Duration of detection of anti-BmR1 IgG4 antibodies after mass-drug administration (MDA) in Sarawak, Malaysia.

The detection rates of brugian filariasis in three regions of Sarawak namely Central, North and South after three courses of mass drug administration (MDA) from year 2004 to 2006 was investigated. A recombinant BmR1 antigen-based IgG4 detection test, named Brugia Rapid and night blood smear for microfilaria (mf) detection were used. All three regions recorded a sharp fall in mf positive rates after a year post-MDA. Meanwhile Brugia Rapid positive rates declined more gradually to 3.8% and 5.6% of the pre-MDA levels in the Central and North regions, respectively. This study showed that in filariasis endemic areas in Sarawak, anti-filarial IgG4 antibodies to BmR1, as detected by the Brugia Rapid test, were positive for one to two years after mf disappearance.

Genetic diversity of enterovirus 71 isolated from cases of hand, foot and mouth disease in the 1997, 2000 and 2005 outbreaks, Peninsular Malaysia.

All known field isolates of enterovirus 71 (EV71) can be divided into three distinct genogroups (A, B, C) and 10 subgenogroups (A, B1-5, C1-4) based on VP1 gene sequences. We examined VP1 gene sequences of 10, 12 and 11 EV71 strains isolated in peninsular Malaysia during the outbreaks of hand, foot and mouth disease in 1997, 2000 and 2005 respectively. Four EV71 strains isolated in the hand, foot and mouth disease outbreak of 2006 in Sarawak (Malaysian Borneo) were included to describe their genetic relationship. Four subgenogroups (C1, C2, B3 and B4) of EV71 co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two subgenogroups (C1 and B4) were noted to cause the outbreak in 2000. In the 2005 outbreak, besides EV71 strains of subgenogroup C1, EV71 strains belonged to subgenogroup B5 were isolated but formed a cluster which was distinct from EV71 strains of the subgenogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to subgenogroup B5. Phylogenetic analysis of the VP1 gene sequences showed that the four Sarawak EV71 isolates belonged to the same cluster as the EV71 strains that were isolated in peninsular Malaysia as early as May 2005. The data suggested that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia.

A retrospective study of malaria infections in an intensive care unit of a general hospital in Malaysia.

AIMS: To study the clinical and demographic aspects as well as the outcomes of severe cases of malaria infections managed in the intensive care unit of the Sarawak General Hospital, Kuching from January 1996 to December 2001. METHODS: All cases of malaria admitted to the intensive care unit of the Sarawak General Hospital from January 1996 to December 2001 were identified from the intensive care records and retrospectively reviewed. RESULTS: A total of 31 cases of malaria were managed in the intensive care unit of the Sarawak General Hospital in the six-year period. Twenty-eight cases were P. falciparum infections; two were P. vivax and one was a mixed infection of P. falciparum and P. vivax. Fever with or without chills and rigors, headache, abdominal pain and vomiting were the four commonest presenting complaints for P. falciparum infections. Patients with both abdominal pain and hepatomegaly have significantly higher mortality. The fatal cases, at presentation, had higher parasite counts, higher bilirubin, aminotransferase, potassium and urea levels, but lower haemoglobin and platelet counts, and more deranged coagulation profiles compared to surviving patients. The major complications include acute renal failure, acute respiratory distress syndrome, cerebral malaria and disseminated intravascular coagulopathy, haemolytic anaemia and liver dysfunction. A single case of vivax malaria, which was complicated by septicaemic shock and disseminated intravascular coagulopathy was also documented. Higher mortality rate was documented if the antimalarial medication was not commenced on the day of admission into hospital. CONCLUSION: Several infections of P. falciparum are still associated with significant mortality. Other confounding factors include the patient's own initiating quinine therapy. Aggressive and appropriate therapy is life saving. Earlier anti-malaria treatment may improve the survival rate for falciparum malaria. The isolated case of death from P. vivax infection argues against complacency in the management of even the "benign" form of the infection.

Iodine deficiency disorders in Sarawak, Malaysia.

The state of Sarawak in Malaysia has a high prevalence of iodine deficiency disorders (IDD). This has been revealed through a review of goitre surveys that were carried out in the State from the early 1970s to the 1990s. The primary cause was low iodine intake. Contributory factors were low iodine content in the soil and water as well as high cassava consumption. Virtual elimination of IDD is one of the nutritional goals of the IDD prevention and control programs. The strategies adopted include the iodination of coarse salt, which is sold in the market by shopkeepers and also provided free from government health clinics; legislation requiring that salt sold in IDD-gazetted areas must be iodised; and the use of iodinators to iodise water supplied by the gravity-feed system to villages and boarding schools in rural areas. The indicators used in the monitoring and evaluation of the program include the availability of iodised salt in the market and households, iodine levels in water supply that had been fitted with iodinators, goitre volume measured by ultrasound, and urinary iodine excretion among school children.

Latrine use in rural Sarawak, Malaysia.

A cross-sectional survey covering 976 households in 41 rural villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the type of latrines they have and their usage of pourflush latrines. The survey was carried out by inspection and interview. Fifty-six percent of the households had pourflush latrines and upon inspection 91.3% of them showed signs of recent use. Based on the interview, ninety percent of the women responded that they always use the latrine for defecation. It was also reported that 86.5% of the husbands and 47.6% of the children below five years, always used the latrine for defecation. The most common reason for not using the latrine among adults was the lack of water to flush the latrines as well as not being home when the need arises. The reason for using the latrines were to keep the compound clean, convenience and health reasons. It is recommended that building latrines continue to be a prerequisite for getting water supply under the program and that non health-related reasons be emphasized in health education which aim to motivate people to build and use the latrines.

Functioning and utilization of rural water supplies in Sarawak, Malaysia.

A cross-sectional survey of 976 households in 41 villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the state of functioning and utilization of rural water supplies. The survey was carried out by inspection and interview. About one-third of the systems were functioning well, one-third imperfectly, and the remainder were no longer functioning. The coverage of households by water supply varied with the type of water supply, the overall coverage being 81.3%. Usage varied with the type of water supply and access, the overall figure being 87.1%, and the overall utilization was 70.8%. The study showed that it is important to account for water supply usage in impact evaluation because not all households have access and not all those with access use the water supply. It is also important to define water use, depending on whether the health outcome is a reduction in diseases that are water-borne or related to washing with water, because the percentage of households using the water for drinking is different from those using it for bathing.

PIP: In 1989, inspectors surveyed 976 households in 41 villages in Sarawak, Malaysia to learn the proportion of different rural water systems which were still operating, the proportion of households and populations actually served by these systems, and the proportion of the households that really used them. 11 of 16 gravity feed systems, 3 of 9 mechanical pump systems, and 71% of rain water tanks were operating well. 14 of 40 hand pump provided dug wells worked well. Overall coverage of households was 81.3%. In villages supplied with gravity feed, mechanical pump, or rain water tank systems, 74% of households continued to have access to water. Only 47.3% of households had access to the dug wells in those villages with them. 51.2% of households which had access to water from the water supply systems or dug wells were content with the amount of water they received from the systems. 75% of households which had used the water supply systems were pleased with the water quality. Yet the water odor displeased 21.7% of households which used dug wells. 60% of households with access to water supply systems drank the water and used it for washing dishes. On the other hand, only 8.8% of households in villages with a dug well drank the water and used it to wash dishes. The remaining households in villages with dug wells used rain water collected in containers or water from rivers and streams. 37.8% used the water from the water systems (gravity feed, mechanical pump, and rain water tank) to bathe. Further only 7.5% with rain water tank systems used the water to bathe compared to 15.5% for those with dug wells. Use of different water systems varied from 6.1% for protected wells to 78.1% for gravity feed systems. Overall use was 70.8%. The study emphasized the importance of water supply use rather than just access to a water supply.

Child-minding and nutritional status of children 6-12 months old in Sarawak.

A case-control study was carried out to determine the child-minding practices and their relationships with nutritional status of children between 6 and 12 months old. Sixty-five percent of the mothers go to the farm and 25 percent of, them bring their children with them. Only 42.8 percent of the children were looked after by their mothers. The odds of being malnourished were greater among children who were not looked after by their mothers. It is suggested that nutrition education be given in the village so that the other child-minders can benefit from it.

Nutritional status of children in rural Sarawak, Malaysia.

The nutritional status of 641 children between the ages of 0 to 4 years old, from 835 households in 41 randomly selected rural villages with water supply in Sarawak were determined. Based on Waterlow's classification and the National Center for Health Statistics (NCHS) standards, 61% of the children were stunted and 44.1% were wasted. Based on Gomez's classification and the NCHS standards 81.9% of the children were malnourished. There was no sex difference in nutritional status. The percentage of malnourished children increased continuously with age while the percentage of children who were wasted increased from 6 to 36 months and then it leveled off. The percentage of stunted children also increased with age but the increase was sharpest in children who were 12 to 23 months old. It is noted that the Gomez classification overestimates the prevalence of undernutrition.