent; Anemia; Anti-Bacterial Agents; Child; Child, Preschool; Drinking Water; Drug Resistance, Multiple, Bacterial; Enterocolitis; Female; Food Contamination; Health Education; Hospitals, Pediatric; Humans; India; Indonesia; Infant; Malaysia; Male; Paratyphoid Fever; Pericardial Effusion; Retrospective Studies; Salmonella paratyphi A; Salmonella typhi; Shock; Singapore; Tertiary Care Centers; Travel; Typhoid Fever; Typhoid-Paratyphoid Vaccines

Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy.. A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013.. A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD.. The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

Topics: Aged; Anemia; Diabetes Complications; Female; Humans; Kidney; Kidney Failure, Chronic; Malaysia; Male; Middle Aged; Prevalence; Quality of Life; Renal Dialysis; Retrospective Studies; Sex Distribution; Sex Factors

To describe outcome and examine factors associated with mortality among human immunodeficiency virus (HIV)-infected children in Malaysia after anti-retroviral therapy (ART).. Retrospective and prospective data collected through March 2009 from children in four different states in Malaysia enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed.. Of 347 children in the cohort, only 278 (80.1%) were commenced on ART. The median CD4 count and median age at baseline prior to ART was 272 cells/μL and 4.2 years (interquartile range (IQR): 1.4, 7.4 years), respectively. The median duration of follow-up was 3.7 years (IQR: 1.8, 6.0) with 32 deaths giving a crude mortality rate of 2.86 per 100 child-years. The mortality rate highest in the first 6 months of ART was 10.62 per 100 child-years and declined to 1.83 per 100 child-years thereafter. On univariate analyses, only baseline median CD4 percentage, weight for age z score, height for age z score and anaemia were significantly associated with mortality. Upon including all four of these predictors into a single multivariate model, only weight for age z score remained statistically significantly predictive of mortality.. Children commenced on ART had high mortality in the first 6 months especially in those with low CD4 percentage, wasting and anaemia. Poor nutritional status is an important independent predictor of mortality in this study. Besides initiating ART therapy, nutritional support and intervention must receive the utmost attention.

Topics: Adolescent; Age Factors; Anemia; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Body Weight; CD4 Lymphocyte Count; Child; Child, Preschool; Female; Follow-Up Studies; HIV Infections; Humans; Infant; Malaysia; Male; Nutritional Status; Prospective Studies; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome

Plasmodium knowlesi is the commonest cause of malaria in Malaysia, but little is known regarding infection during pregnancy.. To investigate comparative risk and consequences of knowlesi malaria during pregnancy, we reviewed (1) Sabah Health Department malaria-notification records created during 2012-2013, (2) prospectively collected data from all females with polymerase chain reaction (PCR)-confirmed malaria who were admitted to a Sabah tertiary care referral hospital during 2011-2014, and (3) malaria microscopy and clinical data recorded at a Sabah tertiary care women and children's hospital during 2010-2014.. During 2012-2013, 774 females with microscopy-diagnosed malaria were notified, including 252 (33%), 172 (20%), 333 (43%), and 17 (2%) with Plasmodium falciparum infection, Plasmodium vivax infection, Plasmodium malariae/Plasmodium knowlesi infection, and mixed infection, respectively. Among females aged 15-45 years, pregnancy was reported in 18 of 124 (14.5%), 9 of 93 (9.7%), and 4 of 151 (2.6%) P. falciparum, P. vivax, and P. malariae/P. knowlesi notifications respectively (P = .002). Three females with knowlesi malaria were confirmed as pregnant: 2 had moderate anemia, and 1 delivered a preterm low-birth-weight infant. There were 17, 7, and 0 pregnant women with falciparum, vivax, and knowlesi malaria, respectively, identified from the 2 referral hospitals.. Although P. knowlesi is the commonest malaria species among females in Sabah, P. knowlesi infection is relatively rare during pregnancy. It may however be associated with adverse maternal and pregnancy outcomes.

Topics: Adolescent; Adult; Anemia; Disease Notification; DNA, Protozoan; Female; Geography; Humans; Malaria; Malaysia; Middle Aged; Plasmodium knowlesi; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Parasitic; Prospective Studies; Tertiary Care Centers; Young Adult

Variations in racial haemoglobin had been previously described in multiple studies locally and abroad. This study was conducted to quantify the differences in haemoglobin of booking primigravidae amongst the three major races in Malaysia at the antenatal clinic of University Malaya Medical Centre, Kuala Lumpur.. One year prospective study of booking full blood count sample of primigravidae taken in one centre was conducted. Multiple comparative analyses of the booking haemoglobin were performed using the One-way ANOVA comparative mean test in each trimester. 622 primigravidae without any known history of haematological disorders were recruited into the study. The mean haemoglobin for the Indian race was the lowest compared to the two other races in the second and the third trimesters, and it was found to be statistically significant lower (p- value 0.001) than the Malay race in the second trimester. It was also found that the Indian race had a significantly higher incidence of moderate to severe anaemia (p- value: 0.029). The prevalence of anaemia in our study population is also significantly higher in the Indian population (p- value: 0.01).. The findings from this study have established that there is racial preponderance to anaemia in pregnancy. The Indian race is at a higher risk of having anaemia in pregnancy particularly in the second trimester.

Topics: Adult; Anemia; Female; Genetic Variation; Hemoglobins; Humans; Malaysia; Pregnancy; Pregnancy Complications, Hematologic; Prevalence; Prospective Studies; Racial Groups

Apart from occasional reports of clinical disease affecting horses, there is no information about Trypanosoma evansi in horses in Peninsula Malaysia. Thus, a cross-sectional study was conducted in eight states in Peninsula Malaysia to determine the active presence of T. evansi in horses. A total of 527 blood samples were obtained and examined by haematocrit centrifugation technique (HCT), Giemsa-stained thin blood smear (GSS), morphometric measurements, polymerase chain reaction (PCR) and cloning of PCR products. The results showed an overall parasitological prevalence of 0.57% (3/527, CI: 1.6-0.19%) with both HCT and GSS. Morphometric study revealed the mean total length of the trypanosomes including the free flagellum was 27.94 ± 2.63 μm. PCR successfully amplified a trypanosome specific 257 bp in 1.14% of samples (6/527, CI: 2.4-0.52%) and was confirmed by nucleotide sequences. The mean packed cell volume (PCV) for the positive cases detected by HCT was lower (23% ± 7.00) compared to the positive cases detected by PCR alone in the state of Terengganu (35% ± 4.73). In conclusion, this study showed T. evansi infection occurred in low frequency in horses in Peninsula Malaysia, and anaemia coincided with parasitaemic animals. PCR is considered as a sensitive diagnostic tool when parasitaemia is undetectable. The slight lengthier mean of parasite and anaemia may indicate a virulent strain of T. evansi circulating throughout the country. Thus, it's highly recommended to shed light on host-parasite relationship for better epidemiological understanding.

Topics: Anemia; Animals; Blood; Clinical Laboratory Techniques; Horse Diseases; Horses; Malaysia; Parasitology; Prevalence; Trypanosoma; Trypanosomiasis; Veterinary Medicine

Given that micronutrient deficiency, neglected intestinal parasitic infections (IPIs) and poor socioeconomic status are closely linked, we conducted a cross-sectional study to assess the relationship between IPIs and nutritional status of children living in remote and rural areas in West Malaysia.. A total of 550 children participated, comprising 520 (94.5%) school children aged 7 to 12 years old, 30 (5.5%) young children aged 1 to 6 years old, 254 (46.2%) boys and 296 (53.8%) girls. Of the 550 children, 26.2% were anaemic, 54.9% iron deficient and 16.9% had iron deficiency anaemia (IDA). The overall prevalence of helminths was 76.5% comprising Trichuris trichiura (71.5%), Ascaris lumbricoides (41.6%) and hookworm infection (13.5%). It was observed that iron deficiency was significantly higher in girls (p = 0.032) compared to boys. Univariate analysis demonstrated that low level of mother's education (OR = 2.52; 95% CI = 1.38-4.60; p = 0.002), non working parents (OR = 2.18; 95% CI = 2.06-2.31; p = 0.013), low household income (OR = 2.02; 95% CI = 1.14-3.59; p = 0.015), T. trichiura (OR = 2.15; 95% CI = 1.21-3.81; p = 0.008) and A. lumbricoides infections (OR = 1.63; 95% CI = 1.04-2.55; p = 0.032) were significantly associated with the high prevalence of IDA. Multivariate analysis confirmed that low level of mother's education (OR = 1.48; 95 CI% = 1.33-2.58; p<0.001) was a significant predictor for IDA in these children.. It is crucial that a comprehensive primary health care programme for these communities that includes periodic de-worming, nutrition supplement, improved household economy, education, sanitation status and personal hygiene are taken into consideration to improve the nutritional status of these children.

Topics: Anemia; Animals; Child; Child, Preschool; Cross-Sectional Studies; Female; Helminths; Humans; Infant; Iron Deficiencies; Malaysia; Male; Neglected Diseases; Parasitic Diseases; Prevalence; Rural Population; Socioeconomic Factors

Anemia is one of the most frequent hematological demonstration of malignant diseases, leading to impairment of function in all tissues and organs of cancer patients and associated with serious stress. This major problem may be exacerbated by radiotherapy or chemotherapy. It is characterized by lower hemoglobin (Hb) level or inadequate circulating red blood cells (RBCs). The present study evaluated the effectiveness of treatment guidelines for anemia among solid cancer patients in Penang hospital and to find associations between treatments and anemia onset and severity.. This is a retrospective observational study was conducted on 534 cancer patients with anemia who were admitted to a government hospital on Penang island i.e., Penang General Hospital in the period between 2003 to 2009.. Effectiveness of standard anemia treatment guidelines was not sufficient because correction of anemia was just temporary.. According to the results, erythropoietin must be used as a cornerstone even for patients who suffer from moderate anemia and blood transfusion should be used just for emergency cases when anemia leads to a critical situation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Antineoplastic Protocols; Disease Management; Erythropoietin; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome; Young Adult

Domestic maid violence is an assault and coercive behaviour, which mainly includes physical, psychological and at times sexual too, by employer or household members of employer against a person hired as a domestic help. Maid abuse is well known but poorly documented in scientific literature. This is an important global issue. In this article, two illustrated cases of maid abuse are discussed. Their employers allegedly subjected both the victims to physical and psychological trauma. The physical examination of the victims showed poor state of clothing, nutrition, and presence of injuries of different duration. The bruises were irregular to patterned, and were inflicted by beating. Both cases had eczematous contact dermatitis over palms and soles, paronechia, and sub-ungal fungal infection due to unprotected working in wet conditions. In both cases, external ears were deformed like cauliflowers due to repeated trauma. All cases had multiple injuries of varying duration. In this paper, medico-legal and social issues related to maid abuse are also discussed in detail. A possible solution to minimise maid abuse is also suggested. This paper highlights and document maid abuse.

Topics: Adult; Anemia; Contracture; Dermatitis, Contact; Dermatomycoses; Domestic Violence; Ear, External; Edema; Female; Finger Joint; Forensic Medicine; Household Work; Humans; Hypoproteinemia; Malaysia; Malnutrition; Nail Diseases; Physical Exertion; Wounds and Injuries

In this study, we compared the platelet count with erythrocyte sedimentation rates (ESR) in patients with tuberculous spondylitis to evaluate the correlation. This was a retrospective 3-year study covering January 2004 to December 2006 at the Hospital Universiti Sains Malaysia. Platelet counts, hemoglobin levels, ESR, peripheral blood counts and peripheral blood smears on 17 patients with tuberculous spondylitis were obtained. The ages of the patients ranged from 20- to 70-years-old. The male to female ratio was 3.2:1. The majority of the patients were anemic (88.2%) and 52.9% of the patients had thrombocytosis. All the patients had normal lymphocyte counts and a high in ESR at diagnosis. There was a linear correlation between the platelet count and ESR (r = 0.60, p < 0.01). The platelet count was also significantly correlated with the hemoglobin level (r = -0.6, p < 0.02). The degree of thrombocytosis was related to the degree of inflammation measured by the ESR. Thrombocytosis also correlated with the hemoglobin level. We suggest that evaluating hematological values in suspected cases of tuberculosis should be considered. The presence of hematological changes should raise the suspicion of tuberculosis in spondylitis patients.

Topics: Adult; Aged; Anemia; Blood Sedimentation; Female; Hospitals, University; Humans; Malaysia; Male; Middle Aged; Platelet Count; Retrospective Studies; Thrombocytosis; Tuberculosis, Spinal; Young Adult

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.

Topics: Adolescent; Adult; Anemia; Cross-Sectional Studies; Ethnicity; Female; Gestational Age; Hemoglobins; Humans; Malaysia; Maternal Nutritional Physiological Phenomena; Nutrition Assessment; Nutritional Status; Parity; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Care; Prevalence; Rural Population; Social Class; Urban Population

The pathogenesis of fatal cerebral malaria (CM) is not well understood, in part because data from patients in whom a clinical diagnosis was established prior to death are rare. In a murine CM model, platelets accumulate in brain microvasculature, and antiplatelet therapy can improve outcome. We determined whether platelets are also found in cerebral vessels in human CM, and we performed immunohistopathology for platelet-specific glycoprotein, GPIIb-IIIa, on tissue from multiple brain sites in Malawian children whose fatal illness was severe malarial anemia, CM, or nonmalarial encephalopathy. Platelets were observed in 3 locations within microvessels: between malaria pigment and leukocytes, associated with malaria pigment, or alone. The mean surface area of platelet staining and the proportion of vessels showing platelet accumulation were significantly higher in patients with CM than in those without it. Platelet accumulation occurs in the microvasculature of patients with CM and may play a role in the pathogenesis of the disease.

Topics: Anemia; Blood Platelets; Brain; Cerebral Arteries; Cerebral Veins; Child; Hemeproteins; Humans; Immunohistochemistry; Leukocytes; Malaria, Cerebral; Malaysia; Microcirculation; Platelet Glycoprotein GPIIb-IIIa Complex

A cross-sectional survey of 365 individuals, (51.9% males, 48.1% females; ages 5-85 years), from five remote interior communities in upper Rejang River basin Sarawak, Malaysia, found 24.4% were anemic. The range and mean of Hb concentration in male and female were: 7.2-17.0 mg/ml and 13.7 mg/ml and 7.9-15.7 mg/ml and 12.9 mg/ml respectively. Amongst the five tribes surveyed, the prevalence of anemia (range: 10.6-46.7%), was higher among the Penans (46.7%), Kenyahs (31.1%), Kajangs (27.8%) and Kayans (19.3%), than amongst the Ukits (10.6%). Anemia is more common among males >40 years and among adolescents and young reproductive females, as well as elderly females > 61 years old. Of the 83 anemic individuals, 6.0% and 3.6% had Trichuris trichiura or hookworm respectively; however there is no clear association with intestinal worm infection.

Topics: Adolescent; Adult; Anemia; Child; Female; Humans; Intestinal Diseases, Parasitic; Malaysia; Male; Middle Aged; Prevalence

Despite concerns about adverse effects, chloramphenicol (CMC) continues to be used in certain situations and, due to its low therapeutic index and variable pharmacokinetics, therapeutic drug monitoring (TDM) is often recommended. At our centre, CMC finds applications in typhoid and meningitis and TDM is routinely performed. Elsewhere in Malaysia, however, CMC is used without TDM. We therefore decided to evaluate our TDM for CMC in relation to its roles in CMC therapy in children, who constitute most of our patients. Our objective was also to develop strategies to improve our TDM for CMC use. Data were collected from 168 children given CMC for various indications and monitored by the TDM service. Plasma CMC was determined by HPLC and used to adjust doses to maintain concentrations within a range of 10-25 micrograms/ml. Outcomes measured included daily temperatures and haematological indices. Daily doses and plasma CMC varied greatly. Doses averaged 40.5 mg/kg for neonates and 75.5 for older children. Average peak concentrations were therapeutic in 60% and trough in 42%. Average duration of fever was 6.3 days and it was unaffected by plasma CMC. Typhoid was eradicated in 97% but nine children with other diagnoses died. Side-effects were confined to mild reversible haematological abnormalities which developed in 11% of children at plasma concentrations which tended to be high. We conclude that CMC remains useful in children with typhoid. Its use for other indications, however, should be reviewed. Routine TDM for CMC is probably not warranted, at least until a clearer role is defined by well designed prospective studies.

Topics: Anemia; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Drug Monitoring; Humans; Infant; Infant, Newborn; Leukopenia; Malaysia; Meningitis, Bacterial; Salmonella typhi; Thrombocytopenia; Typhoid Fever

A cross-sectional study was undertaken to determine the clinical profile, haematological and biochemical changes, seroprevalence of common opportunistic pathogens, and AIDS-defining events in 49 Malaysian male drug addicts with HIV infection. Their mean age was 33.2 years, the majority had been injecting drugs for more than 5 years and 88% reporting sharing needles. Fatigue, weight loss and night sweats were common presenting symptoms and the most frequent physical findings were hepatomegaly (57%), lymphadenopathy (35%) and thrush (29%). Pulmonary infections were the commonest complications seen (61%) and of these, 13 had septic pulmonary emboli, 7 had bacterial pneumonias, 7 had pulmonary tuberculosis, and 4 had Pneumocystis carinii pneumonia. Eight patients had infective endocarditis and 5 had infected pseudoaneurysm in the groin. Anaemia (82%), leucocytosis (53%), hypoalbuminaemia (43%), hyperglobulinaemia (88%), elevated liver enzymes and hyponatraemia (57%) were frequent laboratory findings. The prevalence of HCV, HBV, cytomegalovirus and toxoplasma infection (by serology) were 100%, 12.2%, 72.7% and 59% respectively. All 7 patients with AIDS (4 P. carinii pneumonia, 2 extrapulmonary tuberculosis, and one oesophageal candidiasis) presented with their AIDS-defining illness, suggesting that HIV-infected intravenous drug user (IVDU) patients present late in the course of the disease.. A cross-sectional study of a cohort of 49 male human immunodeficiency virus (HIV)-infected intravenous drug users attending the Infectious Diseases Unit of the National University of Malaysia during 1991-94 yielded a clinical profile of these patients. The mean age of respondents was 33.2 years and the mean duration of intravenous drug use was 12.7 years. On average, these men had known of their HIV-positivity for 53.2 weeks. Intravenous drug use was the only reported HIV risk factor in 34 men (69%). Clinical symptoms at intake included fatigue (49%), weight loss (47%), night sweats (31%), fever (14%), and diarrhea (6%), while clinical findings included hepatomegaly (57%), lymphadenopathy (35%), and oral thrush (29%). Anemia (82%), leucocytosis (53%), hypoalbuminemia (43%), hyperglobulinemia (88%), elevated liver enzymes and hyponatremia (57%) were frequent laboratory findings. The prevalences of hepatitis B virus, cytomegalovirus, and toxoplasma infection were 12.1%, 72.7%, and 59%, respectively. A total of 91 diagnoses were made in these 49 patients: most common were pneumonia, tuberculosis, bacteremia, infective endocardiditis, mycotic aneurysm, and psychiatric disorders. The mean duration of known progression to acquired immunodeficiency syndrome (AIDS) in the 7 patients at this stage was 391 days. Pneumocystis carinii pneumonia was the most common AIDS-defining illness. Three months into the study, 19 men (57%) had defaulted, reflecting the difficulties of involving drug addicts in research and intervention projects. Moreover, 16 patients (33%) were first confirmed HIV-positive at presentation to the hospital, suggesting that many drug users' HIV status remains unknown until they develop symptoms requiring hospital care.

Topics: Adult; Anemia; CD4 Lymphocyte Count; CD4-CD8 Ratio; Cross-Sectional Studies; Follow-Up Studies; HIV Infections; Humans; Malaysia; Male; Substance Abuse, Intravenous; Substance-Related Disorders

A comparative study was done to determine the profile of vitamin B12 and folate status in Malaysians during two different periods. For the period of 1987/88, we analysed a total of 9,162 cases (inpatients) referred for vitamin B12 estimation and 10,290 cases for folate estimation. We found that 2.6% were vitamin B12 deficient and 31.2% were folate deficient. For the period of 1992/93, of the 9,962 cases assayed, 8.2% were found to be vitamin B12 deficient whereas 7.6% of the 10,355 cases referred were folate deficient. Vitamin B12 and folate were assayed either using microbiological or radioassays. These findings indicate that there appears to be a change in the status of both vitamin B12 and folate over the five year interval.

Topics: Anemia; Folic Acid Deficiency; Humans; Malaysia; Prevalence; Vitamin B 12 Deficiency

Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.

Topics: Abortion, Spontaneous; Anemia; Female; Hemorrhage; Humans; Hyperemesis Gravidarum; Hypertension; Malaysia; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Pregnancy, Ectopic

Recent trends in population indicators that relate to food, nutrition, and nutritionally related health situations in Malaysia are reviewed. The overview is supplemented when possible with data obtained from recent community level nutrition assessment surveys. The death rate of children 1-4 years has for many years been accepted as a rough indicator of protein calorie malnutrition. Along ethnic lines, the Malays suffer the highest toddler mortality, being 2.91/1000 compared to 2.38 for Indians and 1.18 for the Chinese for 1978. There is also considerable variation in total mortality rate (TMR) from state to state. If one examines the annual percentage rate of decline of TMR over the 1957-1967 and 1968-1978 periods, one finds that while the average annual percentage decline in TMR was higher for the predominantly urban Chinese during the 1st decade after Merdeka, this is now reversed in favor of the predominantly rural Malay population. During 1978, the national incidence for low birth weight was 17.5% in Indians, 10.8% in Malays, and 7.9% in Chinese. Calorie availability per capita daily has increased from a mean of 2453 during 1961-1970 to 2550 during 1971-1978. Similarly, protein availability has also increased, albeit marginally, from 50 g to 52 g for the corresponding periods. Expressed as % of requirement, calorie avilability now stands at around 123%; protein availabiltiy is at 108%. The food balance sheet analysis gives no indication of the unequal distribution of food between the various socioeconomic groups. Segments of the community with extreme availabilties of calorie and protein, associated with inadequacies or excesses are bound to exist. For the purposes of national planning, the per capita daily availability of calories and protein should be aimed at levels that well exceed their estimated requirements in order to allow for unequal distribution and plate waste. The community nutritional assessments showed that although the prevalence of acute malnutrition in the form of moderate "wasting" was low (1-3%), the moderate forms of chronic malnutrition as manifested by "underweight" (12-37%) or "stunting" (5-36%) were relatively common. There was also a moderate prevalence of anemia (16-33%). In rural Malaysia and the urban squatter areas, the presence of helminthic parasites such as ascaris and trichuris is ubiquitous. Continued efforts should be directed to the improvement of the nutritional health of both rural and urban pover

Topics: Anemia; Child, Preschool; Female; Food Supply; Health Status Indicators; Humans; Infant; Infant Mortality; Malaysia; Male; Nutritional Physiological Phenomena; Protein-Energy Malnutrition; Socioeconomic Factors

Topics: Anemia; Child; Child, Preschool; Ethnicity; Female; Food Supply; Humans; Infant; Infant, Newborn; Intestinal Diseases, Parasitic; Malaysia; Nutrition Disorders; Nutrition Surveys

Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.

Topics: Anemia; Body Weight; Child, Preschool; Developing Countries; Diarrhea, Infantile; Family Characteristics; Hospitalization; Humans; Immunization Schedule; Infant; Infant Mortality; Infant Nutritional Physiological Phenomena; Life Style; Malaysia; Pneumonia; Protein-Energy Malnutrition; Socioeconomic Factors

This study presents clinical observations in pregnancy made on aborigines of the deep jungle and "outside" populations. Migration out of the jungle results in lowered nutritional status as a result of low socio-economic status in the "outside" aborigine. This, together with food habits, increased family size and higher incidence of helminthic infestations, results in lower mean values of Hb, PVC and MCHC and a higher prevalence of anaemia in pregnancy in the migrant aborigine. A higher population density in the "outside" population resulting in frequent intermingling and increased chances of cross-contamination probably explains the increased vaginal bacterial growth in the "outside" Aborigine women. A higher prevalence of vaginal candidiasis in the "outside" aborigine woman is probably related to exposure to oral contraceptives and broad-spectrum antibiotics. On the other hand, better medical and obstetrical services become more readily available to the "outside" aborigine and this results in a favourable influence on perinatal health.

Topics: Anemia; Birth Weight; Candidiasis; Delivery of Health Care; Diet; Ethnicity; Family Planning Services; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Malaysia; Male; Native Hawaiian or Other Pacific Islander; Parasitic Diseases; Parity; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Sanitation; Socioeconomic Factors; Transients and Migrants; Trichomonas Infections

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Birth Weight; Blood; Diet; Female; Fetal Death; Hemoglobins; Hemolysis; Hemorrhage; Humans; Malaysia; Nutrition Disorders; Parasite Egg Count; Pregnancy; Pregnancy Complications, Hematologic; Socioeconomic Factors

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Asian People; China; Diet; Erythrocytes; Erythropoiesis; Ethnicity; Female; Folic Acid; Hemoglobinometry; Humans; India; Malaysia; Neutrophils; Parity; Pregnancy; Pregnancy Complications, Hematologic; Racial Groups; Singapore; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Anemia; Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Asian People; Autoantibodies; Autoimmune Diseases; Blood Transfusion; Child; Cold Temperature; Coombs Test; Hemagglutination; Humans; Malaysia; Prednisolone

Topics: Anemia; Anemia, Hemolytic; Biomedical Research; Genetics; Glucosephosphate Dehydrogenase Deficiency; Glucosephosphates; Hemoglobinuria; Leprosy; Malaysia; Pharmacology; Sulfones

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Ethnology; Female; Humans; Infant; Infant, Newborn; Iron; Leukemia; Malaysia; Postpartum Period

Topics: Anemia; Female; Humans; Malaysia; Morbidity; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic

Topics: Anemia; Anemia, Hypochromic; Female; Humans; Infant Mortality; Malaysia; Maternal Mortality; Maternal Welfare; Obstetrics; Postpartum Hemorrhage; Postpartum Period; Pre-Eclampsia; Pregnancy; Rural Health; Statistics as Topic; Vital Statistics

Topics: Anemia; Anemia, Sickle Cell; Asian People; Erythrocytes, Abnormal; Humans; Malaysia

Topics: Anemia; Anemia, Megaloblastic; Epinephrine; Humans; Malaysia; Vitamin B 12 Deficiency; Vitamins

Topics: Ancylostomiasis; Anemia; Hookworm Infections; Humans; Malaysia

Topics: Anemia; Animals; Culicidae; Female; Malaysia; Pregnancy; Pregnancy Complications; Tracheophyta

Topics: Anemia; Bone Marrow; Humans; Malaysia

Topics: Anemia; Anemia, Hypochromic; Humans; Iron; Malaysia; Prevalence

Topics: Anemia; Animals; Culicidae; Deficiency Diseases; Humans; Malaysia; Tracheophyta