MJM Supplement Reviews of Malaysians Research on Major Diseases 2000 2015
The Medical Journal
of Malaysia
Official Journal of the
Malaysian Medical Association
Volume: 71
Supplement 1
June 2016
THE MEDICAL JOURNAL OF MALA
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MJM
Official Journal of the
Malaysian Medical Association
Volume 71 Supplement 1 June 2016
PP 2121/01/2013 (031329) MCI (P) 124/1/91 ISSN 0300-5283
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The Medical Journal of Malaysia
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Example references Journals:
1. Standard Journal Article
Chua SK, Kilung A, Ong TK, Fong AY, Yew KL, Khiew NZ et al. Carotid intima media thickness and high sensitivity C-reactive protein as markers of cardiovascular risk in a Malaysian population. Med J Malaysia 2014; 69(4): 166-74.
Books and Other Monographs: 2. Personal Author(s)
Ghani SN, Yadav H. Health Care in Malaysia. Kuala Lumpur: University of Malaya Press; 2008.
3. Corporate Author
World Health Organization. World Health Statistics 2015. Geneva: World
4. Editor, Compiler, Chairman as Author
Jayakumar G, Retneswari M, editors. Occupational Health for Health Care Professionals. 1st ed. Kuala Lumpur: Medical Association of Malaysia; 2008. 5. Chapter in Book
Aw TC. The occupational history. In: Baxter P, Aw TC, Cockroft A, Durrington P, Malcolm J, editors. Hunter’s Disease of Occupations. 10th ed. London: Hodder Arnold; 2010: 33-42.
6. Agency Publication
National Care for Health Statistics. Acute conditions: incidence and associated disability, United States, July1968 - June 1969. Rockville, Me: National Centre for Health Statistics, 1972. (Vital and health statistics). Series 10: data from the National Health Survey, No 69). (DHEW Publication No (HSM) 72 - 1036). Online articles
7. Webpage: Webpage are referenced with their URL and access date, and as much other information as is available. Cited date is important as webpage can be updated and URLs change. The "cited" should contain the month and year accessed.
Ministry of Health Malaysia. Press Release: Status of preparedness and response by the ministry of health in and event of outbreak of Ebola in Malaysia 2014
[cited Dec 2014]. Available from:
http://www.moh.gov.my/english.php/database_stores/store_view_page/21/437. Kaos J. 40°C threshold for ‘heatwave emergency’ Kuala Lumpur: The Star Malaysia; [updated 18 March 2016, cited March 2016]. Available from: http://www.thestar.com.my/news/nation/2016/03/18/heatwave-emergency-threshold/.
Other Articles: 8. Newspaper Article
Panirchellvum V. 'No outdoor activities if weather too hot'. the Sun. 2016; March 18: 9(col. 1-3).
9. Magazine Article
Thirunavukarasu R. Survey - Landscape of GP services and health economics in Malaysia. Berita MMA. 2016; March: 20-1.
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CONTENTS
Page
• A Review of Adult Obesity Research in Malaysia
1
Lim Kean Ghee
• A Review of Metabolic Syndrome Research in Malaysia
20
Lim Kean Ghee, Cheah Wee Kooi
• A Review of Smoking Research In Malaysia
29
Wee Lei Hum, Caryn Chan Mei Hsien, Yogarabindranath Swarna Nantha
• A Review of Coronary Artery Disease Research in Malaysia
42
Ang Choon Seong, Chan Kok Meng John
• A Review of Stroke Research in Malaysia from 2000 – 2014
58
Wee Kooi Cheah, Chee Peng Hor, Zariah Abdul Aziz, Irene Looi
• A Review of Lung Cancer Research in Malaysia
70
Kan Chan Siang, Chan Kok Meng John
• A Review of Acute Rehumatic Fever and Rheumatic Heart Disease Research in Malaysia
79
Hung Liang-choo, Nadia Rajaram• A Review of Research on Child Abuse in Malaysia
87
Irene Guat-Sim Cheah, Choo Wan Yuen
• A Review of Occupational Injury Research In Malaysia
100
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Foreword
Approximately three-quarters of deaths worldwide today are caused by non-communicable diseases (NCDs) such as cardiovascular disease, cancer, diabetes, chronic respiratory disease, and injury. Non-communicable diseases used to be the exclusive bane of high income countries, but now more than half of NCD deaths occur in low and middle-income countries. This means that these countries which still have to deal with communicable diseases, would also have to battle the health, social, and economic burden of lifestyle related diseases.
Although NCDs were not part of the 2000 Millennium Development Goals, in 2011, it became a focus with the United Nations and the World Health Organization calling for a 25% reduction in NCD-related mortality by the year 2025. Are we able to achieve this goal? Is the burden of NCDs in Malaysia overwhelming? How prevalent are the risk factors? And what are the issues in prevention, detection, and treatment that must be addressed? As many of the NCDs are of long duration and generally slow in progression, our strategies should also be long-term. But how do we improve health literacy and promote early detection? And how do we do all these cost-effectively?
The greatest of all mistakes is to do nothing because you think you can only do a little. This old quote that was popularised again by the American motivational coach, Zig Ziglar, is the sentiment that we should adopt. The problem and effect of NCDs appear overwhelming but the history of medicine has shown us that we are capable of taking on the challenge if we do our part.
The Clinical Research Centre, (CRC), once again collaborating with Assoc Prof Lim Kean Ghee from the International Medical University, has produced this sequel to 2014’s Medical Journal of Malaysia (MJM) supplement of Malaysian Research on Major Diseases. This MJM supplement serves to reinforce NCDs as a major healthcare problem with a compilation of articles covering nine different conditions. Three reviews cover the critical risk factors - obesity, metabolic syndrome, and smoking. Four other reviews discuss common diseases, i.e. acute coronary syndrome, stroke, lung cancer, and rheumatic heart disease. This supplement also includes two topics which may not be as widely discussed or highlighted as the earlier conditions. The first is child abuse, an important cause of childhood morbidity. And the second focuses on occupational injury, which has high rates in developing countries.
To the authors of the reviews selected for this supplement, congratulations and thank you for taking the time to review the local research conducted in your field of expertise. I hope the reviews are continuously updated so that our recommendations and strategies remain evidenced-based and current. And I hope this encourages other specialties to also come up with their own reviews.
I also take this opportunity to applaud the behind-the-scene team who came together again to ensure that local research publications get their share of the limelight.
Datuk Dr. Noor Hisham Abdullah Director-General of Health, Malaysia
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Foreword
In my foreword for the Medical Journal of Malaysia (MJM) supplement on Malaysian Research on Major Diseases two years ago, I highlighted the importance of systematic reviews in generating a consensus on medical evidence and its implications on patient care. I am happy to see the Clinical Research Centre (CRC) continuing this tradition of reviewing local research with the production of this supplement.
The focus on non-communicable diseases (NCDs) is important as the prevalence of these conditions in Malaysia are rising substantially. The Ministry of Health has already implemented many NCD initiatives at national and local levels; and these include various publications such as survey reports, registry reports, factsheets, annual reports, national strategic plans, and guidelines. The publication of this supplement will add to this repository of information.
The nine conditions featured here have been extensively researched in Malaysia. For instance, the review on coronary artery disease, a primary cause of morbidity and mortality in Malaysia as it is elsewhere in the world, looked at data from over 100 local papers published in this disease area. The snapshots from the reviews in this supplement provide us an overview of the local state of the disease with a bibliography of the relevant papers which healthcare professionals can read further for an in-depth study.
Clinicians can use this MJM publication as reference to guide their treatment decisions, and get a perspective on what fellow clinicians see in their respective practices. Other healthcare professionals can also benefit by getting the latest information with a local flavour. Researchers can refer to this to identify patient profiles and risk factors, and discover where the next wave of research should be. Policymakers can also be better equipped to make important healthcare decisions when they have access to data from their own settings generated by their own clinicians. Therefore, I encourage clinical researchers to publish their data; and to those who already do, keep publishing to keep your data relevant. Without your publications, how would we know whether our treatment choices are effective and efficient? Or why a particular approach worked so well in one setting but not in another? Or whether a certain innovation is practical or cost effective? Or how to improve patient care and experience? Finally, I thank all parties involved in this endeavour - the authors for searching, assessing, and summarising the research; and the editorial team for putting this supplement together. I encourage the CRC to continue producing thematic compilations like this, as clearly the reviews in this supplement feature research that matter to both healthcare professionals and patients. I look forward to the next compilation.
Datuk Dr Shahnaz Murad
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ABSTRACT
A literature search of articles as detailed in the paper Bibliography of clinical research in Malaysia: methods and brief results, using the MESH terms Obesity; Obesity, Abdominal; and Overweight; covering the years 2000 till 2015 was undertaken and 265 articles were identified. Serial population studies show that the prevalence of obesity increased rapidly in Malaysia in the last decade of the twentieth century. This follows the rising availability of food per capita which had been begun two to three decades previously. Almost every birth cohort, even up to those in their seventh decade increased in prevalence of overweight and obesity between 1996 and 2006. However, the rise in prevalence in obesity appears to have slowed after the first decade of the twentieth century. Women are more obese than men and Malays and Indians are more obese than Chinese. The Orang Asli are the least obese ethnic group in Malaysia but that may change with socio-economic development. Neither living in rural areas nor having low income protects against obesity. On the contrary, a tertiary education and those in the highest income bracket are associated with less obesity. Malaysians are generally not physically active enough, in the modes of transportation they use and how they use their leisure time.
Other criteria and measures of obesity have been investigated, such as the relevance of abdominal obesity, and the Asian criteria or Body Mass Index (BMI) cut-offs value of 23.0kg/m2for overweight and 27.0 kg/m2for obesity, with the view that the risk of diabetes and other chronic diseases start to increase at lower values in Asians compared to Europeans. Nevertheless the standard World Health Organisation (WHO) guidelines for obesity are still most widely used and hence is the best common reference. Guidelines for the management of obesity have been published and projects to combat obesity are being run. However, more effort needs to be invested. Studies on intervention programmes show that weight loss is not easy to achieve nor maintain.
Laboratory research worldwide has uncovered several genetic and biochemical markers associated with obesity. Similar studies in Malaysia have found some biomarkers with an association to obesity in the local population but none of great significance.
KEY WORDS:
overweight, obesity, Malaysia, abdominal obesity, physical activity, food intake, hypertension, diabetes, metabolic syndrome, psychiatric conditions, breast cancer, colorectal cancer
INTRODUCTION
265 articles were identified and examined in a literature search on adult obesity in Malaysia. The search using the medical subject headings (MeSH) Obesity; Obesity, Abdominal; and Overweight; followed the method that has been previously described.1 In brief, clinical research publications containing data on Malaysia for the period Jan 2000 - Dec 2015 were included (last search date 2 Feb 2016). Conference proceedings (but not conference abstracts), relevant theses/dissertation, books/book chapters, reports and clinical practice guidelines were included. 365 articles were initially identified, but 100 articles pertaining to childhood and adolescent obesity were excluded.
Nutrition is vital for health. Undernourishment was a significant burden on human health in the past. However, human morbidity and mortality increases not only with undernourishment but also with excessive nutrition. Obesity, the disease of excessive adipose tissue is increasingly prevalent worldwide.
The WHO criteria for Body Mass Index(BMI) classifies a BMI of 25-29.9kg/m2as overweight and >30kg/m2as obese.2BMI does overestimate obesity in muscular individuals and underestimate it in such as the elderly who have lost body mass. However, it still is the most widely used index for obesity. Obesity is recognized as a major determinant of non-communicable diseases such as cardiovascular disease, cancers, type 2 diabetes mellitus, respiratory problems, gallbladder diseases, post-operative morbidity and musculoskeletal disorders such as osteoarthrosis.
There has been a clearly documented dramatic increase in the prevalence of obesity in Malaysia over the last three decades since large scale population data became available. The rise of obesity is not a problem unique to Malaysia. In the global context, alongside development and prosperity, in many countries especially in Asia, obesity has become a leading health issue.
This process has been termed nutrition transition, from low availability of calories mainly in the form of plant products to diets high in fats, sugars and energy dense processed foods. This in turn has been the result of rapid economic development which has taken place in Malaysia in the last quarter of the twentieth century. Malaysia has recently been ranked second highest in East and Southeast Asia in terms of being overweight.3
A Review of Adult Obesity Research in Malaysia
Lim Kean Ghee, FRCSInternational Medical University Clinical School, Jalan Rasah, 70300 Seremban
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SECTION 1: REVIEW OF LITERATURE PREVALENCE OF OBESITY
In the Adult* Population
There have been six large (>10,000 respondents) national population studies on the prevalence of obesity (Table I) The National Health Morbidity Survey(NHMS II) in 1996 found that 16.6% prevalence of the adult population are overweight and 4.4% obese.4(This study is often quoted as finding a prevalence 20.7% of individuals aged 20 years and older who were overweight and 5.8% obese).5Six year later, the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and July 2003,6 found that the prevalence of obesity had more than doubled and that the number of adults overweight increased more than 60%. If that rather rapid increase in the prevalence of obesity seemed hard to believe, the findings were confirmed in another study in 2004.7 Following shortly, the Third National Health and Morbidity Survey (NHMS III) in 2006 conducted among 33,055 adults found 29.1% were overweight and 14.0% obese.8 When the next NMHS was done five years later in 2011, it showed only a slight increase in the rates of those overweight and obese. 9 The NHMS 2015 shows the prevalence of overweight plateauing (Table I) but is obesity still rising. This just means the number of people moving into the overweight category about equals the number of overweight people moving into the obese category.10(Figure 1 and 2)
Age
The NSCVDRF study only reported data for obesity and not overweight. Leaving that study aside the other five large population nutritional surveys come at almost 5-year intervals. The MANS study is two years late in 2003 instead of 2001. The NMHS 2015 comes only 4 years after the NHMS 2011. Using these five large studies as a five year plots alongside each other for examination of the prevalence of overweight and obesity in the various age groups we can observe the trend on cohorts over time, albeit bearing in mind they are not all exactly five years apart.
The prevalence of both overweight and obesity are lowest among young adults but more than doubles to a peak in middle age (Figure 3 and 4). In the NHMS II in 1996, the peak age for obesity was the 40-49 year age band (Figure 4). In the NMHS III,8 which reported age in 5 year bands, the peak was the 50-54 year age band and in the NMHS 20119 the peak had moved further to the 55-59 year band (Figure 4). It therefore appears that the cohort born between 1952-1957 carried the high peak of obesity with them as they aged. Although they are no longer the age group with the highest prevalence of obesity in 2015, having reached the 60-64 year band, their prevalence of obesity rose just slightly (Figure 6 bolder line).10 The cohort behind them aged 55-59years became the age group with highest obesity.
Does the rising prevalence of obesity mean only the young age groups move up in age carrying their higher prevalence with them or did all age groups also increase in weight? Figures 5 and 6 which shows the prevalence of overweight and obese by birth cohorts shows us that every birth cohort
increased in prevalence of overweight and obesity between 1996 and 2006. Even the cohort born between 1927-1936 who were >60 years old in 1996 showed an increased in prevalence of overweight and obesity 10 years later in the NMHS III survey when they were the >70year age group. (prevalence of overweight 15.6% rose to 21.1-29.3%, obesity 3.1% rose to 7.2-8.6%). It appears that the period between 1996 to 2006 saw the most rapid rise in weight gain in the Malaysian population.
However between 2006 and 2015, cohorts born before 1952, ie. those who were above 55 years old in 2006, appeared no longer to have increased in prevalence of overweight (Figure 5), but instead plateaued or even decreased slightly in prevalence.
The Elderly
As noted, from the age of about 60 years upwards, the prevalence of overweight and obesity declines. The prevalence of obesity declines more rapidly than overweight, reaching less than half the peak age value in the 70-75year age group (Figure 4). The prevalence of overweight on the other hand stays up to 60-70% the peak age prevalence rates (Figure 3). This may indicate the obese suffer a higher mortality rate. The decline in prevalence among those 80+years is even more striking.Their prevalence of obesity is only half that of the 75-79 year age group (Figure 4). Suzana et. al.have also noted that while a large proportion of the elderly may be overweight and obese, signs of malnutrition may be present among them11,12(malnutrition will not be explored further in this review).
Sex
Consistently across the studies, more women are obese than men,4,6,7,8,9,10but more men are overweight than women.4,6,7,8,9,10 Only among young adults are more men obese than women.6,14 By the late 20s women have overtaken men in obesity; the cause of this is usually attributed to weight gain after pregnancy. This greater prevalence of overweight among men was especially true among Chinese but among Indians more women are overweight compared to men.6It appears that when women put on weight they ‘go all the way’. Furthermore the gap between the prevalence of obesity between women and men has widened.4,8
Three studies reported the prevalence of obesity by age and also by sex.4,6,7In the NHMS II and NSCVDRF studies4,7men appeared to have a peak age younger than women, but that is not clear in the MANS study.6
Suzana et al.have noted that elderly women are twice as obese as men, and by weight circumference (measure for abdominal obesity) women are three times as obese as men.11,12
There have been several studies focusing specifically on women (Table III). Chee et. al.found that the prevalence of overweight among women electronic factory worker for younger age groups were similar to the survey NHMS II done four year before, but older women electronic factory worker had higher overweight prevalence and mean BMI than the * Unless otherwise stated, the adult population refers to those aged 18 years and above, and overweight and obesity are defined according to the WHO
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A Review of Adult Obesity Research in Malaysia
Table I: Sample size and prevalence of overweight and obesity of Large Malaysian Obesity Studies
Sample Size Prevalence of
Overweight* Obesity*
National Health and Morbidity Survey II (NHMS II) 19964 28,737 16.6% 4.4%
(20.7%#) (5.8%#)
Malaysian Adults Nutrition Survey (MANS) 20036 10,216 26.7% 12.2%
The National study on Cardio-Vascular Disease Risk Factors(NSCVDRF) 20047 16,127 11.7%## (12.6%#) Third National Health and Morbidity Survey (NHMS III) 20068 33,055 29.1% 14.0%
National Health and Morbidity Survey 2011 (NHMS 2011)9 28,498 29.4% 15.1%
National Health and Morbidity Survey 2015 (NHMS 2015)10 18,499 30.0% 17.7%
# Prevalence among 20 years and above## Prevalence among 15 years and above
Table II: Prevalence of Overweight and Obesity by sex
Overweight (%) Obese (%)
Men Women Men Women
NHMS 1996 20.1 21.4 4.0 7.6
MANS 2003 28.6 24.8 9.7 14.7
NSCVDRF 2004 9.6 13.8
NHMS 2006 29.7 28.6 10.0 17.4
NHMS 2011 30.9 27.8 12.7 17.6
NHMS 2015 31.6 28.3 15.0 20.6
Table III: Prevalence of overweight and obesity among women in several localised studies
Author, year of Sample size Age group Characteristics Ethnicity (%) Overweight Obesity
study (years)
Chee 200015 1612 17-55 Women Electronic Malays=78.5
factory workers Chinese=2.2 24.1 13.3
Indians=17.7
Sherina 200417 972 20-59 Women in Selangor Malays=54.9 19.4
Chinese=20.0 6.2
Indians=23.4 19.0
Poh 200618 253 30-45 Women Teachers and civil Malays=64.4 53.4
servants in Kuala Lumpur Chinese=26.1 28.8
Indians=9.5 66.7
Norsa'adah 200019 175 20-70 Women with Breast Cancer, Malay=77.7
Kelantan Chinese=20.6 34.3 13.7
Others=1.7
Yong20 368 20-75 Women with Breast Cancer, Malay=57.1
from 8 different Hospitals Chinese=33.2 31.5 10.9 Indians=9.8
Lee21 115 20-59 Women Office Workers, Malays 33.0 22.6
Kuala Lumpur and Selangor
Siti Affira22 215 18-55 Women in Corporate Malays=81.9
Companies, Petaling Jaya Chinese=10.2 24.7 7.9 Indians=7.9
Lua 201123 41 24-68 Women with Breast Cancer, Malay=92.7 29.1 12.2
Terengganu and Kelantan Chinese=7.3
Hasnah24 125 50-65 Women in Low cost Malays 45.6 31.2
Housing Cheras
Table IV: Prevalence of Overweight and Obesity by ethnic group
Overweight (%) Obese (%)
Malays Chinese Indians Malays Chinese Indians
NHMS II 16.5 15.1 18.6 5.1 3.5 5.0
MANS 2003 27.2 25.0 31.0 15.3 7.2 12.7
NSCVDRF 2004 13.6 8.5 13.5
NHMS III 29.8 28.5 33.2 16.6 8.7 17.7
NHMS 2011 31.1 27.6 30.8 18.7 9.7 20.6
NHMS 2015 31.0 28.1 35.0 21.1 11.7 27.1
Table V: Prevalence of Overweight and Obesity by sex and ethnic groups
Overweight (%) Obese (%)
Men Women Men Women
Malays Chinese Indians Malays Chinese Indians Malays Chinese Indians Malays Chinese Indians
NHMS 1996 20.0 24.5 24.2 23.9 18.7 25.6 4.5 4.7 3.8 9.5 5.3 9.8
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national sample.13 It has also been noted that being overweight and obese was associated with earlier menarche among women in a study of university students.16
Ethnic Differences
Across the national population surveys, Indians are more overweight than Chinese and Malays.6,8,9,10 (Table IV) The prevalence among Malays and Chinese appear to have stabilised, but among Indians the NHMS 2011 survey showed an unusual decrease followed by a steep rise in 2015. The obesity trend is clearer. Indians are becoming much more obese, with rates approaching three times more than Chinese.10
Indians of both sexes are more overweight than Chinese and Malays (Table V), the difference between Indian women and the other ethnic groups being wider than among the men.4,6,8 Data comparing men and women separately by ethnic groups are only available in three studies.4,6,7 Malay and Indian women were about equally obese in 2004 but Chinese women have only about half their prevalence rates. Chinese women are about equally as obese as Chinese men, but both Malay and Indian women are much more obese than their male counterparts. Among men, Chinese had the highest prevalence of obesity in 1996, but they have been overtaken by both Indian and Malay men in later studies.6,7,8
Two studies listed the bumiputera of Sarawak and Sabah as separate categories6,7which allows better observations to be made than when they are put together as just other indigenous people or others.4,8,9The results shown in Table VI are inconsistent, probably due to sampling error as there are many bumiputera groups spread over a wide area in both
states. Their prevalence of overweight and obesity in 2003-2004 are lower than those of Indians and Malays and comparable to the rates among Chinese. It is hard to say with certainty whether the men or women are more overweight and obese. Except for one study which found bumiputera men in Sabah more overweight and obese than women (MANS), the rest of the data shows bumiputera women in Sarawak more overweight and obese than men, as did the NSCVDRF study find in contradiction with the MANS data (Table VI). Listed as other bumiputerain the NHMS 2011 and NHMS 2015, they have overweight rates similar to other races and obesity rates (14.1%, in 2011 and 18.0% in 2015) higher than Chinese but not as high as Malays and Indians.10 The ethnic group with the lowest prevalence of obesity in Malaysia are the Orang Asli. None of the Orang Asli were obese in the MANS study, and only 15% were overweight, but they only had a sample size of 28 Orang Asli. We must look at more focused studies for information. Chronic Energy Deficiency(CED) or under-nutrition(BMI<18.5 kg/m2) has been and is still the larger nutritional problem among Orang Asli, but that is not the subject of this review.
A nutritional status survey of Orang Asli adults (Jahai, 58.7% Temiar, 41.3%) in Lembah Belum, Grik, of 138 subjects found 26.7% underweight and 10.1% were either overweight/ obese.25 Based on percentage body fat and waist circumference (WHO criteria) only 1(0.7%) was obese. A study of 57 adult Orang Asli (Che Wong ) in Pahang found 3 men(10.3%) and 8 women (29%) overweight and 1 man(3.3%) obese.26However, where the Orang Asli live very close to economic development such as in Sungai Ruil in Cameron Highlands, among 138 respondents, by BMI 25.4%
Table VI: Prevalence of Overweight and Obesity by sex among bumiputera in Sabah and Sarawak
Overweight Obese
Men Women Men Women
Bumiputra Bumiputra Bumiputra Bumiputra Bumiputra Bumiputra Bumiputra Bumiputra
Sabah Sarawak Sabah Sarawak Sabah Sarawak Sabah Sarawak
MANS 2003 24.3 24.6 23.2 31.9 8.4 5.3 7.4 8.4
NSCVDRF 2004 6.1 9.3 8.5 12.3
Table VII: The prevalence of overweight and obesity by state in Malaysia
Overweight (%) Obesity (%)
NHMS II NMHS III NHMS 2011 NHMS 2015 NHMS II NMHS III NHMS 2011 NMHS 2015
Johore 17.4 28.9 28.5 31.0 4.4 14.1 15.9 18.1
Kedah 14.9 31.1 31.6 30.1 3.3 15.5 15.2 20.5
Kelantan 12.9 28.3 31.5 30.3 3.4 12.5 16.2 16.2
Melaka 18.9 31.1 25.7 31.8 5.1 17.4 17.7 21.9
N Sembilan 19.4 29.5 27.6 27.7 6.3 18.6 16.0 23.5
Pahang 18.3 28.8 30.2 26.9 5.6 15.3 15.3 19.4
Penang 15.9 29.3 31.1 30.6 3.7 13.7 12.8 13.8
Perak 18.0 27.6 31.9 29.8 4.7 12.9 16.2 17.5
Perlis 18.2 32.1 29.5 30.2 5.1 17.2 21.7 22.3
Sabah 14.5 24.9 28.8 28.2 3.4 9.7 10.6 13.4
Sarawak 14.2 28.7 30.3 30.1 3.4 11.5 14.0 18.4
Selangor 17.0 31.0 27.3 30.3 4.8 16.0 17.1 18.7
Terengganu 17.9 28.6 32.8 28.9 5.8 15.2 14.0 18.6
Kuala Lumpur 17.5 29.8 29.2 33.7 4.8 12.5 13.5 14.9
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A Review of Adult Obesity Research in Malaysia
Table VIII: Prevalence of Overweight and Obesity in several small localised studies
Author, year Sample size Age group Characteristics Ethnicity (%) Overweight Obesity
of study (years)
Yunus 199929 570 >15 Hoseholds in Malays=23.3 12.0
Dengkil, Selangor Chinese=57.1 14.3
Indians=30.5 10.5
Orang Asli=30.8 11.5
Hapizah30 609 30-65 Rural Community Malays 33.5 11.2
Raub, Pahang
Rampal 200431 2219 >15 Households in Selangor Malays=52.9 15.2
Chinese=30.9 7.3
Indians=15.4 11.6
Mohd Nazri 200532 348 >18 Households in Pulau Malays=99.4 49.1
Kundur, Kelantan
Chang33 260 20-65 Rural Community, Serian, Malays=32.3 14.3
Sarawak Bidayuh=33.1 11.6
Iban=34.6 39.6 10.0
Wan Nazaimoon 4428 >18 Households in 5 Different Malays=62.5 34.0 23.2
200734 states Chinese=14.6 32.1 8.2
Indians=8.5 39.5 24.6
Ind Sabah=12.2 30.9 12.3
Akter 200735 219 >18 Bukit Sekelau (rural) Malays 54.8(BMI>27.5)
Pahang
Narayan36 441 >20 Coastal Viiages, Kedah Malays 25.9 17.0
Suzana12 820 >60 4 Rural Villages Malays 24.7 11.4
Hamid Jan 200937 297 18-59 Bachok, Kelantan Malays 41.7 13.4
Rampal 201038 454 30-68 University staff in Selangor Malays=86.3 30.1 12.0
Chinese=8.8 37.5 17.5
Indians=4.9 36.4 0
Chew 201139 258 >21 Suburban New Village Chinese 40
Selangor
Hazizi40 233 18-59 Government Employees Malays 29.6 20.6
Penang
Ayiesah41 82 21-59 Military Hospital Staff Malays 24.3 58.5
Malacca
Ayiesah41 211 19-24 Medical Students Malays=63.5 16.6 3.8
Kabir, 2012-1443 945 20-43 Postgraduate University Malays=79.3 23.1 8.9
Students, Chinese=13.5
Indians=5.0 Others=2.2
Fig. 1: Percentage of Malaysians overweight and obese
(BMI>25kg/m2) in studies from 1996 to 2015.
Fig. 2: Percentage of Malaysians obese (BMI>30kg/m2) in studies from 1996 to 2015.
Table IX: Physical Activity among Malaysians
Adequate Exercise Physcially Inactive
Men Women Men Women
NHMS II 16.2% 7.7% 60% 75%
MANS 18.9% 9.4% 60.0% 77.7%
MyNCDS-1 55.4% 60.1%
NMHS III 35.3% 50.5%
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Fig. 3: Prevalence of Overweight (BMI 25-29kg/m2) among Malaysians of Different Age Groups.
Fig. 4: Prevalence of Obesity (BMI >30kg/m2) among Malaysians
of Different Age Groups.
Fig. 5: Prevalence of Overweight at Various Age Groups for
Different Birth Cohorts using data from NMHS II, MANS, NHMS III, NHMS 2011 and NMHS 2015.
Fig. 6: Prevalence of Obesity (BMI >30kg/m2) at Various Age Groups for Different Birth Cohorts using data from NHMS II, MANS, NHMS III and NHMS 2011.
Fig. 7: Change in available calories, fat and protein per capita in
Malaysia 1961-2011.
Source: FAO food balance sheet
Fig. 8: Changes in source of calories in Malaysia between 1970
and 2009.
Source:Jan Mei Soon, E. Siong Tee. Changing Trends in Dietary Pattern and Implications to Food and Nutrition Security in Association ofSoutheast Asian Nations (ASEAN).International Journal of Nutrition and Food Sciences.Vol. 3, No. 4, 2014, pp. 259-269.doi: 10.11648/j.ijnfs.20140304.15
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A Review of Research on Child Abuse in Malaysia
48. Chan LF, Tan SM, Ang JK, Kamal Nor N, Sharip S. A case of sexual abuse by a traditional faith healer: are there potential preventions? Journal of child sexual abuse. 2012; 21(6): 613-20.
49. Cheah IGS CW. Child maltreatment prevention: Readiness assessment in Malaysia. University of Malay a Press 2013.
50. Ping NCL, Sumari M. Malaysia Women Survivors’ Perspective on Healing from Childhood Sexual Abuse through Spirituality. Procedia - Social and Behavioral Sciences. 2012; 65(0): 455-61.
51. Ismail ZM, Rahman NSNA. School Violence and Juvenile Delinquency in Malaysia: A Comparative Analysis between Western Perspectives and Islamic Perspectives. Procedia - Social and Behavioral Sciences. 2012; 69(0): 1512-21.
52. Husain R. YR, Yaacob MJ., Sulaiman Z. Depression and coping strategies among sexually abused children in a Malay community in Malaysia ASEAN Journal of Psychiatry. 2009; 10(2): 169-80.
53. Othman S, Mat Adenan NA. Domestic violence management in Malaysia: A survey on the primary health care providers. Asia Pacific family medicine. 2008; 7(1): 2.
54. Li M, D'Arcy C, Meng X. Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychological medicine. 2016; 46(4): 717-30.
55. Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS medicine. 2012; 9(11): e1001349.
56. Butchart A HA, Mian M, Furniss T, Kahane T. Preventing Child Maltreatment: A guide to taking action and generating evidence. . World Health Organisation and International Society for Prevention of Child Abuse and Neglect 2006;WHO Library
57. Shaw JA LJ, Loeb A, Rosado J, Rodriguez RA. Child sexual abuse: psychological perspectives. Child Abuse and Neglect 2000; 24(12): 1509-668.
58. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychological bulletin. 1993; 113(1): 164-80.
59. Trickett PK, Noll JG, Reiffman A, Putnam FW. Variants of intrafamilial sexual abuse experience: implications for short- and long-term development. Development and psychopathology. 2001; 13(4): 1001-19. 60. Wahab S, Tan SM, Marimuthu S, Razali R, Muhamad NA. Young female survivors of sexual abuse in Malaysia and depression: what factors are associated with better outcome? Asia-Pacific psychiatry. 2013; 5 Suppl 1: 95-102.
61. Abd Rahman FN, Mohd Daud TI, Nik Jaafar NR, Shah SA, Tan SM, Wan Ismail WS. Behavioral and emotional problems in a Kuala Lumpur children's home. Pediatrics international. 2013; 55(4): 422-7.
62. Loh SF, Maniam T, Tan SM, Badi'ah Y. Childhood adversity and adult depressive disorder: a case-controlled study in Malaysia. East Asian archives of psychiatry. 2010; 20(2): 87-91.
63. Lukman ZM. Childhood abuse among children involved in prostitution in Malaysia. The Social Sciences. 2009; 4(6): 567-72.
64. Kasim MS, Cheah I, Shafie HM. Childhood deaths from physical abuse. Child abuse & neglect. 1995; 19(7): 847-54.
65. Hong JYH, Ismail AB, Jabbar AI, Wong JSL, Ashwin Kaur JS, Fuziah MZ, Nora'i Ms. Trending of child abuse cases presented to Putrajaya Hospital Malaysian Journal of Paediatrics and Child Health. 2010; 16(2): (supp). 66. Alias A, Krishnapillai R, Teng HW, Abd Latif AZ, Adnan JS. Head injury
from fan blades among children. Asian journal of surgery. 2005; 28(3): 168-70.
67. Lope RJ, Kong WK, Lee VW, Tiew WT, Wong SY. Sleep position and infant care practices in an urban community in Kuala Lumpur. Medical journal of Malaysia. 2010; 65(1): 45-8.
68. Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bulletin of the World Health Organization. 2009; 87: 353-61.
69. Choo WY, Walsh K, Marret MJ, Chinna K, Tey NP. Are Malaysian teachers ready to assume the duties of reporting child abuse and neglect? Child abuse review. 2013; 22(2): 93-107.
70. Weatherley R, Siti Hajar AB, Noralina O, John M, Preusser N, Yong M. Evaluation of a school-based sexual abuse prevention curriculum in Malaysia. Children and Youth Services Review. 2012; 34(1): 119-25. 71. Ab Rahman A, Ab Rahman R, Ibrahim MI, Salleh H, Ismail SB, Ali SH, et
al. Knowledge of sexual and reproductive health among adolescents attending school in Kelantan, Malaysia. The Southeast Asian journal of tropical medicine and public health. 2011; 42(3): 717-25.
72. Anwar M, Sulaiman SA, Ahmadi K, Khan TM. Awareness of school students on sexually transmitted infections (STIs) and their sexual behavior: a cross-sectional study conducted in Pulau Pinang, Malaysia. BMC public health. 2010; 10(1): 1.
73. Low W-Y, Ng C-J, Fadzil KS, Ang E-S. Sexual issues: let's hear it from the Malaysian boys. The Journal of Men's Health & Gender. 2007; 4(3): 283-91.
74. Kirby D, Laris BA, L R. Impact of sex and HIV education programs on sexual behaviors of youth in developing and developed countries. FHI youth research working paper no 2. North Carolina: Family Health International. 2006:1-56.
75. Mokhtar MM, Rosenthal DA, Hocking JS, Satar NA. Bridging the Gap: Malaysian Youths and the Pedagogy of School-based Sexual Health Education. Procedia - Social and Behavioral Sciences. 2013; 85(0): 236-45. 76. Dunne MP, Zolotor AJ, Runyan DK, Andreva-Miller I, Choo WY, Dunne SK, et al. ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries. Child abuse & neglect. 2009; 33(11): 815-25.
77. Runyan DK, Dunne MP, Zolotor AJ, Madrid B, Jain D, Gerbaka B, et al. The development and piloting of the ISPCAN Child Abuse Screening Tool-Parent version (ICAST-P). Child abuse & neglect. 2009; 33(11): 826-32. 78. Mikton C, Power M, Raleva M, Makoae M, Al Eissa M, Cheah I, et al.The
assessment of the readiness of five countries to implement child maltreatment prevention programs on a large scale. Child abuse & neglect. 2013; 37(12): 1237-51.
79. Choo WY, Walsh K, Chinna K, Tey NP. Teacher Reporting Attitudes Scale (TRAS): confirmatory and exploratory factor analyses with a Malaysian sample. Journal of interpersonal violence. 2013; 28(2): 231-53. 80. Dunne MP, Chen JQ, Wan Yuen C. The evolving evidence base for child
protection in Chinese societies. Asia-Pacific journal of public health. 2008; 20(4): 267-76.
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ABSTRACT
A literature review of 16 papers on occupational injury research in Malaysia published during a 13-year period from 2000-2013 was carried out. The objective of this review and article selection was based on relevance to the research theme and mention of areas for future research. Most of the publications have focused on descriptive epidemiology, management practices, worker’s knowledge, attitude, training, and rehabilitation services. The transportation, agriculture and construction sectors were found to be the most hazardous sectors and would benefit the most from Occupational Safety & Health (OSH) research and interventions. There is a strong need to develop a national injury surveillance system and also a mechanism to ensure adherence to the Occupational Safety & Health Act(OSHA) 1994. Detailed description and identification of risk factors for occupational injury in the environment, including machinery and equipment used was generally lacking. Future research on occupational injury should focus on surveillance to determine the magnitude of occupational injuries, determination of risk factors, identifying cost-effective interventions (such as enforcement of OSHA regulations), and assessment of rehabilitation services. Relevant government agencies, universities, corporate sector and occupational safety organizations need to play a proactive role in identifying priority areas and research capacity building. Funding for occupational injury should be commensurate with the magnitude of the problem.
INTRODUCTION AND METHODS
The Organization for Economic Co-operation and Development (OECD) defines occupational injury as “Any personal injury, disease or death resulting from an occupational accident”. Worldwide, there are about 100 million cases of occupational injury each year,1resulting in
350,000 deaths.2 Developing countries have the highest
injury fatality rate.3,4 Occupational safety and health is
important for moral, legal and financial reasons. We identified all publications on occupational injury research in Malaysia from year 2000 to year 2013 through a database dedicated to indexing all original data relevant to medicine in Malaysia using the medical subject heading (MeSH) Occupational Injuries.5Sixteen publications were selected for
inclusion in this review based on relevance to the research theme and mention of areas for future research.5A summary
of the findings and recommendations was made. The objective of this review article is to summarize what has already been published in Malaysia on Occupational
Injuries, to identify gaps in knowledge, policy and to explore potential areas for future research.
SECTION 1: REVIEW OF LITERATURE
Occupational Injury Prevention, Surveillance and Rehabilitation in Malaysia
In Malaysia, the Department of Occupational Safety and Health (DOSH) under the Ministry of Human Resource is responsible for enforcing the law on occupational safety and health, which was introduced in 1994. The Occupational Health Unit conducts surveillance activities. The notification of occupational poisonings, diseases and injuries is done by hospitals and clinics within the Ministry of Health. Malaysia’s Social Security Organization (SOCSO), also known as Pertubuhan Keselamatan Sosial (PERKESO), was set up in 1971 to provide socioeconomic security for non-government employees. The Employees Social Security Act 1969 mandates all employers to insure their employees for workplace diseases or injuries by contributing to PERKESO. Data obtained from PERKESO are more comprehensive than those obtained from Malaysia’s Department of Safety and Health.6
Up till 2006, PERKESO covers 67% of total formal workforce within Malaysia.7,8 PERKESO provides employment injury
insurance schemes, disability benefits, rehabilitation programs and certified training programs for disability assessment (CMIA).
Workers compensation for injury is provided by both the government and private sectors. The Persons with Disability (PWD) Act 2008 empowers PWDs to obtain various privileges such as the right to special barrier –free access to public facilities. The Labor Department has various vocational programs for the employment of PWDs.
PERKESO introduced the Return-To-Work program(RTW) in the year 2007 to rehabilitate workers suffering from injuries to achieve their maximum functional capacity at work. The RTW process can be divided into 4 phases: (i)Off duty, (ii)Re-entry, (iii)Maintenance and (iv)Advancement. The RTW programs are managed by the Ministry of Human Resource.
Epidemiology
Adinegara et al.conducted a secondary data analysis of the PERKESO database to examine the fatal occupational injures in Malaysia.7This refers to the death of an employee in the
workplace as a result of any injury occurring during employment. This also included death occurring outside the Ganesh CS, MBBS1, Krishnan R, FCRP, FRACGP2
1Clinical Research Centre & Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia, 2Professor
and Head of Department, Department of Family Medicine, Penang Medical College
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A Review of Occupational Injury Research In Malaysia
workplace while performing official duties as an employee. This analysis had revealed a total of 2822 fatal occupational injuries with an average annual incidence of 9.2 fatal occupational injuries per 100,000 workers. This figure is higher than that in the United States (4.0 per 100,000 [US Bureau of Labor Statistics, 2006]) and Great Britain(0.71 per 100,000 [Health and Safety Executive UK, 2006]). From the year 2002 till 2006, there was a 16% decline in the annual number and 34% decline in the annual incidence of fatal occupational injury. Older workers in the 60+ and 50–59 age groups had the highest incidence of fatal occupational injury. Indians had the highest average annual incidence compared to Malays or Chinese (17.6 vs 8.7 vs 8.1 per 100000 workers). Men had a 12 times higher annual average incidence compared to women (13.8 vs 1.2 per 100,000 workers) and the authors suggested it is probably because men are more likely to have high-risk jobs. The transportation sector reported the highest incidence (35.1 per 100,000), followed by the agriculture (30.5 per 100,000) and construction (19.3 per 100,000) sectors. These accidents involved transport and lifting equipment (53%), working-environment (22%) followed by machines (5%). The most common fatal occupational injuries were fractures (15%), unspecified wounds (8%), concussions and internal injuries (6%), and contusions and crush injuries (4%). The main causes of these injuries were falling from height (28%), being struck by moving objects (17%), and struck by falling objects (9%). Adinegara et al. also conducted a secondary data analysis of the PERKESO database to study the non-fatal occupational injuries in Malaysia.8Between the years 2002-2006 there were
a total of 249,904 non-fatal occupational injuries occurring in 211,875 individuals. There was a decrease in both annual number and annual incidence by 37% (62,737 to 39,366) and 51% (11.4 to 5.6 per 1000 workers [p trend < 0.001]) respectively. The agriculture sector had the highest incidence (24.1 per 1,000), followed by the wood-product manufacturing (22.1 per 1,000) and non-metallic industries (20.8 per 1,000). Highest incidence was seen in the 40-49 year group(7.9 per 1000) followed by the 30-39 year age-group (7.5 per 1000) and 19-29 year age-age-group (7.4 per 1000). Those more than 60 years of age had a lower incidence. The authors suggested that these employees were probably stationed in senior positions which are at a lower risk. Men had a higher average annual incidence (10.7 per 1000) compared to women (3.6 per 1000). Indians had the highest average annual incidence (21.1 per 1000) followed by Chinese (8.9 per 1000) and Malays (6.8 per 1000). Most common injuries were unspecified wounds (55%), superficial injuries (10%), fractures (10%), strains and sprains (7%), concussions and other internal injuries (4%), contusions and crush injuries (4%), dislocations (2%), burns (2%), and amputations (2%). The main causes of these injuries were being struck by moving objects (33%), falling from height (19%), and trapped between objects (17%). These injuries resulted from accidents from within the working-environment (41%), during handling of machines (20%) and during exposure to materials and substances (12%).
There were several limitations Adinegara et al.noted in the PERKESO database.7,8The database was set up for monitoring
the total number of employee related claims/benefits and
was not specifically designed for surveillance. The database does not include data from all categories of employees. Data from four categories of employees are excluded, namely: self-employed, foreign workers, government employees and domestic servants. About half of the reported injuries (47%) were classified as “unspecified”, meaning there is no specific classification suitable for these cases. Though a worker could have died of multiple injuries, only one entry is allowed for classification of injuries. The database does not contain data from certain industries such as mining and quarrying. The database has a risk of under-reporting less severe injuries because willingness-to-report depends in part upon the discretion of the workers. Hence, less severe injuries often go unreported. The authors suggested improvements to the current PERKESO database in order to increase its utility, especially for prevention purposes. Reporting of all injuries (including those less-severe ones) should be made mandatory by PERKESO. Some of the classifications within PERKESO database, such as type of injury, need to be revised to avoid misclassification. A national injury surveillance system (specifically tailored for occupational health surveillance) should be developed to include all categories of employees. Al-Husuny et al studied work-related hand injuries (WRHIs) in Hospital Universiti Kebangsaan Malaysia (HUKM).9 The
authors found that 24.9% of industrial accidents were WRHIs and 30% of all occupational accidents seen in the emergency department involved the hands. This study found a significant association between the severity of WRHIs and the locations of injury, mechanisms of injury, sources of injury and sectors of industry. WRHIs occurred most commonly in industries such as manufacturing, construction and food preparation. Seventy percent of hand injuries were caused by operating machines. Machine operators were found to be 26 times more prone to experience severe WRHIs. Fifty four percent of workers with WRHIs were from metal machinery industry. Employees in this industry had an 8 fold higher risk of sustaining severe WRHIs.
Abdullah et al also conducted a study on 57 workers admitted to HUKM for acute hand injuries sustained at work.10 The
vast majority (93%) of workers were male. About half (48%) of the workers were between 25 to 35 years old. The right hand was more often affected compared to the left. Most of the injuries involved the fingers. More injuries occurred on the weekends. Lacerations were the most common injury followed by fractures and crush injuries.
Anuar et alconducted a 5-year survey on laboratory-acquired injuries in 3 medical laboratories (Hospital Kuala Lumpur (HKL), HUKM, and Pusat Perubatan University Malaya (PPUM).11 The average annual incidence was 2.05 per 100
full-time equivalent (FTE) employees which is lower than that in the United States (2.1 per 100 FTE, BLS 2006). The annual incidence rate in each individual medical laboratory is 2.04 per 100 FTE (HKL), 2.07 per 100 FTE (HUKM) and 2.04 per 100 FTE (PPUM) employees, respectively. From year 2001 to year 2005, the most common injuries were cuts by sharp objects (24 cases, 25.3%) followed by exposure to biohazards and chemical substances (18 cases, 19.9%), needle-prick injuries (16.8%,), fire (8.4%), falls/slips (6.3%), gas leak (1 case) and locked in a cold room (1 case). There was an increasing
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accreditation with the relevant agencies and had hence improved their safety practices. This study helped to identify those areas in laboratory safety that needed improvement. Dayang et al. analyzed accidents in the construction industry which were reported to the Department of Occupational Safety and Health (DOSH), Social Security Organization (SOCSO) as well as the Construction Industry Development Board (CIDB).12 The authors remarked that the construction
sector was a highly hazardous industry and that SOCSO recorded an increasing incidence of injuries which had resulted in permanent disabilities and fatalities from year the 1996 till 2008. The Department of Occupational Safety and Health (DOSH) under the Ministry of Human Resources recorded an increase in the number of accidents within the construction industry, with severe and fatal accidents occurring every month in the years 2007 and 2008 (17 cases in the year 2007 and 12 cases in the year 2008).
Htayet al. conducted a cross-sectional study on the profile of injuries in villages within the Jasin district of Melaka.13 The
study showed that 56% of villagers reported sustaining injuries in the one-year period. Home injuries were the most common (60.2%), followed by road traffic injuries and occupational injuries. Falls were the most common type of injuries at home and mostly occurred in the evening. Road injuries most commonly occurred in the evening and at night. The extremities were the most-severely injured. Most of the injured villagers preferred to seek treatment from the government healthcare facilities.
Jegatheswaran et al. studied the occupational accidents among migrant contract workers in the furniture industry.14
Migrant contract workers were found to be more productive and had a lower incidence of occupational injuries than their local counterparts. The authors attributed this to a better compliance with occupational safety and health practices. Zainalet al.conducted a case-control study on occupational accidents among the Royal Malaysian Navy personnel in Lumut.15This study showed that the malays had the lowest
incidence of injuries compared to personnel of other races.
Prevention and Management
Adinegara et al. conducted a study on fatal and non-fatal occupational injuries and found a decreasing annual incidence of occupational injuries.7,8 The authors attributed
this to a more organized workplace, and an increased attention to safety and health practices in the workplace. The government had allocated additional resources under the 9th Malaysia plan (2006 – 2010) for the enforcement of OSHA 1994. However, the mechanisms to ensure universal adherence to this regulation are lacking.
Ahmadon et al. published a review on “Occupational Safety and Health Management Systems (OSHMS)”.16 They
concluded that a better understanding of OSHMS helps in its application and enforcement of legislations.
organizations benefited through a reduced loss-of-work hours and amount of compensations offered for accidents. Employees are hence more motivated and this will increase the productivity of the organization. This study also revealed that the attitude of individual employees influenced the incidence of occupational injuries. The authors suggested that further studies on the relationships between workers’ safety awareness, risk perceptions, participation in safety committees and the incidence of workplace injuries.
Dayang et al.suggested that it was the employer’s negligence that was responsible for the occurrence of accidents within the construction sector.18 The Construction Industry
Development Board came up with a Master Plan for Occupational Safety and Health within the Construction Industry. The plan helps all stakeholders to strengthen their OSH activities. This master plan focuses on six areas as identified by the National OSH committee for the construction industry. These six areas are (i)Enforcement & Legislation, (ii)Education and Training, (iii)Promotions, (iv)Incentives & Disincentive, (v)Standards and Research & (vi)Development and Technology10. Similar plans need to be developed for other high-risk occupational areas.
Ali et al. found that only a third (33.6%) of workers received OSH training before or within a month of starting work.19
This study also found that only 38.9% of workers that felt that they needed PPE were given so by their employers. The authors suggested further research to identify the reasons for the lack of risk reduction practices in the workplace.
Lugah et al. conducted a survey to assess OSH knowledge among healthcare professionals20. About a third (34.2%) of respondents had a good knowledge of OSH. Doctors had a better knowledge on OSH compared to other healthcare workers. Nurses and administrative staff had the poorest knowledge on OSH. Administrative officers usually represent employers within the OSH committee and this may lead to a less emphasis on OSH within the workplace. This survey also showed that healthcare workers were most knowledgeable about personal protective equipment (PPE) (mean score of 72.0 %) compared to other areas such as the general OSH (58%), legislations (57%), and occupational hazards (64%). The authors suggested for more training workshops to promote OSH knowledge.
Abdullah et al. made some recommendations to reduce occurrence of occupational hand injuries.10 The authors
suggested for a proper working technique, a conducive working environment and wearing of protective gadgets. They suggested for a longer period of rest for workers since fatigue may reduce attention to safety practices.
Jegatheswaran et al. suggested improving workforce psychology to improve workers attitude towards OSH, and to reduce the rate of occupational accidents.14
Htayet al.had recommended environmental and behavioral modifications together with community participation at a district level to prevent injuries at home13.
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A Review of Occupational Injury Research In Malaysia
Chan et al.reviewed the occupational rehabilitation services in Malaysia and Singapore.21
Efforts to rehabilitate injured workers are generally lacking in Malaysia. Publications on occupational rehabilitation are scarce. The authors suggested that the Ministry of Health (MOH) rather than the Ministry of Human Resources should be responsible for providing occupational rehabilitation services. MOH has more personnel and expertise to provide occupational rehabilitation services. However, the authors recommended that their clinical skills and knowledge needs to be enhanced. There should also be more awareness among employers and funding for provision of occupational rehabilitation services. A closer cooperation between various ministries and departments is needed to improve the delivery of occupational rehabilitation services.
Murad et al. conducted a study to assess the relationship between occupational competence (OC) and emotional health among injured workers participating in the Return To Work (RTW) programs.22 The results showed that injured
workers had a significantly lower OC and a significantly higher NES (Negative Emotional States) especially in the off duty and re-entry phases. This study also showed that lower levels of OC were associated with higher levels of NES. The authors suggested that the RTW programs should focus more on OC and NES and not just on physical defects. The authors also suggested that psychologists and occupational therapists should be given a more active role in the RTW programs. Rozali et al. reported a case study of decompression illness in a diver working for a private company.23 He developed
decompression illness when he ascended suddenly from a depth of 48 meters because his tank ran out of air. The authors recommended that all decompression illness should be notified. All divers should be registered with SOCSO.
SECTION 2: RELEVANCE OF FINDINGS FOR PRACTICE AND FUTURE RESEARCH DIRECTION
Malaysia is a developing nation undergoing rapid industrialization. OSH practices play an important role in improving organizational efficiency by reducing labour cost and loss-of-work hours due to injuries. They, therefore, have a significant impact on the national economy. Descriptive research helps in identifying the magnitude and impact of occupational injuries while analytical studies on practices of both workers and management helps to examine the causes of injuries with a view to develop preventive measures. The National Institute for Occupational Safety and Health (NIOSH), United States has recommended an occupational research agenda encompassing the traditional public health model24. This includes (a) injury surveillance to identify and prioritize the magnitude of the problem (b) analytic research to establish risk factors and causative mechanisms c) identification of effective strategies or developing new strategies for prevention d) effective intervention through widespread communication, enforcement and technology transfer and e) evaluation of interventions.
Further research should also focus on safety practices and enforcement of OSHA in high-risk industries such as transportation, agriculture and construction. Pilot interventions should be implemented and evaluated for widespread implementation. Studies of hazards in the environment (including machinery and equipment) should be encouraged and preferably carried out by the concerned industries.
Standard operating procedures for the proper handling of industrial equipment should be evaluated for feasibility and compliance. The efficacy of standard safety practices such as rotation of workers in hazardous work areas should be evaluated.
In conclusion, research on occupational injury in Malaysia is generally lacking and needs to be strengthened. Future research should focus on high-risk industries (agriculture, construction and transportation), Future occupational management systems and the role of a safer design of the environment including equipment and machinery. The effectiveness of OSHA should be evaluated and measures to further implement it should be developed. Comparative research into the effectiveness of occupational safety practices in our country with other developed nations will be helpful.
ACKNOWLEDGEMENT
We would like to thank the Director General of Health Malaysia for his permission to publish the paper, Prof Teng Cheong Leng of International Medical University for making the literature search, Dr Goh Pik Pin and Dr. Kirubashni Mohan of Clinical Research Centre for their valuable contribution and assistance in editing and formatting the review articles."
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