THE TREND OF COMMUNICABLE DISEASES ESPECIALLY SOIL TRANSMITTED HELMINTHIASIS (STH) AMONG THE INDIGENOUS PEOPLE: EFFECT OF SOCIOECONOMIC DEVELOPMENT AND COMMUNITY EMPOWERMENT PROGRAM ON INTESTINAL PARASITIC COMMUNITY EMPOWERMENT PROGRAM ON INTESTINAL PARASITIC INFECTIONS AMONG ORANG ASLI SABARIDAH ISMAIL, BHARATHALINGAM SINNIAH, MYINT MYINT SOE AND OSMAN ALI FACULTY OF MEDICINE, UNIVERSITI KUALA LUMPUR ROYAL COLLEGE OF MEDICINE PERAK, IPOH PERAK MALAYSIA IPOH, PERAK, MALAYSIA.
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THE TREND OF COMMUNICABLE DISEASES ESPECIALLY SOIL TRANSMITTED HELMINTHIASIS (STH) AMONG THE INDIGENOUS
PEOPLE: EFFECT OF SOCIOECONOMIC DEVELOPMENT AND COMMUNITY EMPOWERMENT PROGRAM ON INTESTINAL PARASITIC COMMUNITY EMPOWERMENT PROGRAM ON INTESTINAL PARASITIC
INFECTIONS AMONG ORANG ASLI
SABARIDAH ISMAIL, BHARATHALINGAM SINNIAH, MYINT MYINT SOE AND OSMAN ALIFACULTY OF MEDICINE, UNIVERSITI KUALA LUMPUR ROYAL COLLEGE OF MEDICINE PERAK,
IPOH PERAK MALAYSIA IPOH, PERAK, MALAYSIA.
OUTLINE OF TALK
• Who is the Orang Asli.• Communicable diseases problems among the Orang
Asli.• STH trends and its epidemiology.• Community development program to improve the
lit f lif OA i M l iquality of life among OA in Malaysia• Conclusion & references.
ORANG ASLI
• TRANSLATED AS “ORIGINAL PEOPLES”
• INDIGENOUS INHABITANTS
• CONSTITUTE 0.6% (ABOUT 150 000) OF (ABOUT 150,000) OF MALAYSIAN POPULATION.
• CLASSIFIED INTO 3 DISTINCT ETHNO-LINGUISTIC GROUPS : SENOI PROTO MALAY AND SENOI, PROTO MALAY AND NEGRITO.
Population of OA 1947-2010
• Around 150,000 pop (0.6% of Malaysian population)
• 3 main tribal groups – senoi, Proto Malay & Negrito. They have different language & culture.
• Choose to stay in isolated areas (60%)(60%).
• Around 80% still under poverty.• IMR 51.7 per 1000 LB.• Average life expectancy 53 years.• Communicable diseases are still
i th t t th i i himain threat to their survivorship.• Some has been settled in village
resettlement scheme with proper housing and amenities.
MALARIA AMONG ORANG ASLI
year *Prevalence (%)year Prevalence (%)1950th 18-25
h1960th 2-671970th 16-431980th 13-49
th1990th 372000th 4-24
* Parasite prevalence rate
FILARIASIS / MICROFILARIAMICROFILARIA
year Prevalence (%)year Prevalence (%)1950th 17-66
h1960th 10-201970th 3-101980th 0.3-2.1
1990th 23-25
2000th 142000 14
AMOEBIASIS
Population prevalence authors
Hospital Orang 3 1-10 3 Bolton (1968)prevalence(%)
Hospital – OrangAsli; all age
3 .1-10.3 Bolton (1968)
Community – OrangAsli; children
1.5 Bisseru & Aziz (1970) 20
25
Community – OrangAsli ; all age
8.6 Lai (1992)15
Community – OrangAsli; all age
6.9 Kamel et al. (2002)
C it O 18 5 N A i t 5
10 prevalence(%)
Community – OrangAsli; all age
18.5 Noor Azian et al. (2007)
Community – Orang 22.5 Hartini &
0
68 70 92 2 7 9y gAsli; children Mohamed
Kamel (2009)
19 197
199
200
2007
2009
scabiesscabies
Yaws
li
tinea
lice
SOIL TRANSMITTED HELMINTH (STH) SOIL TRANSMITTED HELMINTH (STH) AMONG THE ORANG ASLI IN MALAYSIA
• Parasitic infections is still a public health problem among the Orang Aslidespite the continuous efforts to improve their quality of lifedespite the continuous efforts to improve their quality of life.
• STH is the most prevalent NTD– Ascaris lumbricoides, hookworm (Ancyclostoma duodenale & Necator americanus) and Trichuris trichiura.
• Exclusively among poorest section of population - remote, rural areas, urban slums and conflict zones.
Significant predictors of PEM Iron def anemia (IDA) Vit A def (VDA) and poor • Significant predictors of PEM, Iron def anemia (IDA), Vit A def (VDA) and poor academic performance among school children.
• Successful control of STH has improved the nutritional status and heath status of the children hence improve their educational attainment, productivity and income of the population.
PATTERN OF STH AMONG OA SUBGROUPSSUBGROUPS
• The earliest study of STH among OA was recorded in 1938. More than 30 studies was reported till 2013.was reported till 2013.
• The prevalence rate has not changed much over time. In 2013, the prevalence still ranged between 50-90% although many control strategies has been implemented. Some subgroups have shown much improvement in their rate of STH probably due to higher SES development.
• The latest report by Ngui et al. Am. J. Trop. Med. Hyg, 2015; 361-370 revealed the following results:
a.STH infections are still a major public health problem among OA in Malaysia. The prevalence rate is around 60%.
b.Trichuris trichiura infection was the most prominent infection, followed by Ascaris lumbricoides. Mixed infection of these two parasites are common.
c.Heavy infection mainly among children 5-15 year old.
d.Main risk factors were poor SES, poor environmental condition and lacking p , p gsanitary behavior.
STH INFECTIONPopulation Prevalence
(%)year prevalence (%)
(%)
Community– OrangAsli; all age (Northern
96 1960th
050
100150
prevalence all age (Northern States)Community – OrangAsli;
78 1970th
0 p(%)
TemiarCommunity – OrangAsli ; Semai, Kuala Koyan
84 1980th
yCommunity – OrangAsli; Temuan, Pangsoon
82 1990th
Community – OrangAsli;Children in Selangor
67 2010th
Year No . Percentage of Infection (%) Overall References
List of studies on prevalence of intestinal helminths in Orang Aslicommunities,1970- 2014
Trichuris Ascaris Hookworm Strongyloides
1970 100 80.0 69.0 51.0 Ns 93.0 Bisseru & Aziz 19701972 1273 57.2 39.1 68.7 Ns 91.3 Dunn 19721977 126 80.9 47.6 95.2 0.8 99.2 Dissanaike et al 19779 6 80.9 .6 95. 0.8 99. ssa a e et a 91995 59 24.0 20.0 16.0 1.7 61.5 Karim et al 19951996 93 36.6 58.0 Ns Ns 79.6 Mohd Sham 19961997 205 91.7 62.9 28.8 ns 92.0 Norhyati et al 19971997 84 41 7 59 5 6 0 Ns 79 8 Rahmah et al 19971997 84 41.7 59.5 6.0 Ns 79.8 Rahmah et al 19971998 Ns 29.0 17.0 24.0 Ns 24.0 Norhyati et al 19981999 268 29.7 43.9 6.3 Ns 47.4 Zulkifli et al 19992000 183 38.9 62.8 12.6 Ns 69.4 Zulkifli et al 20002000 159 55 3 33 3 44 7 Ns 55 3 Ghani et al 20022000 159 55.3 33.3 44.7 Ns 55.3 Ghani et al 20022004 281 26.0 19.0 3.0 Ns 26.0 Nor Aini et al 20042005 368 98.2 61.9 37.0 Ns 98.2 Al‐Mehklafi et al 20052007 292 95.5 76.8 13.4 Ns 100 Al Mehklafi et al 20072007 74 31 1 25 7 8 1 N 59 8 H ki t l 20072007 74 31.1 25.7 8.1 Ns 59.8 Hakim et al 20072008 120 97.8 Ns 55.8 Ns 65.8 Al‐Mehklafi et al20082010 75 66.7 20.0 33.0 0 77.3 Sinniah et al 20102011 716 66.8 38.5 12.8 Ns 73.2 Ngui et al 2011
h d & l2011 289 84.6 47.6 3.9 ns 60.5 Ahmed & Kamel 20112012 77 39.0 26.0 3.9 Ns 50.6 Sinniah et al 20122013 484 71.7 37.4 17.6 7.1 78.1 Nasr et al 20132014 86 34.9 38.4 8.1 0.0 50.0 Sinniah et al 2014
INTESTINAL PARASITES IN PERAK(SINNIAH ET AL, 2012)
• In Perak, among 3 orang aslicommunities, the prevalence of helminthic infection was 50.6%
• The main parasites has not h h ti change very much overtime :
Trichuris Trichiuara 39%, Ascaris Lumbricoides 26.9%, giardia 5.2%, hookworm 3.9%.
• Main factors - 85-92% of orang asliare involved in agro based industries are involved in agro based industries resulting in use of hands coming in contact with contaminated soil.
Monday, November 02, 2015
Nasr et al. Parasite and vectors 2013, 6:27 & Al-
OSDelaimy et al PLOS Neglected Tropical Disease 2014
484 OA h l • 484 OA school children in Lipis, Pahang
• 78.1%were found i f t d Tt th infected, Tt the highest
• Poly parasitism is high (>70%).M tl d t & • Mostly moderate & heavy infections.
• Main risk factors are unsafe water
l b t f supply, absent of toilet in the house and poor hand washing behavior.R i f ti i • Reinfection is very high.
TREND DISTRIBUTION OF STH INFECTION BY AGE, 2011
PATTERNS OF STH POLY-PARASITISM
COMMUNITY DEVELOPMENT PROGRAM TO IMPROVE THE QUALITY OF LIFE AMONG OA IN IMPROVE THE QUALITY OF LIFE AMONG OA IN
MALAYSIA
2012 THEME: "INDIGENOUS MEDIA, EMPOWERING INDIGENOUS VOICES"EMPOWERING INDIGENOUS VOICES
• THE INTERNATIONAL DAY OF THE WORLD'S INDIGENOUS PEOPLE (9 AUGUST) WAS FIRST PROCLAIMED BY THE GENERAL ASSEMBLY IN DECEMBER 1994.
• IN 2004, THE ASSEMBLY PROCLAIMED A SECOND INTERNATIONAL DECADE, FROM 2005 – 2015, WITH THE THEME OF "A DECADE FOR ACTION AND DIGNITY"DIGNITY."
• THE FOCUS OF THIS YEAR'S INTERNATIONAL DAY WAS "INDIGENOUS MEDIA EMPOWERING "INDIGENOUS MEDIA, EMPOWERING INDIGENOUS VOICES".
Monday, November 02, 2015
Monday, November 02, 2015
EDUCATION – KNOWLEDGE, BEHAVIOR AND PRACTICE DEVELOPMENTAND PRACTICE DEVELOPMENT
PRIMARY HEALTH CAREPRIMARY HEALTH CARE
• ADDRESSES THE MAIN HEALTH PROBLEMS IN THE PROBLEMS IN THE COMMUNITY, PROVIDING PREVENTIVE, PROMOTIVE CURATIVE AND REHABILITATIVE SERVICES.
• IT ADVOCATED THE FOLLOWING • IT ADVOCATED THE FOLLOWING ELEMENTS OF PHC WHICH ARE:
• PROPER NUTRITION, • SUPPLY OF SAFE WATER AND BASIC
SANITATION SANITATION, • MATERNAL AND CHILD
HEALTH/FAMILY PLANNING,• IMMUNIZATION, IMMUNIZATION, • PREVENTION AND CONTROL OF
ENDEMIC DISEASES, • HEALTH EDUCATION AND • APPROPRIATE TREATMENT FOR
COMMON DISEASES AND INJURIES.Monday, November 02, 2015
CORPORATE SOCIAL RESPONSIBILITIES
CONCLUSION Orang Asli still economically and socially behind compares to
other Malaysian ethnic communities C i bl di h l i STH ki i f ti Communicable diseases such as malaria, STH, skin infections,
tuberculosis, scabies, amebiasis and leprosy are still the main health problems.
Socioeconomic development in rural areas did have some Socioeconomic development in rural areas did have some positive impact on the health of the Orang Asli especially on STH
Orang Asli communities has to be involved in mainstream of national education and economic development including ;
Land development program Socio-economic development & health program (PHC) Resettlement (resettlement village) Resettlement (resettlement village) Provision of infrastructure and public amenities Training and human development Implementation of the WHO-HVI (Health Volunteer Initiatives)p ( ) Orang Asli will be empowered to take responsibility for all their
community health and hygiene.Monday, November 02, 2015
Thank you
Millennium Development Goals : How to achieve the goals Millennium Development Goals : How to achieve the goals h th i l di it b t b d l h th i l di it b t b d l when there is clear disparity between urban and rural when there is clear disparity between urban and rural
areasareas.
MDG lMDGoal
1.Eradicate extreme poverty and hunger
2 Achieve universal primary education 2. Achieve universal primary education
3. Promote gender equality
4 Reduce child mortality 4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/ AIDS, malaria and other
7. Environmental sustainability
8. Global partnership for development 28
Source: The Millennium Development Goals Report 2005 United Nations, New York 2005.http://unstats.un.org/unsd/mi/pdf/MDG%20Book.pdf
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