National Health & Morbidity Survey (NHMS)

Diabetes mellitus can be classified into 2 major clinical conditions namely insulin dependent (IDDM) and non-insulin dependent (NIDDM) diabetes mellitus. The NIODM usually comprise 90% of diagnosed diabetes. Diabetes is a life threatening disease. It is a risk factor to cardiovascular diseases. The disease is associated with severe neurological, cardiovascular, ocular and renal complications. Hence, the socio economic implication is enormous. Development of a global surveillance system and programs for primary, secondary and tertiary prevention interventions in the control of diabetes are pertinent. The mainstay of diabetes treatment is diet and exercise before pharmacological treatment is started. Thus, patients' compliance is essential. The goal of diabetic care is to improve the quality of life for the diabetics. In Malaysia, it is felt that there is an increasing prevalence of diabetes that directly or indirectly has great socio-economic implications to the country due to its chronicity and complications. Hence, diabetes was included in this National Health and Morbidity Survey in an attempt to determine, through a community-based approach, the prevalence of diabetes and the health-seeking behavior of diabetic patients. The methodology for this survey was described in detail in Volume 1 of the series of these survey reports. The survey revealed that the national prevalence of diabetes in the Malaysian population of 30 years and above was 8.3%. This comprised of 5.7% known diabetics (self-reported) and 2.5% undiagnosed diabetics (determined by the 2-hour post glucose-load test in which the blood glucose level was more than 11 mmol/1). However, this varied among the states and several socio-demographic parameters. Majority of the known diabetics was on medication and diet control while only about 8.5% were on diet control alone. The common perceived complications associated with the disease were visual problems and numbness. The survey also showed that only 7.7% of the known diabetics currently on medication ever stopped medication. Two common reasons were cited for this. One was they felt they had recovered from illness and the other was the doctor advised them to stop. The survey revealed that among the known diabetics, 10. 9% had hypertension, 11.3% were obese and 22.8% had hypercholesterolaemia. Thus, it is proposed that the national diabetes programs should strengthen its primary, secondary and tertiary interventions in order to control the diabetes situation in this country. Recommended strategies included intensifying health promotion and patient education, early and opportunistic screening especially among those with associated risk factors and, further training to the medical and paramedical personnel both in private as well as public sectors on effective management of diabetes. The burden of health care remained in the government health facilities as the survey showed that majority of this chronic disease still used government facilities especially those in the rural areas although a reasonable percentage especially the urbanites used the private health facilities.

Asthma is a debilitating disease. It affects all races and all ages especially children. The prevalence of asthma varies among different populations. from less than 2% to 50% in some. Asthma can be controlled but cannot be cured. The use of peak flow meter is important in assessing the severity of patients and justification as well as assessment of treatment for asthmatics. Medications for asthma are used to relieve as well as to act as prophylactics against occurrence of asthmatic exacerbation. Inhalers are the treatment of choice currently. In Malaysia, statistics showed that there is an increase in the reporting of asthma cases between 1990 to 1995. Increase in such incidences should be of growing concern and should be addressed appropriately. The National Health and Morbidity Survey (NHMS2) 1996 was conducted with the objectives of determining prevalence of asthma by different socio-economic and geographical subgroups, finding out the pattern of utilisation of health facilities and adequacy of the clinical management of stlatics. For asthma, the data was collected using pre-coded questionnaires by trained interviewers through interviewing all household members in the selected living quarters. The detail of the sampling: design is described in Volume 2 ofa series of the NHMS 1996 reports. The survey revealed that the national prevalence of self-reported doctor-diagnosed asthma was found to be 4.2% (3.9-4.4%). This prevalence shows that asthma is a problem in Malaysia. Comparatively, African countries reported prevalence ranging from 2% to 5%. The survey also shows that the prevalence of childhood asthma was 4.5% (4.1-4.7%) and asthma among adults was 4.1% (3.8-4.8%). However, the estimated prevalence of asthmatic children in Australia is 8 to 11 % whilst in adults is 6 to 7%. It was observed that among the children, males and Other Bumiputeras as well as those living in the urban areas, recorded higher prevalence. In general, it was observed that the asthmatics occurred among the lower educational and income group. The prevalence among the adults increased with age. This was probably due to other diagnosis being included in the self-reporting for example cardiac asthma. Majority of the adults who had asthma in this survey sought treatment from the government health facilities while majority of the childhood asthmatics sought treatment from the private facilities. The survey also revealed that there was inadequate clinical management of asthmatics due to the underutilization of Peak Expiratory Flow meters and the large proportion of asthmatics being treated with non inhalers. An asthmatic control program is therefore essential in view that asthma can be controlled so that the asthmatics can have a better quality of life.

In this survey, the prevalence rate of acute respiratory infections in children less than five was 39.3%. Upper respiratory infections made up 91.1% of these infections, pneumonia 6.9%, and severe pneumonia 2.0%. The prevalence rate was found to be highest in Sabah (49.4%) and lowest in Perak (30.1%). It was higher in rural areas as compared to urban areas. By ethnicity, it was highest in other Bumiputera (49.6%) followed by the Others (42.6%). and it was lowest in the Chinese (27.8%). Families with the lowest income of less than RM400 per month also had the highest prevalence rate. These children in rural areas and of other bumiputra ethnicity as well as from families with income of less than RM400 per month had also higher percentage of pneumonia and severe pneumonia. There was no significant difference in the prevalence rate between boys and girls, but there was a significant difference in the rates in different age groups. By age group with severity of the disease, neonates recorded the lowest percentage of upper respiratory infection (69.2%) but the highest percentage (25.9%) with severe pneumonia. The older age groups suffered higher percentage of upper respiratory infection (URI). The majority of children (39.2%) sought treatment at private facilities while 29.98% at government facilities. However, more children with the more serious infections sought treatment at government facilities; 33.0% for pneumonia and 38.7% for severe pneumonia. 14.9% of children with pneumonia and 17.1% with severe pneumonia did not go for any treatment. The main reason given for not seeking treatment was that the illness was not considered to be serious. For severe pneumonia, the most common reason given (37.0%) was that there were no specialist services. This survey identified children who were at higher risk of having the more serious acute respiratory infections vis-a-vis pneumonia and severe pneumonia. Doctors in the private sector have an important role to play in the management of acute respiratory infections. I is recommended that mothers and child minders need to be taught to recognize signs of serious illness in children with acute respiratory infections.

Exercise is an important component of a healthy lifestyle and has been identified as an important factor in the prevention of certain illness. If therefore contributed to rising health status and reducing the demand for health services. Exercise in this survey is classified into 2 types namely "ever exercise" and "adequate exercise". This classification is made based on frequency, duration and the type of activity engaged in an exercise. Worldwide, the importance of exercise in prevention of certain illness especially cardiovascular disease, has been recognized. Hence, exercise was included in this National Health and Morbidity Survey in an attempt to obtain the community based data on the prevalence of exercise in order to strengthen the Healthy Life Style Campaign in Malaysia. The methodology for this survey is described in detail in Volume 1. The types of exercise were identified from self-reporting and 2-week recalling by the respondents aged 18 years and above. The national prevalence of ever exercise and adequate exercise were found to be 30.9% and 11.6% respectively. Only 37.6% of those who ever exercised did it adequately. The four most common types of activities engaged by Malaysians were jogging, team sports, brisk walking and racket sports. The almost 70% of Malaysians who did not exercise were likely to be those from rural stratum, older people, the socio-economically disadvantaged, women, private employees and those 111 agriculture and production sector, and those who are obese and underweight. It is proposed that the Healthy Life Style Campaign of the Ministry of Health should have programmes to motivate persons who currently do not engage in exercise to begin doing physical activity. Those who are irregularly active should strive to adopt a more consistent pattern of activity.

Overweight is a major public health issue and the Ministry of Health has implemented several activities to encourage the public on good eating habits and avoidance of overweight. However, no baseline data on the Body Mass Index (BM!) distribution of the adult population is available to monitor the effectiveness of the education campaigns and to estimate the population at risk of diet related diseases. Hence, for this reason nutritional status of adults was included as a scope in the Second National Health and Morbidity Survey. A household interview survey was conducted in 17,995 living quarters and the respondents were adults aged 18 years and above in the household. The cut off points for BM! used were: less than 18.5 for underweight, 25 to less than 30 for overweight and greater than 30 for obese. Results of the survey showed that the overall prevalence of obesity, overweight and underweight was 4.4%, 16.6% and 25.2% respectively. The mean BM! was 22.48 kg/m. Malaysia was comparable to other developing countries where the problem of nutrient excesses now exists side by side with the problem of under-nutrition. Strategies to prevent and reduce the prevalence of overweight should focus on the specific target groups identified in this survey whilst the problem of under-nutrition requires further research and serious policy considerations. Many strategies to improve the nutritional status of the population have been laid out in the National Plan of Action for Nutrition and the relevant agencies should seriously consider the implementation of these strategies.