Vitamin D status and clinical implications in the adult population of Malaysia: a position paper by the Malaysian Vitamin D Special Interest Group.

PURPOSE: Vitamin D deficiency and insufficiency is common among populations globally, and in Asia and Malaysia. The purpose of this Position Paper is to propose recommendations for both clinicians and non-clinicians to promote vitamin D sufficiency in Malaysian adults. Formation of a national multisector, multidisciplinary alliance is also proposed to progress initiatives relating to safe sun exposure, adequate vitamin D intake through food fortification, and vitamin D supplementation for high-risk groups. METHODS: Literature reviews were undertaken to inform summaries of the following: vitamin D status globally and in Asian and Malaysian populations, vitamin D status among individuals with common medical conditions, and current recommendations to achieve vitamin D sufficiency through sun exposure, food intake and supplementation. Recommendations were based on the findings of the literature reviews, recent European guidance on vitamin D supplementation, the 2018 road map for action on vitamin D in low- and middle-income countries, and research recommendations proposed by the Malaysian Ministry of Health in 2017. RESULTS: Recommendations on assessment of vitamin D in the adult Malaysian population include using serum or plasma 25-hydroxyvitamin D concentration as a biomarker, widespread participation by Malaysian laboratories in the Vitamin D Standardization Program, adoption of the US Endocrine Society definitions of vitamin D deficiency and insufficiency, and development of a comprehensive nationwide vitamin D status study. Specific high-risk groups are identified for vitamin D assessment and recommendations relating to loading doses and ongoing management are also made. CONCLUSION: This Position Paper provides individual clinicians and national stakeholder organisations with clear recommendations to achieve vitamin D sufficiency in the adult population of Malaysia.

Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: implications for ACSM.

SETTING: Forty hard-to-reach villages in the East and West Singhbhum Districts of Jharkhand State, India. OBJECTIVES: To document knowledge and awareness of tuberculosis (TB) among the general population, understand gender differences and inform intervention activities for the improvement of TB control programmes in tribal-dominant hard-to-reach areas in India. DESIGN: A cross-sectional community-based survey was carried out among 825 respondents using population proportionate sampling. RESULTS: Most of the respondents were in the 18-35 years age group, tribal and married; 44% were illiterate. The study shows poor knowledge about TB symptoms, causes, modes of transmission and moderate awareness about government TB services. Correct knowledge about the cause of TB was negligible: half of the respondents reported local liquor as the cause, 61% considered TB as transmissible and one third considered sharing of food as the mode of transmission. Awareness about the availability of free treatment services at government health facilities was high, but awareness about DOTS was low. Significant gender differences were observed in knowledge and awareness levels. CONCLUSION: Study findings point to the importance of urgent intensification of culturally congruent and gender-sensitive advocacy, communication and social mobilisation activities.

Contexte : Quarante villages difficiles d'accès de l'Est et de l'Ouest des districts de l'état de Singhbhum, Jharkhand, Inde.Objectifs : Documenter les niveaux de connaissances et de sensibilisation en matière de la tuberculose (TB) parmi les membres de la communauté, de comprendre les différences entre les sexes et de contribuer à l'élaboration d'activités d'intervention afin d'améliorer le programme de lutte contre la TB dans des zones à dominante tribale difficiles d'accès en Inde.Schéma : Une enquête transversale à base communautaire a été réalisée auprès de 825 répondants grâce à une méthode d'échantillonnage proportionnel de la population.Résultats : La majorité des répondants appartenait à la tranche d'âge 18­35 ans, à une minorité ethnique et étaient mariés ; 44% étaient illettrés. L'étude a montré une faible connaissance des symptômes, causes et modes de transmission de la TB et une connaissance modérée des services gouvernementaux de TB. Les connaissances relatives à la cause exacte de la TB était négligeables­la moitié des répondants a attribué la TB à la consommation d'alcool local ; 61% savaient que la TB était transmissible et un tiers affirmait que le partage de nourriture était une voie de transmission. La connaissance de la disponibilité de services gratuits de prise en charge dans des structures de santé étatiques était élevée, mais la stratégie DOTS était très mal connue. Des différences significatives entre les sexes ont été observées en matière de niveau de connaissance et de sensibilisation.Conclusion : Les résultats de l'étude soulignaient l'importance d'une intensification urgente des activités de plaidoyer, de communication et de mobilisation sociale culturellement adaptées et spécifiques au genre.

Marco de referencia: Cuarenta poblaciones de difícil acceso de los distritos de Singhbhum oriental y occidental en el estado de Jharkhand de la India.Objetivos: Documentar los conocimientos y la sensibilización en materia de tuberculosis (TB) de los miembros de la comunidad general, comprender las diferencias asociadas con el sexo y aportar recomendaciones a la formulación de intervenciones destinadas a mejorar el programa contra la TB en las zonas de difícil acceso con predominio de población tribal, en la India.Método: Se llevó a cabo una encuesta transversal comunitaria a 825 personas escogidas mediante un muestreo proporcional a la población.Resultados: La mayoría de las personas que respondieron a la encuesta se encontraba en el grupo etario de 18 años a 35 años, pertenecía a un grupo tribal y su estado civil era casado; el 44% era analfabeto. El estudio puso en evidencia un conocimiento precario de la TB con relación a los síntomas, las causas y los modos de transmisión y una sensibilización moderada a la existencia de servicios gubernamentales de atención de la TB. El grado de conocimientos sobre causa real de la TB era exiguo, pues en la mitad de las respuestas se atribuía la TB al consumo de un licor local. El 61% de quienes respondieron consideraba que la enfermedad era contagiosa y un tercio atribuía el modo transmisión al hecho de compartir los alimentos. Se observó un alto grado de conocimiento de la existencia de servicios de tratamiento sin costo en las instituciones públicas de salud, pero pocos conocían la estrategia DOTS. Se observaron diferencias notables entre los sexos en materia de conocimientos y sensibilización.Conclusión: Los resultados del estudio destacan la urgencia de intensificar las actividades de promoción, comunicación y movilización social que sean culturalmente adaptadas y tomen en consideración las diferencias entre los sexos.

Neurocysticercosis an uncommon intra-cerebral infection in Malaysia.

Neurocysticercosis, infection of the central nervous system (CNS) by larvae of the pork tapeworm Taenia solium, is the commonest neuroparasitic infection in humans. However in countries as in Malaysia it poses a diagnostic problem as the disease in not seen amongst the local population; however with the arrival of immigrant workers, a number of cases have recently been diagnosed. There were 3 cases of neurocysticercosis reported in our centre over the last 5 years.