A 10-Year Impact Evaluation of the Universal Salt Iodization (USI) Intervention in Sarawak,Malaysia, 2008–2018

A universal salt iodization (USI) was introduced in Sarawak, Malaysia in 2008 to control the iodine deficiency disorders (IDD) among its population. The purpose of this study is to evaluate the impact of the USI among school children in Sarawak after 10 years of implementation. The data were extracted from 2008 and 2018 Sarawak state-wide IDD surveys. Briefly, both surveys were cross-sectional surveys covering information on the socio-demographic, status of goitre, urinary iodine, and the amount of iodine in the salt samples. A total of 1104 and 988 between the ages of 8 and 10 were involved in the 2008 and 2018 surveys, respectively. The overall prevalence of goitre among the school children in Sarawak was significantly lower in 2018 (0.1%) compared to 2008 (2.9%). The median urinary iodine concentration (UIC) in urine samples had risen significantly from 102.1 µg/L in 2008 to 126.0 µg/L in 2018. In terms of iodine content in salt samples, the median concentration improved significantly in 2018 (35.5 µg/L) compared to 2008 (14.7 µg/L). After 10 years of USI implementation in Sarawak, the results from both surveys confirmed the effectiveness of mandatory USI in increasing the nutritional iodine status of school children in Sarawak.     

Asylum blues: staff attitudes towards psychiatric nursing in Sarawak, East Malaysia

This paper draws upon findings from an ethnographic study of psychiatric service users in a psychiatric institution in Sarawak, East Malaysia. Findings focus primarily on the accounts of nursing staff in relation to attitudes towards psychiatric work and patients. These indicate that despite a rhetoric of decentralized services, a custodial 'asylum' model continues to influence the care of patients at many levels. Negative professional attitudes towards patients lead to issues of both moral and physical containment. However, an associated attitude of stigma and prejudice towards mental illness impacts upon how attractive a career in psychiatric nursing is perceived to be by respondents, subject to gender differentials.     

Evaluation of the Healthy Village program in Kapit district, Sarawak, Malaysia

Sarawak, Malaysia has a large population of ethnic minorities who live in longhouses in remote rural areas where poverty, non-communicable diseases, accidents and injuries, environmental hazards and communicable diseases all contribute to a lower quality of life than is possible to achieve in these regions. To address these issues and improve the quality of life for longhouse people, the Kapit Divisional Health Office implemented the World Health Organization's Healthy Village programme in 2000. An evaluation was undertaken in 2003 to determine physical and behavioural changes resulting from the programme. The main changes evaluated were those involving smoking habits, exercise habits, health screening, fire safety, environmental improvements and food preparation and hygiene. A qualitative evaluation was conducted using participant observation and key-informant interviews, focus groups and observation. Results indicate that the programme is inspiring changes in various behavioural and physical characteristics of the study population. It is clear that the Healthy Village programme is a widely accepted way of improving health outcomes in longhouses, and that it is succeeding in making beneficial health changes.     

Epidemiology of abdominal aortic aneurysm in an Asian population

Background: Abdominal aortic aneurysms (AAA) are common in the Caucasian population. Apart from reported differences in the occurrence of AAA in the black and white populations, there are few studies on the incidence of AAA in the Asian population. Methods: A prospective database of all patients with AAA seen between 1996 and 1999, in the South‐East Asian state of Sarawak in Borneo Island, was analysed. The demographic data included patient's age, sex, ethnic group, date of diagnosis, comorbidities, presentations and treatment outcomes. These were compared with the state population's demographic statistics. Results: Diagnoses of AAA were made in 123 patients during the study period. The male to female ratio was 3.5 : 1. The age range was 39?88 years with a median age of 70 years. Four patients were younger than 55 years. The incidence rate for the at‐risk male population older than 50 years was 25.6/100 000. The incidence rate reached 78.3/100 000 for males older than 70 years. The incidence rate for females older than 50 years was 7.6/100 000 and for those older than 70 years it was 18.7/100 000. All races were affected. Smoking, hypertension or respiratory disorders were present in more than 40% of the patients. Half of the patients underwent surgical repair. Conclusion: This study shows that AAA in this Asian population is not uncommon and the incidence is comparable to the Western world.     

Nasopharyngeal carcinoma among the Bidayuh of Sarawak,Malaysia: History and risk factors

Nasopharyngeal carcinoma (NPC) is a cancer of the epithelial cells lining the nasopharynx. The incidence of NPC has a distinct geographical distribution, mainly affecting the Chinese population of Southern China. In Malaysia, this cancer is exceptionally prevalent among males. There is a high incidence rate of NPC among the Bidayuh natives in Sarawak, Malaysia. Other than epidemiology reports, there has not been an article describing plausible cancer risk factors contributing to NPC within this native group. Researchers are still trying to understand the reasons the Bidayuh and Southern Chinese are highly susceptible to NPC. This article discusses the risk factors of developing NPC: Epstein-Barr virus infection, genetic predisposition, diet, environmental exposure and tobacco smoking. There is a need to improve the understanding of the role of risk factors to identify new ways to prevent cancer, especially among high-risk groups.     

Time series modelon hand,foot and mouth disease in Sarawak,Malaysia

ObjectiveTo model and forecast hand, foot and mouth disease (HFMD) cases since there has not been any studies on time series modelling of HFMD in Sarawak, Malaysia.MethodsThe longitudinal data of HFMD collected over the past 7 years (2006-2012) showed a cyclical pattern of outbreak every 2 to 3 years. The data consisted of weekly number of HFMD reported cases from 2006 to 2012. An auto regressive moving average (ARMA) model was fitted to the data. Batting average was used to measure the performance of our forecast for 2013.ResultsThe results indicate that ARMA model fit the trends of HFMD in Sarawak very close to the actual data during our study period. Our prediction for the number of HFMD reported cases lies within the 90% interval range for the first 16 weeks in 2013.ConclusionsAn ARMA(1,4) model fits the data well and has good prediction ability of over 90% accuracy.     

Recessive distal renal tubular acidosis in Sarawak caused by AE1 mutations

Mutations of the AE1 (SLC4A1, Anion-Exchanger 1) gene that codes for band 3, the renal and red cell anion exchanger, are responsible for many cases of familial distal renal tubular acidosis (dRTA). In Southeast Asia this disease is usually recessive, caused either by homozygosity of a single AE1 mutation or by compound heterozygosity of two different AE1 mutations. We describe two unrelated boys in Sarawak with dRTA associated with compound heterozygosity of AE1 mutations. Both had Southeast Asian ovalocytosis (SAO), a morphological abnormality of red cells caused by a deletion of band 3 residues 400–408. In addition, one boy had a DNA sequence abnormality of band 3 residue (G701D), which has been reported from elsewhere in Southeast Asia. The other boy had the novel sequence abnormality of band 3 (Q759H) and profound hemolytic anemia.     

Evaluating Household Food Insecurity: Applications and Insights from Rural Malaysia

Hunger is complex, encompassing experiences ranging from a family's forced acceptance of a monotonous diet to individual physiological pain. I evaluate the Household Food Insecurity Access Scale (HFIAS) as a means of capturing the universal elements of hunger without doing violence to its culturally-specific expressions within two Malay communities. The HFIAS is assessed conceptually by comparing its assumptions and concept-to-measurement gap with competing indicators and practically with respect to village conditions and practices. This case study recommends the HFIAS for this site and for communities that similarly lack maternal buffering, while highlighting the unique features of the local hunger experience.