Archive for the ‘Health’ Category

How can we tell if our health system is healthy?

Monday, July 8th, 2019

Malaysia’s health system is so large, complex and inter-connected that there is no one solution for all its problems; but we can improve it together by first deconstructing the system and understanding it.

“WHAT are the patient’s vital signs?” asks the emergency physician as the unconscious patient is hurriedly wheeled into the Accident and Emergency Department.

A team of nurses and paramedics spring into action, coordinating their efforts towards one single objective: the stabilisation of the patient’s blood pressure, pulse rate, breathing rate and temperature – his vital signs.

Every doctor seeing every patient in almost every setting will check the patient’s vital signs.

Vital signs are, well, vital because the human body should always be in homeostasis (i.e. a state of physiological equilibrium, or more simply, balance).

Any readings outside the normal ranges, either too high or too low, will cause concern; the larger or the more sudden the deviation, the bigger the concern.

Doctors will search for the causes, and treat if necessary. This is the basis of medicine.

So, if there are vital signs for the human body, are there vital signs for a country’s health system too?

How would we know if Malaysia’s health system also requires urgent life-saving measures?

Are there vital signs for health systems? Or are they so big that a few numbers or data points will not be able to properly represent their “health”?

These are good questions for citizens, as health is too important to be left to governments, the private sector and non-governmental agencies (NGOs) alone.

In the World Health Organisation’s (WHO) “whole-of-society” approach to health, all citizens can and must be equal and thoughtful participants in health systems, and not just passive recipients of health services.

Fortunately and understandably, all Malaysians already want urgent reforms for cheaper, better and more accessible healthcare.

However, we cannot successfully implement any reforms before we understand our health system slightly better.

There is one colossal challenge though: Malaysia’s health system is a “hyperobject”, which is so large that we can only understand it through patient and systematic deconstruction, and so complex that there are no simple explanations or solutions.

The term “hyperobject” was introduced by Prof Timothy Morton in 2010 in his book The Ecological Thought.

He suggested plastics, Styrofoam or climate change as examples of things so massive that they transcend time and space.

I will share two more examples: although we use WiFi and ATMs daily, it is difficult to grasp the full extent of the Internet or the US$80 trillion (RM333.2 trillion) global economy – objects so massive that they stretch our understanding, and perhaps even our control.

Too huge to comprehend

WHO divides health systems into six building blocks – workforce, financing, delivery, essential medicines, information systems and governance – each of which are infinitely complex.

To demonstrate the gargantuan size and complexity of Malaysia’s health system, here are some fun facts for each block.

In 2017, Malaysia spent a total of RM56 billion on health, with 3.5 million inpatient admissions and 70.1 million outpatient attendances in 417 hospitals and 9,849 clinics.

The Health Ministry’s 2017 annual report runs to 490 pages, and the ministry has approximately 268,000 employees, with 65,000 nurses, 35,000 doctors, and 27 different sub-categories of allied healthcare professionals (from dieticians to entomologists).

There are at least 26 different laws (PDF) governing Malaysia’s healthcare, at least 86 clinical practice guidelines by the Academy of Medicine Malaysia that list best medical and treatment practices for a variety of different medical conditions, and hundreds of ways that Malaysia can fund our healthcare.

These massive numbers prove that Malaysia’s health system is so gargantuan and complex that it could become incomprehensible or ungovernable, despite our best efforts and intentions.

Some may then argue that we must return to our previous “small /simple” health system, but that’s impossible.

Indeed, the success of yesterday’s system created today’s “large/ complex” system. We can see this in our larger and healthier population, all of whom live longer, have with more complicated diseases, are more educated and demand better quality care.

To understand and improve our health system, we must accept that it has complex and inter-connected problems with multiple root causes, and that there are no easy, magic or overnight cures.

While we can and must simplify processes and bureaucracy, there will still be no single/ simple solutions to the rising cost of healthcare, the over-supply of junior doctors or long queues in public hospitals, to name just three problems.

With many causes, there must be many solutions. Therefore, what Malaysia needs is a basket-of-solutions.

As our health system issues do not have only one single best answer, we must adopt a multipronged approach because there are many right answers.

Then, we will need everyone in society, from the Prime Minister to the man (and woman) on the street, to help implement these solutions, with all citizens actively participating in the health system that we jointly own.

Part of the solution

This column aims to be a part of that basket-of-solutions.

In it, we will deconstruct our large and complex health system into its smaller component parts, provide more light (rather than heat) into the public discourse, and deliver solutions for a large and complex system with more civil participation.

We will examine our system in digestible weekly doses using a structured, neutral and pragmatic approach.

Every column will look at a single element, peel back the layers, connect it to other relevant (and sometimes surprising!) elements, and discover some practical improvements.

This methodical approach and holistic view will also never neglect the urgent issues of the day.

Malaysia’s health system isn’t dramatically dying in our arms. A better description is of a complacent middle-aged person with some mild-to-moderate disease, who needs better lifestyle choices and a few bitter remedies to avoid deteriorating.

We still have time (but not a lot) to “save” our health system. If we work together on that basket-of-solutions, we can surely achieve the health and well-being that we Malaysians all want and deserve.

By Dr Khor Swee Kheng
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70 child cancer cases in Sabah every year

Sunday, July 7th, 2019

KOTA KINABALU: Some 70 children are diagnosed with cancer every year in Sabah, said State Health and People’s Wellbeing Minister Datuk Frankie Poon.

He said based on recent statistics, the numbers are under-reported as there is still a lack of childhood cancer awareness.

Based on the statistics, Poon said 43 children are diagnosed with cancer every single day around the world and 400 children in Malaysia are diagnosed with blood-related cancer every year.

“The three most common childhood cancers are leukaemia, brain cancer and lymphoma.

“3.34 per cent of these children will die within 30 years. Nineteen per cent will survive at least 30 years but suffer life-threatening or disabling chronic health conditions.

“Twenty-five per cent will survive at least 30 years but suffer mild or moderate chronic health conditions, while 22 per cent will live at least 30 years without any chronic health condition.

“These rates can be reduced and cure rates could be much greater through early detection and awareness,” said Poon when launching Junior Chamber International (JCI) Kota Kinabalu’s second year flagship project “Go Botak 2019”, here, Saturday.

Poon hoped JCI KK will continue to hold the project and pledged support for it in any way he could to ensure its success.

He said the project is to create awareness on childhood cancer as well as to help cancer-stricken children.

“As a community, we play a huge role too to fight childhood cancer.” Meanwhile, project organising chairperson Kimberly Lim said the objectives of the project are to create awareness of childhood cancer and also to produce children wigs by raising funds and inspire the community to donate their ponytails or shave their heads.

“This is to encourage the young cancer patients to regain their confidence to battle childhood cancer with a positive and fighting spirit, and to know that they are not alone in the fight.

“We want to raise awareness of childhood cancer by educating parents or anyone that childhood cancer patients need to pay more attention and need early detection.

“This project will end in September in conjunction with the childhood cancer awareness month.

“I am very positive that this project will create a sustainable impact in our community, as awareness and support for childhood cancer is still minimal,” said Lim during a press conference on the project, here, Saturday.

According to Lim, the minimum length to donate ponytail is 15cm and must be natural and untreated and it takes 35 to 40 donated ponytails to produce one children wig.

Lim said the ponytail donations may be made at collaborating saloons, namely Ar Saloon, Young Style Unisex Saloon, Turning Points, Hair Impressions, Mission Cut and G Cut.

For this year project, the E-Post is the main sponsor.

By: Cynthia D Baga.

Early diagnosis and treatment of mental illness increases chances of recovery

Tuesday, July 2nd, 2019
In Malaysia, there has been a three-fold increase in mental health problems among the population over the past 20 years.

THE workplace is not immune to mental health problems and their impact in psychological, social and economic terms is high.

Globally, it was reported that an estimated 264 million people suffer from depression, one of the leading causes of disability; the cost of mental illness has been estimated at US$2.5 trillion (RM10.35 trillion) in 2010 and is projected to reach US$6 trillion in 2030.

In Malaysia, there has been a three-fold increase in mental health problems among the population over the past 20 years. If we apply the same projection, than the estimated loss for Malaysia was US$10.6 billion for 2010; by 2030 it is expected to soar to US$24.3 billion.

A study conducted by the Education Ministry in 2017 also shows that 4.4 per cent or 2,123 teachers were identified as experiencing moderate stress level while civil servants also achieved an average score in the Malaysia Psychological Wellbeing Index which was conducted in August 2018.

According to the Malaysian Health System Research report (March 2016), mental illness is a leading cause of economic loss at the individual, family, employer, health system, and national levels, due to direct and indirect health costs, absenteeism, lost productivity while at work, and decreased income which can result in reduced national economic output.

When addressing participants at Malaysia’s 1st Mental Health Experiential Conference (# MyMHEC2019) in Petaling Jaya recently (June 19), I stressed that mental health at workplace should no longer be ignored as it could cost employers and the country billions of ringgit if not properly addressed.

Neglect of mental health and psychosocial factors at the workplace is not only detrimental to the individual worker but also directly affects productivity, efficiency and output of any organisation.

Accidents at workplaces are not only caused by poor work safety practices but also due to mental health issues. I have consistently raised about mental and psychosocial issues as they are also affecting workplaces.

Meal health issues at the workplace are caused by a combination of factors such as personal work, work environment and organisational factor.

Workplace stress is defined by the World Health Organisation (WHO) as “the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope”.

There are many types of work-related stress such as job insecurity, low control in work, low social support from co-workers, dissatisfaction with work and problems associated with depression and anxiety.

Unemployment is a well-recognised risk factor for mental health problems and negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity.

Studies show that workplaces that promote mental health and support for people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains.

More young workers nowadays are also stressed out or experiencing symptoms of stress-related illnesses such as anxiety or depression due to life experiences or environmental factors.

Struggling to cope with work, new financial commitments, family expectations and relationships are among the topics of concern for young adults.

It is not only happening here but all around the globe since the demands of living in current times are causing depression, anxiety and other mental health problems in young people.

As fresh graduates for example, it is normal for them to wish for a permanent job with a handsome salary, dream car and house but life is not always smooth sailing.

While some young working adults might soldier on amidst the trials and tribulations, others struggle with emotional and physical issues as soon as they leave university, or even before and enter the working world.

Though each generation has faced its own set of problems, dilemmas faced by young adults during present time appear to have wide-ranging social and economic implications, with a rising number being diagnosed with depression, anxiety or other mental health problems.

A healthy workplace can be described as one where workers and managers actively contribute to the working environment by promoting and protecting the health, safety and well-being of all employees.

Mental health interventions should be delivered as part of an integrated health and wellbeing strategy that covers prevention, early identification, support and rehabilitation.

Key to success is involving stakeholders and staff at all levels when providing protection, promotion and support interventions and when monitoring their effectiveness.

All parties should also strive to stop the stigmatisation of mentally ill persons who are often regarded as “orang gila” or crazy people.

Instead of insulting them, the community members should help those with mental disorders to get counselling or psychiatric treatment.

Prevention in the early stage can certainly reduce the likelihood of people with mental problems turning violent or doing extreme things including murder and committing suicide.

Family members, office colleagues and the local community should know how to identify the symptoms and ways to help those who are suffering from mental illness.

Most families, employers and co-workers are not prepared to cope with learning that their loved ones or office mates have mental illness.

As for the victims, It can be physically and emotionally trying, and can make them feel vulnerable to the opinions and judgments of others.

The World Health Organisation (WHO) has stressed that organisations have a responsibility to support individuals with mental disorders in either continuing or returning to work.

Soe of the initiatives that may help individuals with mental disorders include flexible hours, job-redesign, addressing negative workplace dynamics and supportive and confidential communication with the management.

Researches also show that unemployment, particularly long term unemployment, can have a detrimental impact on mental health.

Asthe country’s leading institute for occupational safety and health (OSH), NIOSH has already introduced several programmes to help employers and their staff manage mental health at the workplace apart from organising various health promotional programmes.

One of them is the mental health module, which was introduced under a collaboration with the Ministry of Health. It is part of NIOSH’s Total Wellness and Health Promotion Program (TWHP), where the employers and their employees will learn about mental health issues and adopt the best strategies to manage the problem.

It is important to know that early diagnosis and treatment greatly increases the chances of individuals affected by mental illness to regain a reasonable state of health and wellbeing and satisfying quality of life.

There is a need to implement the Employee Assistance Programme (EAP) which can provide both prevention and early intervention for employees affected by stress, emotional and mental health issues which jeopardise job performance.

Funds spent on EAPs have documented investment returns in such areas as productivity and work performance. Companies are finding that investing in employee’ emotional wellbeing can mean a healthier bottom line.

It was predicted that mental health problems will become the second biggest health problem affecting Malaysians after heart disease by 2020, unless proper measures are taken to address the issue.

Because of the stigma associated with mental disorders, employers need to ensure that individuals feel supported and able to ask for support in continuing with or returning to work and are provided with the necessary resources to do their job.

Article 27 of The UN Convention on the Rights of Persons with Disabilities (CRPD) provides a legally-binding global framework for promoting the rights of people with disabilities (including psychosocial disabilities). It recognizes that every person with a disability has the right to work, should be treated equally and not be discriminated against, and should be provided with support in the workplace.


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A price control headache

Sunday, May 12th, 2019
Addressing the very complex issue of setting up a drug price control mechanism to ensure people have better access to affordable drugs.

ELEEN Ooi, 38, could not believe her eyes when she got the bill for the removal of a peanut stuck in her four-year-old daughter’s nose.

The private hospital’s itemised bill for the 15-minute procedure ran into two full pages and came up to RM4,000.

And she noticed that she was charged RM43.60 for a baby nasal spray which she could get for RM27 from a pharmacy.

She, like many patients, alleges that hospitals are charging high prices for drugs and services resulting in high insurance premiums in the country.

Drug prices are a major contributor to high healthcare costs and the government should regulate them across the board and at every dispensary, she says.

“The price of drugs needs to be more affordable for the public, especially drugs where patents have expired,” says Ooi, a lecturer.

She says when people cannot afford to sustain paying for the high costs of medicine, especially those taken for the long-term, they are forced to use the public health system.

For this reason, she welcomes the Cabinet’s decision to impose drug price controls.

A solution to fit all

Health Minister Datuk Seri Dr Dzulkefly Ahmad says the Cabinet approved the measure on April 12 and that the ministry will get pharmaceutical companies’ responses on the price control mechanism this month.

The ministry will use external reference pricing to benchmark drug prices in Malaysia, choosing the three lowest prices and averaging them to determine the ceiling price.

The ministry has not decided which country’s system it will model the control mechanism on, he said at a press conference held recently in conjunction with Pakatan Harapan’s first year in office.

Dzulkefly says the ceiling price will be imposed at the wholesale level as well as the retail/consumer level at clinics, hospitals and pharmacies.

Controlling the prices of drugs is provided for in the Price Control and Anti-Profiteering Act 2011, which is monitored by the Domestic Trade and Consumer Affairs Ministry. The Cabinet has agreed that this ministry will appoint Health Ministry officers as price assistant officers to carry out drug price control enforcement activities, he says.

Dzulkefly says the move will ensure that people have access to affordable drugs, especially expensive new drugs; it will also encourage innovation and healthy competition for industry growth.

The private sector may not be happy with a price control but the country needs a solution that fits all, he says.

It was recently reported that Penang Institute political studies senior analyst Lim Chee Han had quoted the 2017 Medicine Prices Monitoring report showing that the median mark-up for originators’ and lowest-priced generics’ retail prices in private hospitals was 51% and 167% respectively.

In pharmacies these figures were lower, at 22.4% and 94.7%.

“This shows that the mark-up range can be exceedingly large; in some extreme cases in private hospitals, it could even spike up to 117.4% and 900%!” Lim says.

NGOs welcome move, industry wants competition

Non-governmental organisations (NGOs) welcome a drug price control but local drug producers prefer market competition.

Third World Network (TWN) adviser Dr Lim Mah Hui says he supports the effort but it should not be rushed as it is a complex issue and the government needs to look at different models and choose the best to emulate.

Dr Lim says there is a lack of transparency in drug pricing at different levels – manufacturers, middlemen, pharmacies, hospitals and clinics – and there should be some regulation of the price range they can mark up.

“We hear about discriminatory preferential pricing. Manufacturers selling (the same) drugs at different rates to different buyers and some medicines not being made available to certain pharmacies.

“I am not saying that the industry should not make a profit, but the profits should be reasonable,” he says.

Africa introduced a single exit price in 2004 which requires the manufacturer to declare the price when the drug comes out of the factory. It also put a stop to discounts and preferential pricing, he says.

In June last year, The Star quoted Dr Lim saying the government should initiate centralised purchasing and regulate drug prices as is done in advanced countries, and carry out a study on the drug procurement system to ensure drug prices are affordable.

Last August, TWN programmes director Chee Yoke Ling also highlighted the need to tighten up unnecessary patent monopoly and additional patents that extend monopolies beyond 20 years, pushing up the cost of some crucial medications.

Malaysian Pharmaceutical Society president Amrahi Buang says the government’s decision shows it has the political will to address this chronic problem, calling it a “major breakthrough”.

He adds, “The price control should not be applicable to all types of medicines but should focus on medicines requiring prescription and also address proper labelling and itemised billing,” he says.

Meanwhile, Medical Practitioners Coalition Association of Malaysia representative Dr M. Raj Kumar recently said that prices of drugs should be controlled but this should be done in tandem with the harmonisation of the fee schedule for general practitioners with private hospital-based doctors.

Malaysian Organisation of Pharmaceutical Industries (Mopi) president Billy Urudra says Mopi, which is made up of 45 members who are mostly local generic drug manufacturers, prefers that open market competition determines fair price instead of a price control. This was expressed to the Health Minister in a townhall meeting on April 2.

He says it is more important for the government to expedite approval of generic drugs to get them into the market faster and allow competition, and to update intellectual property laws to prevent the lengthening of protection for innovators that leads to continuous high prices.

A mechanism to establish a price based on prices from various countries seems acceptable, Urudra says, but it is best to choose a country that has a similar economic growth as Malaysia because benchmarking against developed countries may result in higher prices, he says.

Although Thailand and the Philippines do not have such a control mechanism, the prices in these countries could serve as a comparison, he adds.

Consider cost variance

While the Pharmaceutical Association of Malaysia declined comment for this article, the Association of Private Hospitals of Malaysia president Datuk Dr Kuljit Singh says the association does not support a move that seeks to control the prices of medicines in private hospitals.

Unlike dispensing in a retail pharmacy, medication administration in a hospital involves other costs, such as medication review, drug counselling, compliance monitoring, and titration of dosages as patient conditions change, he says.

He says there is a host of direct and indirect costs associated with dispensing medications in a hospital, which varies across private hospitals depending on geographical locations, levels of service, and specialities.

“We have cautioned against a blunt policy that disregards this cost variance and brought this up with the Pharmaceutical Services Division at a townhall meeting on Feb 28 this year.

“We were given an undertaking it would be considered,” he says.

Dr Kuljit also says that such policy and regulatory measures should be made in tandem with adjustments to private hospitals’ overall payment system where direct and indirect costs are lumped together into a few chargeable items – medication services is one of these.

“This was the result of a distorted payment structure for private healthcare where proposals to realign increases in these costs to their proper categories – such as room and board rates – were met with resistance.

“The increases were inevitable due to a number of factors such as inflation, exchange rates and higher manpower requirements,” he says.

Asked what other charges are lumped together with medicines and other “charge-able items”, Dr Kuljit says there is expensive equipment that hospitals can only charge for when used such as medical pumps, used after cardiac surgery in an emergency.

On why drug prices in private hospitals are much higher than that of drugs sold in pharmacy outlets, he says the overhead costs of running the pharmacies are lower and they can buy in bigger bulk.

Dr Kuljit argues that private hospitals make an average of 5% to 7% profit, up to a maximum of 10%, and this is considered low.

Ooi, who is also a business consultant, questions the need for the high mark ups on drugs when the hospitals are already charging for almost every other possible thing, including cotton wool.

“The only way to show proof is to see their bottom line,” she says.

Private hospitals have captive customers which retail pharmacies do not have, which indicates a higher economies of scale, she argues.

Moreover, most retail pharmacies are placed in prime locations with rental per month ranging from RM7,000 to as high as RM50,000, she says.

Meanwhile, TWN’s Dr Lim asks if private hospitals are not making money hand over fist, adding that the CEO of one healthcare company is one of the highest paid CEOs in the country, earning more than RM33mil last year, according to reports.

“And are the big private hospitals not making huge profits, or else why are they expanding?” he asks.

For decades, Malaysians have complained of high medical charges, with some facing a financial catastrophe or maxing out their insurance coverage in a health crisis. High drug costs are a major concern here.

The drug price control measure and a central pool procurement system for medicines (to begin at the end of the year) are the bold measures the government has announced it will implement to address the issue.

However, in tandem with these measures, the government also needs to remove the unnecessary extensions of patents and examine the role of the middleman in the drug supply chain to the government.

By Loh Foon Fong
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Rise in Sabah Malaria cases

Thursday, May 2nd, 2019

KOTA BELUD: A total of 2,316 Malaria cases were reported in Sabah in 2018 with two deaths compared to 2,004 cases in 2017. This showed an increase of 15.56 per cent in the number of cases.

“This year alone, 768 Malaria cases have been reported,” said Tempasuk Assemblyman Datuk Musbah Jamli.

For Kota Belud, in 2018, there were 57 cases reported where Kg Taburon contributed nine cases. This year there were 11 cases reported compared to 25 cases in 2018.

“Most of Malaria cases were attributed to the various activities of villagers comprising plantation, agriculture, hunting and forestry.

“The prevention of malaria should not only be the responsibility of the Health Department or government alone, but society should be equally responsible for maintaining the health of families,” he said when officiating at the World Malaria Day Programme at Kg Taburon, here.

Musbah said the department carried out various preventative measures including fogging and raising awareness on the matter.

It is important for the community to take precautionary measures to prevent malaria infection, in line with the theme of World Malaria Day this year, “Zero Malaria Starts From Us”.

“Among the steps we can take is to reduce outdoor activities at night and wear appropriate clothing when performing activities such as rubber tapping. The use of insect repellent is also strongly encouraged.

By: Gindanau Sakat.

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Eat more rice, lose weight … yes, according to this study.

Wednesday, May 1st, 2019

GLASGOW (Bloomberg): Eating rice may help prevent obesity, research suggests.

Experts found that people following a Japanese or Asian-style diet based on rice were less likely to be obese than those living in countries where rice consumption was low.

Researchers said low-carbohydrate diets “which limit rice” are a popular weight-loss strategy in developed countries but the effect of rice on obesity has been unclear.

They looked at rice consumption in terms of grams per day per person and calorie intake in 136 countries.

The researchers calculated that even a modest increase in rice consumption of 50g per day per person could reduce the worldwide prevalence of obesity by 1% (from 650 million adults to 643.5 million).

Prof Tomoko Imai, from Doshisha Women’s College of Liberal Arts, Kyoto, Japan, who led the research, said: “The observed associations suggest that the obesity rate is low in countries that eat rice as a staple food.

“Therefore, a Japanese food or an Asian-food-style diet based on rice may help prevent obesity.

“Given the rising levels of obesity worldwide, eating more rice should be recommended to protect against obesity even in Western countries.”

Giving possible reasons why rice can help, Prof Imai said rice was low fat, adding: “It’s possible that the fibre, nutrients and plant compounds found in whole grains may increase feelings of fullness and prevent overeating.”

The authors concluded: “The prevalence of obesity was significantly lower in the countries with higher rice supply even after controlling for lifestyle and socioeconomic indicators.”

Tam Fry, chairman of the National Obesity Forum, said: “We have known for centuries that Far Eastern populations tend to be slimmer than in the West because rice is a staple food, but few obesity specialists may have appreciated why.

“This novel research is the first to hypothesise that we could nail obesity by eating a modest amount more.”

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‘Be aware on importance of healthy, balanced diet’

Monday, April 29th, 2019

KOTA MARUDU: Everyone should be aware on the importance of a healthy and balanced diet, said State Health Director, Datuk Dr Christina Rundi.

Dr Rundi said although it seems a trivial matter to some, nutrition should be taken seriously because imbalance to it give rise to many diseases

“Not only because of over eating, one can suffer from diseases such as hypertension, obesity and diabetes, but lack of food is also a cause of illness due to lack of nutrients.

“Having awareness on keeping a balanced diet is important, especially during this current times, with the diversity of food sources, plus easy access, including online trading,” she said at the State level Nutrition Month 2019 held at the Kota Marudu Community Hall, Saturday.

Over 800 people attended the one-day event which featured various activities such as health screening, blood donation drive, dental treatment, colouring contest, games and interaction exhibition, lucky draw tickets and sales of local food products, among others.

Dr Rundi also presented a special programme award called “Cara Hidup Anda Terbaik (C-HAT)” to Sekolah Kebangsaan Bawang in Tamparuli.

The event was made possible by Kudat Health Officer, Dr Kwang Kugan and Kota Marudu Health Officer Dr Athira Naseruddin together with members of the Ministry of Health.

Dr Rundi said the Nutrition Month programme is not just for the community in Kota Marudu but for all the people in Sabah, especially those who are busy working to be aware and begin to invest in the importance of a balanced nutritional care from now on.

She said Sabahans should be grateful that there are many choices of food including a variety of seafood, vegetables, fruits and rice.

By: Patimang Abdul Ghani.

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Lee: Educational enforcement on smoking ban to be intensified in rural areas.

Sunday, April 28th, 2019
Filepic is for illustration purposes

Filepic is for illustration purposes

IPOH: Educational enforcement on smoking ban will be intensified in rural areas nationwide, says Deputy Health Minister Dr Lee Boon Chye.

He said support of the ban at urban areas was encouraging, but there were still pockets of non-compliance at rural areas.

“We need to enhance educational enforcement at villages, and out of town areas, because we find people settling there are still not adhering to the ban,” he told reporters at a health community event held in Gunung Rapat here on Sunday (April 28).

It was reported recently that the ministry had extended the six-month educational enforcement period that was enforced in Jan 1, this year.

Dr Lee said the extension did not mean that people could smoke at open air eateries.

“If people are still smoking openly at such eateries, refuse to follow advice, they can be issued a fine.

“We are not punishing smokers, but our intention is to give them a chance to quit, reduce smoking or if they can’t do that, then at least they should not smoke in public,” he added.

On claims by restaurant owners that their business was dropping, and the economy was affected, Dr Lee said “The government collects between RM4bil and RM5bil in taxes from the tobacco industry annually, but spends at least RM16bil a year to treat smoking related illnesses.”

By Manjit Kaur
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Influenza: A real threat to young children.

Wednesday, April 24th, 2019

In their imaginary world, children could be superheroes fighting fearsome monsters.

In real life however, children are quite helpless against many threats to their health and well-being – influenza is one of them.

Worldwide, this disease is responsible for between 290,000 and 650,000 respiratory-related deaths annually, many involving young children.

Younger age, higher risk

Children are a high-risk group when it comes to influenza. While healthy individuals tend to experience mild to moderate symptoms, young children may suffer severe flu.

This is shown in a study where children hospitalised from influenza were either admitted into intensive care (12%), developed respiratory failure (5%), had bacterial co-infection (2%), or even died (0.5%).

The US Centers for Disease Control and Prevention (CDC) also estimates that every year, flu-related hospitalisation among children younger than five years ranges from 7,000 to 26,000 in the United States.

This could be because such young children have immature immune systems. Furthermore, those below six months are not old enough to be vaccinated against influenza.

Children with pre-existing medical conditions have a higher likelihood of getting hospitalised for influenza. Of the 40% of children studied by Dawood, 18% had asthma, 15% (of those below two years) had been born prematurely, and 7% had developmental delay.

However, this does not mean that other children are safe.

A 25 year-long study of 1,665 healthy children found that influenza was associated with high death rates in otherwise healthy children aged below five years.

Acute otitis media (painful middle ear infection) and lower respiratory tract disease were highest among children aged under two years old.

Children easily catch and spread influenza

Influenza can spread in a couple of ways. If an infected person coughs or sneezes openly, influenza viruses are released into the air.

When inhaled by someone else, these viruses make their way into the respiratory tract and start to replicate.

Alternatively, the droplets may land on, or be transferred by touch to, items like toys, remote controls, door handles, bed sheets, blankets and so on. The viruses can live there for hours or days.

In that time, anyone handling those contaminated objects (called fomites) will get the viruses on their hands and eventually into their mouths, nasal passages and eyes where the viruses can enter the body.

Seeing how children share toys and have close contact with their school friends, siblings and other family members, it is no surprise that they can easily catch and spread the disease.

In fact, they shed greater amounts of the virus for longer periods than adults do, despite displaying symptomatic illnesses for a shorter time. All this often comes at their own and their family’s detriment.

A study by Principi et al found that most children with influenza attended day-care centres or schools. They also had a higher likelihood of fever and croup (an infection of the upper airway characterised by a barking cough), and a longer school absence.

Their parents and siblings also had more respiratory illnesses, needed more medical visits, missed more work or school days, and needed help at home to care for the ill children for a longer period of time.

Vaccinate children against influenza

It helps to teach children good hygiene and etiquette to reduce the risk of influenza infection, to some extent. These include hand washing, and staying away from friends who show signs of influenza.

However, vaccination is the best way to prevent influenza.

The CDC recommends vaccination for all children older than six months (as well as adults who care for children).

Two doses of vaccine should be given to children aged six months to eight years while only one dose is required subsequently.

Influenza vaccination should be given annually to protect against new mutations of the viruses that are expected in the coming season.

This will substantially reduce the risk of severe disease that may result in hospitalisation or serious complications.

It will also help prevent the virus from spreading at home (particularly if you have a baby under six months old) or in school.

While temperate countries experience influenza seasons in winter, we in Malaysia have it all-year round. As such, you should get your child vaccinated as soon as possible, and repeat the process every year.

Article courtesy of the Immunise4Life programme by Health Ministry, Malaysian Paediatric Association and Malaysian Society of Infectious Diseases and Chemotherapy, supported by Sanofi Pasteur. Learn more at or

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Five women died after consuming abortion pills bought online, says report.

Wednesday, April 17th, 2019

PETALING JAYA: Five women died after consuming abortion pills purchased online from 2015-2017, reported Sinar Harian.

Health Minister Datuk Seri Dr Dzulkefly Ahmad told the Malay daily that four cases occurred in 2015 while one more case occurred in 2017.

“Four of the cases were caused by bleeding after delivery, while another case involved an amniotic fluid embolism. All the cases involved the intravaginal insertion of products that contained misoprostol,” he was quoted as saying.

The Ministry also recorded three cases that were classified as life-threatening to the women who consumed the pills.

Dr Dzulkefly said that to avoid their sales from being detected by the Pharmaceutical division, the syndicates selling the pills used blogs, Facebook, Instagram and WhatsApp among others.

They also used online websites such as, 11street, Lazada, Shopee and others.

Dzulkefly said that since 2017, 10 raids were successfully carried out and 17 items that contained misoprostol worth RM85,313 were seized

About 17 items worth RM85,513 smuggled in mostly from India and China have been seized.

Most of the pills were imported illegally from overseas, especially China and India.

Health Ministry director-general Datuk Dr Noor Hisham Abdullah said that data recorded from January until April 15 recorded 18 websites that sold cytotec were determined and investigated.

Most of them were operating on Facebook and blogs.

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