Disease Patterns & Health Problems in Malaysia PDF

Disease patterns & health problems in Malaysia Tuan Mazlelaa Tuan Mahmood, PhD, RPh Faculty of Pharmacy, UKM  Communicable and non-communicable disease (NCD) Communicable disease: – An illness caused by pathogenic microorganisms (e.g. bacteria, viruses, parasites or...

Disease patterns & health problems in Malaysia Tuan Mazlelaa Tuan Mahmood, PhD, RPh Faculty of Pharmacy, UKM  Communicable and non-communicable disease (NCD) Communicable disease: – An illness caused by pathogenic microorganisms (e.g. bacteria, viruses, parasites or fungi) or its toxin – Spread, directly or indirectly, from one person to another or from an animal to a person (zoonotic diseases). – The spread often happens via airborne viruses or bacteria, but also through blood or other bodily fluid. – The terms infectious and contagious are also used to describe communicable disease. – E.g.: – Malaria – Hepatitis – HIV/AIDS  Communicable and non-communicable disease (NCD) (continued) Non-communicable diseases (NCD): Also known as chronic diseases They are not passed from person to person Of long duration and generally slow progression.  Four main types: CV diseases (e.g. heart attacks and stroke) Cancers Chronic respiratory diseases (e.g. COPD, asthma) Diabetes Top 5 principal causes of death in Malaysia (2021):  Notifiable diseases: Any disease that is required by law to be reported to government authorities. Regulated by the Prevention and Control of Infectious Diseases Act 1988 (Act 342) – 25 diseases The collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks. – Dengue fever – Tuberculosis – Food poisoning – Hand, foot and mouth diseases (HFMD) – HIV/AIDS – Covid-19 Incidence rate and mortality rate of communicable diseases per 100,000 population  Communicable diseases (Food and water borne diseases) Cholera (taun): – An acute diarrhoeal infection caused by ingestion of food or water contaminated by the Vibrio cholerae – It can kill within hours if left untreated. – Related to water quality and food prepared by carriers. – The usual intervention strategy is: To reduce deaths by ensuring prompt access to treatment – IV or oral hydration, antibiotics e.g. doxycycline, tetracycline To control the spread of the disease by providing safe water, proper sanitation and health education for improved hygiene and safe food handling practices by the community – Two types of oral cholera vaccines - Dukoral and Shanchol (off-market) are available (end of 2021, local cholera vaccine is under clinical trial – AIMST+USM)  Communicable diseases (Food and water borne diseases) Thyphoid (demam kepialu): – Typhoid fever is a bacterial disease caused by Salmonella typhi (S.typhi). – A person with typhoid fever has this bacterium in their blood stream and intestinal tract. – It is transmitted through the ingestion of food or water contaminated by the feces or urine of infected person. – Caused by unhygienic food preparation and tendency to eat at hawker stalls with inadequate safe, clean water and sanitation. – Tx: hydration and antibiotic therapy: ciprofloxacin, azithromycin, ceftriaxone  Communicable diseases (Infectious diseases) Tuberculosis (TB) ❑ An infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. ❑ It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. ❑ In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to “wall off ” the bacteria. ❑ The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. ❑ Important high risk groups include: close TB contacts, immunocompromised patients, substance abusers and cigarette smokers, people living in overcrowded conditions. ❑ Causes: ▪ Associated with HIV infection ▪ Decreased awareness ▪ Migration of foreign workers from countries with high incidence of TB ❑ Tuberculosis is treatable with a six-month course of antibiotics (6-8 months). ❑ Usually isoniazid, rifampin, ethambutol and pyrazinamide for 2 months, followed by isoniazid and rifampin for 4 to 6 months) if the TB is not drug resistant. ❑ DOT – Direct Observation Treatment (at least 6-month regimen): to improve adherence, otherwise may lead to treatment failure, relapse and acquired drug resistance.  Communicable diseases (Infectious diseases) HIV & AIDS Major public concern 1st case detected in 1986 (3 cases). Reducing trend: 6,978 cases in 2002 (incidence rate of 28.5 cases per 100,000 population) to 3,146 cases in 2020 (incidence rate of 9.31 cases per 100,000 population). HIV and AIDs cases published in 2020: New HIV infections notified in 2019 – 3564 (decreasing trend for male, increasing trend for female) – 18 children AIDS related deaths notified in 2019 – 986 (4 children < 15 y.o.) Average daily new infections in 2019 - 10 a day.  Transmission Sharing of needles – 47.6% (IDU - injecting drug users) Sexual transmission (heterosexuals & homosexuals) – 48.5% *heterosexual - 40% of new reported cases Vertical transmission - 0.7 25 cases in 2004 because of blood transfusion Most are males, % of females increased from 9.4% in 2000 to 15% in 2006 (a ratio of 2 females for every 8 males reported). Harm reduction programme (2005) – Needle Syringe Exchange Programme & drug substitution therapy (the Methadone Maintenance Therapy) PMTCT programme – the prevention of mother-to-child transmission – introduced in 1998: ARV prophylaxis for the child, safer delivery and infant feeding practices.  Communicable diseases (Infectious diseases) Leprosy: Leprosy is a chronic disease caused by Mycobacterium leprae. An acid-fast, rod-shaped bacillus. M. leprae multiplies slowly and the incubation period of the disease is about 5 years. Symptoms can take as long as 20 years to appear. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes. Leprosy is curable. Rifampicin, dapsone and clofazimine for all leprosy patients, with a duration of treatment of 6 months for paucibacillary (PB) leprosy and 12 months for multibacillary (MB) leprosy. PB and MB: based on the number of skin lesions, presence of nerve involvement and identification of bacilli on slit-skin smear.  Although not highly infectious, it is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. Early diagnosis and treatment with multidrug therapy (MDT) remain key in eliminating the disease as a public health concern Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Prevalence of less than 1.5/10000. About 17% of new cases are among immigrants (mainly in Sabah) Malaysia has achieved WHO’s target elimination rate of less than 1/10000 every year since 1994.  Communicable diseases (Vector borne disease) Malaria Decrease in # of cases (2000-2020). Most cases in Sabah and Sarawak Mostly caused by Plasmodium vivax, followed by Plasmodium falciparum and Plasmodium malariae Anti-malarial agents e.g. chloroquine, mefloquine, quinine Dengue Increased even more in 2020 Main reason – public apathy regarding aedes breeding Mainly in Selangor, Johor, Perak and Kuala Lumpur  Filariasis 172 cases, mainly peninsular, 78% among foreign workers, most common Wuchereria Bancrofti Chikungunya 1999 – 27 cases, 2006 – 227 cases (Perak)  Causes of death About 50% of deaths not certified in hospitals (mostly old age in homes) Cancer Related to an ageing population Males – lungs, colorectal, prostate, nasopharynx, liver Females – breast, colorectal, ovary, cervic uteri, corpus uteri National Immunisation Programme  Immunisation compliance (2005) BCG 100% Hepatitis B 3rd dose 93.8% DPT 3rd dose 94.2% Oral polio 3rd dose 95.2 MMR 80% Thank you!