BY KASMIAH MUSTAPHA - 16 SEPTEMBER 2014 @ 8:04 AM
If Malaysia went for a full health check today, this is what doctors will say, writes Kasmiah Mustapha
LIKE most other countries around the world, Malaysia is grappling with non-communicable diseases (NCDs) which include heart disease, diabetes, stroke and hypertension.
According to the World Health Organisation (WHO), the top five contributors to the health burden in the country are NCDs, similar to those of developed nations.
WHO, which described NCDs as an invisible epidemic, stated that these diseases were driven by forces, such as rapid unplanned urbanisation and unhealthy lifestyles.
At the same time, Malaysia also have to deal with other issues, such the emerging and re-emerging of infectious diseases. Here’s a look at the major health issues the country is facing at this time:
CORONARY HEART DISEASE
In Malaysia, coronary heart disease has been the number one killer for the past three decades. According to the National Cardiovascular Disease Database, the average age of heart attack sufferers is 59. While there is no official data, there are cases of people younger than 40.
Data also showed that of the 16,866 patient admissions from 15 main hospitals in Malaysia from 2006 to 2010, the rate of in-hospital mortality for heart attack was 10 per cent. Sudden death cases are almost usually determined as due to heart attacks. Between 70 and 80 per cent of sudden cardiac deaths are caused by coronary heart disease.
Factors that increase the risk of coronary heart disease include being overweight, high levels of cholesterol, lack of exercise, smoking, excessive alcohol consumption, stress, high blood pressure and diabetes.
What we can do: With the increasing number of childhood obesity and young smokers, it is likely that younger people will suffer from coronary heart disease. This is because many risk factors start during childhood and some can even develop within the first 10 years of life. Behavioural changes are important to prevent coronary heart diseas and avoid fatal heart attacks.
OBESITY
In the second National Health and Morbidity Survey (NHMS) in 1996, it was found that 4.4 per cent and 16.6 per cent of the adult population were obese and overweight respectively. In the latest survey conducted in 2011, the figure have increased to 5.4 million or 33.3 per cent of adults are pre-obese and 27.2 per cent or 4.4 million are obese.
It seems that obesity in the country has even surpassed that of neighbouring countries. A recent study published by the British medical journal The Lancet has put the country as Asia’s most obese. The study showed that 49 per cent of Malaysian women and 44 per cent of men were either obese or overweight.
Childhood obesity is also another problem that the country is facing. Results from a study by the Institute for Public Health of the Health Ministry found that the prevalence of overall overweight among Malaysia’ primary school children — between 7 and 12 years old— was at 19.9 per cent. One out of five are overweight.
What we can do: Sedentary living and an unhealthy diet have been blamed for the rising number of people who are overweight and obese. It is important that each individual and parents be aware of the impact of obesity as it is not a solitary health issue. Obesity poses a major risk for serious diet-related NCDs, including diabetes mellitus, cardiovascular disease, hypertension, stroke and certain forms of cancer.
DIABETES
The fourth NHMS 2011 showed that there has been an increase of 20.8 per cent rate of diabetes from five years earlier. In 2001, it was 8.3 per cent among adults above the age of 30. In 1986, the first NHMS reported a prevalence of diabetes at 6.3 per cent.
Diabetes is the seventh highest cause of deaths in the country in 2011. It is the leading cause of limb amputation, blindness, renal failure and heart failure. Diabetes is a problem commonly faced by people above 30 and is largely due to the accumulation of blood sugar over many years because of an unhealthy diet.
The Consumer Association of Penang said Malaysians consume an average of 26 teaspoons of sugar a day. In the 1970s, Malaysians consumed about 17 teaspoons of sugar a day. In the 1980s, it was 21 teaspoons a day.
What we can do: Consumption of sugar is not the only cause of diabetes. High calorie foods also increases blood sugar level. Diabetes can be controlled or prevented through a healthy diet and physical activities.
BREAST CANCER
The National Cancer Registry 2006 reported that there were 3,525 female breast cancer cases in the country and this made it the most commonly diagnosed cancer in women (29.9 per cent of all new cancers). Breast cancer is the commonest cancer in all ethnic groups and in all age groups in females from the age of 15 years onwards.
Since 1991, breast cancer has been the second leading cause of cancer admissions in government hospitals, and deaths due to breast cancer are in fourth place, accounting for six to eight per cent of all cancer deaths.
A study looking at awareness of breast cancer in Malaysia found that increased tumour size and poor long-term survival have been associated with delayed presentation of symptomatic breast cancer for three or more months from the first detection to the time of diagnosis and treatment. Between 50 and 60 per cent of women present in stages three and four had little or no benefit from any form of therapy. Previous studies have revealed that factors related to women’s knowledge and beliefs about breast cancer and its management may contribute significantly to medical help-seeking behaviours.
What we can do: The earlier breast cancer is detected and diagnosed, the better the chances of survival. Many cases of mortality were due to waiting too long or refusal to seek treatment. When diagnosed, it is best to seek accurate information to ensure successful treatment.
HYPERTENSION
Just like diabetes, hypertension is also known as a silent killer because it often has no warning signs or symptoms. In most cases, a person is diagnosed as having hypertension after suffering a heart attack or stroke. The NHMS 2011 has shown that the prevalence of hypertension in those aged between 18 and 30 years has increased from 32.2 per cent in 2006 to 32.7 per cent. For those above 30, the prevalence has increased from 42.6 to 43.5 per cent. Unfortunately, 60.6 per cent of total hypertensive people were undiagnosed.
The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development. These include being obese, lack of physical activity, consuming too much salt, stress, smoking and alcohol consumption.
In a recent study it was found that the consumption of salt among Malaysians was 8.7g daily which is 1.7 times higher than the WHO recommendation of 5g a day.
Table salt is the major source of sodium in the Malaysian diet. But it is also present as food additives such as monosodium glutamate, sodium bicarbonate (leavening agent), sodium nitrate and sodium benzoate (preservatives) and in many other commonly used sodium-based additives.
What we can do: The challenge in the treatment of hypertension is early detection as well as awareness of the symptoms and risk factors. Diet and exercise again play important roles to prevent this deadly disease. Those who are at risks of hypertension should have regular check-ups.
DENGUE
This mosquito-borne viral disease is a major public health problem in the country. It is endemic to Malaysia with an increasing number of cases and deaths. In 2010, said to be the deadliest year, 134 people died from dengue. Last year, more than 43,000 cases were reported with 92 deaths, up from 35 dead in 2012. As at July this year, there were 50,804 cases of dengue with 94 deaths recorded.
The Health Ministry has stated that the number of Malaysians infected with dengue and succumbing to it is much higher than the influenza A (H1N1).
There is currently no treatment and no vaccine for dengue fever. Prevention is through elimination of the aedes mosquitoes breeding ground, awareness of the symptoms and seeking treatment early.
What we can do: Researchers are working on a vaccine for dengue. Even when there is a vaccine, it is only to treat the fever. It is still up to the public, authorities and health agencies to work towards prevention methods.
Stroke
In 2012, there were 50,000 reported stroke cases (new and recurrence) annually. Admissions for new stroke cases increased from 12 per cent in 2003 to 55 per cent in 2008.
A study done from 2009 to 2010 at Hospital Sultanah Nur Zahirah Kuala Terengganu and Hospital Seberang Jaya, Penang found that out 1,018 acute stroke patients, ischemic stroke accounted for the majority of cases (73.3 per cent). The most common risk factor was hypertension, followed by diabetes mellitus, previous stroke or transient ischemic attack, hyperlipidemia and active smoking. There were 121 mortality cases with massive cerebral bleed (21.6 per cent) as the main contributing factor.
It has been reported that six new stroke cases occur in the country every hour.
What we can do: Like all non-communicable diseases, the challenge in reducing the number of stroke cases relies heavily on lifestyle changes. Awareness should start early as non-communicable diseases-risk behaviours are on the rise among young people. As their unhealthy lifestyle will continue into adulthood, more people below the age of 40 could suffer from strokes.
HIV/AIDS
According to the Health Ministry, as of December 2010, an estimated 80,922 people are living with HIV. By the end of 2010, Malaysia had a cumulative figure of 91,362 of HIV cases, 16,352 AIDS cases and 14,298 deaths.
Ten cases of HIV infections are reported each day with a ratio of two females for every eight males reported. In 2010, an average of five persons acquired HIV through injecting drugs while five others were infected sexually.
Males continue to represent the majority (90 per cent) of cumulative HIV cases in Malaysia. About 35 per cent of reported infections are among young people between the ages 13 and 29. Most reported infections occur among young heterosexual males between the ages of 20 and 39 who inject drugs. Children aged 13 and below consistently comprised one per cent of cumulative total of HIV infections from 1986 to December 2010. It has been estimated that by the end ofnext year, Malaysia will have an estimated 81,946 people living with HIV.
What we can do: HIV/AIDS was a taboo subject back in the 1980s and 1990s. It was not until recently that efforts to raise awareness of this deadly infectious disease have been put in place. Unfortunately, until now there is no vaccine to prevent HIV infections and no cure for AIDS. As such education remains the only way of prevention.
http://www.nst.com.my/node/33792
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