Groups In Peninsular Malaysia Research Articles

Impact of cultural, nutrition, and lifestyle transition on human milk composition between the Orang Asli communities in Peninsular Malaysia: A study protocol.

Background: Human milk provided by healthy, well-nourished mothers represents the best food available for infants. Human milk is species-specific and recommended as the sole source of nutrition for the first 6 months of life and is an important food source until the infants reach 2 years of life. Unlike infant formula, which has a standardized composition, human milk composition varies among and within women. Aim: While many studies of human milk composition have been conducted, none have been done among the Orang Asli people in Malaysia. Hence, this study protocol is designed to determine the human milk composition of the Orang Asli in Peninsular Malaysia and how the transition of culture, nutrition, and different lifestyle experiences will affect the nutrient content of their milk. Methods: Quantitative (interviewer-administered questionnaire) and qualitative (focus group discussion) approaches will be employed in this study and in addition, laboratory works will also be carried out to analyze the nutrient composition of the milk samples collected from various Orang Asli subethnic groups in Peninsular Malaysia. Conclusion: Standardized, multipopulation studies of human milk composition are sorely needed to create a rigorous, comprehensive reference inclusive of nutrients and other factors. The establishment of any dietary parameters positively affecting the nutrient content of human milk may help design healthcare strategies in Malaysia to improve the quality of human milk and therefore the infants' health status.

Menstrual food restrictions and taboos: A qualitative study on rural, resettlement and urban indigenous Temiar of Malaysia.

Menstruation is arguably the first stage in a woman's reproductive cycle. Among the Temiar, as in many other traditional societies, menstruation represents a time during which a woman is considered to be vulnerable or polluted and there may be food or behavior avoidances and restrictions. The Temiar is one of the eighteen indigenous sub-ethnic groups in Peninsular Malaysia. The objective of this study was to examine the food restrictions and taboos imposed on menstruating Temiar women. A total of 38 participants from four different locations took part in five focus group discussions which represents different lifestyle experiences of the Temiar sub-ethnic group. The findings unfolds many practices: foods to be avoided and spirit in the landscape in order to protect the menstruating woman; isolating the menstruating woman in order to protect the community; consequences of not observing the menstruation food taboos and maintenance of the menstrual taboos. The menstruating women in all locations were prohibited from consuming salt, cooking oils, wild or domesticated animals, and Monosodium glutamate to protect themselves from the excessive flow of menstrual blood and future ill-health. They must eat separately from others because they are deemed polluted and dangerous to the community. The study concludes that the taboos directed towards the menstruating women often do have a caring and protective intention. Menstrual restrictions function not only to protect the menstruating women and the community but also to keep intact the symbolic boundary between human and the non-human world from which disease and weakness comes.

PERSPECTIVES ON ANCESTRAL LINEAGES AND GENETIC MARKERS OF MALAY POPULATION IN PENINSULAR MALAYSIA

The Malay people are the majority in Peninsular Malaysia, but their population structure and genetic profile remain poorly studied. The exposure to the origins of Malays and their sub-ethnic groups is vital prior to study about their genetic profiles as it can narrow down the haplogroups of their ancestral lineages. In this review, we have highlighted theories related to the origin of Malays from Yunnan, New Guinea, Taiwan, Sundaland, Nusantara and the theory of Bani Jawi. Nevertheless, these theories were established based on speculations without evidence. Despite the theories developed, the migration of Malay population is more prominent during the era of Malacca Sultanate. The trading activities and seafaring way of life had welcomed various ethnic groups in Peninsular Malaysia which formed a part of the Malay population today. Thus, the origin of major sub-ethnic groups of Malay population are discussed in this paper. The origin of Malay community has a key relationship with modern genomic field that was conducted through mitochondrial DNA analysis. Human identification in forensic application is tedious due to the need for sequencing whole DNA profile of Malay population. Therefore, identification of specific genetic markers for Malay population is vital to facilitate forensic investigation. We gathered data by systematically searched with Google Scholar, Pubmed, Science Direct with advanced search builder for papers titles with Malay population and genetic markers. This study shed some light on the mitochondrial DNA markers of indigenous people and Malay population in Peninsular Malaysia which can be used in future prospects.

Digital inclusion of the Orang Asli of Peninsular Malaysia: Remote virtual mechanism for usability of telecentres amongst indigenous peoples

AbstractOver the last decades, researchers and development practitioners have been experimenting with models, frameworks and devises to meet the needs of diverse users of information communication technologies. Turning to an ICT‐based community development known as the Telecentre Programme amongst Orang Asli, an indigenous people groups in Peninsular Malaysia, this paper describes why a remote virtual management devise was invented to encounter challenges related to rugged terrain constraints, which would have directly impacted the planning and the execution of programmes designed at the telecentres. This paper argues as a technological solution, the virtual remote management system has powered an ecosystem, which shored up the digital inclusion of the indigenous communities and in the process enabled the enhancement of local informational capabilities. To this end, it reduced their technological dependency on outsiders leading to the usability and sustainability of the telecentre for local capacity building and socioeconomic benefits for the disadvantage communities.

Hak Orang Asal Berkaitan dengan Pengambilalihan Tanah: Kajian Perbandingan antara Malaysia dengan Filipina

The Orang Asli are in a precarious position compared to other majority groups in Peninsular Malaysia as their customary land rights are continuously infringed upon. This is worrying because land is a vital part of the Orang Asli livelihood. Several issues regarding the provisions of native land rights, acquisition of Orang Asli ancestral land not in line with correct procedure, and issues concerning compensation for any acquisition of ancestral land are the main problems faced by the Orang Asli. Hence, the main objective of this research is to examine the legal rights of the Orang Asli to their ancestral land in Peninsular Malaysia, to throw light on the correct procedure of acquisition of such according to legal provisions, and to compare and contrast acquisition of native ancestral land in Peninsular Malaysia to that in the Philippines. Through a doctrinal and comparative approach, this research hopes to enhance knowledge regarding Orang Asli customary rights to land and land acquisition in Peninsular Malaysia, as well as to aid law-makers to reform existing laws and policies in order to ensure protection of Orang Asli rights in the future.

Prevalence of Asymptomatic and/or Low-Density Malaria Infection among High-Risk Groups in Peninsular Malaysia.

Asymptomatic and/or low-density malaria infection has been acknowledged as an obstacle to achieving a malaria-free country. This study aimed to determine the prevalence of asymptomatic and/or low-density malaria infection in previously reported malarious localities using nested PCR in four states, namely, Johor, Pahang, Kelantan, and Selangor, between June 2019 and January 2020. Blood samples (n = 585) were collected and were extracted using a QIAamp blood kit. The DNA was concentrated and subjected to nested PCR. Thin and thick blood smears were examined as well. Of the 585 samples collected, 19 were positive: 10 for Plasmodium knowlesi, eight for Plasmodium vivax, and one for Plasmodium ovale. Asymptomatic and/or low-density malaria infection is a threat to malaria elimination initiatives. Eliminating countries should develop guidance policy on the importance of low-density malaria infection which includes detection and treatment policy.

Differences in Risk Preferences of the Main Ethnic Groups in Peninsular Malaysia: A Field Experiment

It is widely held that risk preferences differ between the three ethnic groups in Malaysia with the Chinese having the highest preference for risk and Malays having the lowest. This has been used to explain the Chinese preference for, and success in, business ventures relative to Malays. However, this assumption has never been tested in a controlled environment. Three hundred working adults from the three groups were recruited and participated in two-choice lottery games with real monetary reward and risk. The results were analysed using the framework of cumulative prospect theory. The outcomes indicate that broad generalisations regarding inter-ethnic risk tolerance are inaccurate. Malays were less risk averse than the Chinese or others when facing choices with the possibility of losing but became more risk averse only when facing choices with the possibility of winning. Malays were also more willing to take greater risk to reduce possible loss than to settle for a sure gain, compared to the others.

Citizenship Knowledge among Secondary School Students from Multiple Ethnicities in Peninsular Malaysia

The aim of this research which was carried out throughout the Peninsular of Malaysia is to identify the level of citizenship knowledge among secondary school students in Peninsular Malaysia according to gender and ethnicity. Citizenship knowledge among students which is under investigation is comprised of three aspects, namely the establishment of a sovereign country, democratization and ethnic diversity. The research design was a survey using a quantitative approach. The instrument used for this research was a questionnaire while the number of respondents recruited for this study was 1812 secondary school students from various ethnic groups in Peninsular Malaysia. The data were analyzed using descriptive statistics and inferential analysis of Manova by using SPSS software. The findings show that the level of citizenship knowledge among the students based on two of the aspects studied, namely the establishment of a sovereign country and democratization, are at a moderate level while the ethnic diversity aspect is at a medium high level. Overall without citizenship knowledge, students are at a moderate level. The findings also show that there are significant differences in citizenship knowledge of students based on gender and ethnicity. With regards to gender, it is found that male students show higher levels of citizenship knowledge with regards to the aspect of the establishment of a sovereign country and democratization compared to female students. In the meantime, female students showed higher levels of knowledge in terms of ethnic diversity than male students. With regards to ethnicity, Malay students showed higher levels of citizenship knowledge on democratization and ethnic diversity compared to Chinese and Indian students. Meanwhile, Indian students show the highest level of knowledge in terms of the establishment of a sovereign country compared to Malay and Chinese students. The findings of this study can affect the education process of the country in producing knowledgeable and skilled citizens in line with the aspiration of the National Education Philosophy in Malaysia. Hence, the implementation of citizenship education needs to be improved in order to increase the level of students’ citizenship knowledge.

Neglected Intestinal Parasites, Malnutrition and Associated Key Factors: A Population Based Cross-Sectional Study among Indigenous Communities in Sarawak, Malaysia

Intestinal parasitic infections (IPIs) have been recognized as one of the most significant causes of illness among disadvantaged communities. Many studies have been conducted on the prevalence of IPIs in Malaysia. However, these studies mostly focused on the indigenous groups in Peninsular Malaysia. The present study was conducted to provide the current baseline data on prevalence of IPIs, anaemia, malnutrition and associated risk factors among the indigenous communities in Sarawak, situation at northwest Borneo island of Malaysia. A cross sectional study was conducted among the longhouses communities. Stool samples were obtained and examined for the presence of IPIs using microscopy technique. Haemoglobin measurement was done using a portable haemoglobin analyzer. Malnutrition (i.e., stunting, underweight and wasting) was assessed using the WHO Anthro software. Statistical analysis was carried out using SPSS software. A total of 341participants took part in this study. The overall prevalence of IPIs was 57.5%. Multivariate analysis indicated that the absence of toilets (OR = 1.6; 95% CI = 1.1–2.7; p = 0.002) and close contact with animals (OR = 1.8; 95% CI = 1.3–2.9; p = 0.027) as significant predictors for IPIs. The incidence of anaemia was 36.4%. The incidence of underweight, wasting and stunting were 22.2%, 5.6% and 35.4%, respectively. Multivariate analysis demonstrated that low level of parental education attainment (OR = 1.9; 95% CI = 1.2–3.0; p = 0.006) was identified as significant predictor for anaemia. The incidence of wasting was significantly associated with mild anaemia (OR = 1.2; 95% CI = 0.9–1.7; p = 0.024). Low household income was identified as significant predictor for stunting (OR = 2.1; 95% CI = 9.8–22.2; p = 0.001) and underweight (OR = 1.9; 95% CI = 5.6–18.7; p = 0.037), respectively. Essentially, the present study highlighted that intestinal parasitic infections, anaemia and malnutrition are still prevalent among rural indigenous community in Sarawak. Improvement of socioeconomic status, periodic mass deworming, iron supplementation and health education program should be included in the control and prevention of public health strategies.

MALAYSIAN BREAST CANCER PATIENTS’ PERFORMANCE IN USING SOCIAL NETWORK SITES: A TASK PERSON TECHNOLOGY FIT MODEL

Social network communities that provide information about cancer offer environments in which cancer patients can interact, and access information related to the disease, its treatment and its survivorship. Current research into the assessment of cancer patients‟ performance in the use of Social Network Sites (SNS) continues to be limited, despite SNS potential to serve as a platform for providing cancer information. To investigate the factors that influence the performance of cancer patients in using SNS, this study utilizes the use of a Task Person Technology Fit (TPTF) Model. Questionnaires were distributed to 178 respondents in two hospitals and four cancer support groups in Peninsular Malaysia, using purposive sampling. Data was analysed through the use of Smart PLS 2.0 M3. The results indicated that the performance of cancer patients in using SNS has been determined directly by the fit between self-efficacy and the characteristics of task and technology.

Prevalence and risk factors of intestinal parasitism among two indigenous sub-ethnic groups in Peninsular Malaysia

BackgroundIntestinal parasitic infections (IPIs) among indigenous people have been widely documented in Malaysia, however, the prevalence of these infections remains high. In the past, most studies have focused on specific species of parasites but polyparasitism has received limited attention. In addition, epidemiology studies on indigenous people tend to consider them as a homogenous group, whereas in reality different sub-ethnic groups have different cultural and living practices. Variations in living habits such as personal hygiene practices may predispose different groups to different parasitic infections. To better understand prevalence and risk factors of intestinal parasitism among different sub-ethnic groups, the present study was conducted among two sub-ethnic groups of indigenous people (Temuan and Mah Meri) residing in Selangor state, Malaysia.MethodsA cross-sectional study that focused on two distinct sub-ethnic groups was carried out from February to September 2014. Faecal samples were collected from 186 participants and examined using the formalin-ether sedimentation technique. A molecular approach was adopted to conduct a genetic characterisation of the parasites. Additionally, questionnaires were administered to obtain information on the demographics, socio-economic backgrounds and behavioural risks relating to the participants, as well as information about their environments. Statistical analyses (i.e. binary and multivariate logistic regression analyses) were performed to measure risk factors.ResultsFor Temuan communities, trichuriasis (64.2 %) was the most common infection found, preceding hookworm infection (34 %), ascariasis (7.5 %), giardiasis (14.2 %) and amoebiasis (7.5 %). As for the Mah Meri communities, trichuriasis (77.5 %) prevailed over ascariasis (21.3 %), hookworm (15 %), giardiasis (7.5 %) and amoebiasis (3.8 %). Significant differences in proportions of trichuriasis, ascariasis and hookworm infections were observed between the Temuan and Mah Meri sub-ethnic groups. Polyparasitism was more common among the Temuan sub-ethnic group (41.5 %) compared to the Mah Meri sub-ethnic group (32.5 %), with the majority of participants harbouring two parasites concurrently (Temuan: 33 %, Mah Meri: 20 %). Trichuris trichiura and Ascaris lumbricoides co-infections were most prevalent (10 %) among the Mah Meri communities, while a co-infection of T. trichiura with hookworm (19.8 %) was most common among the Temuan communities. Multivariate analyses showed that being unemployed, having a large family and drinking unboiled water were found to be significantly associated with intestinal parasitism.ConclusionThe present study highlights substantial polyparasitism and risk factors for infections in the Temuan and Mah Meri sub-ethnic groups. The high prevalence of IPIs among these two sub-ethnic groups indicates that parasitic infections are important health issues in these communities. Hence, it is imperative to implement sound intervention strategies such as periodic preventive chemotherapy coupled with health education in order to reduce and eradicate these infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0168-z) contains supplementary material, which is available to authorized users.

The Semang Kensiu Orang Asli of Lubuk Legong, Baling: Their Language and Cultural Endangerment

This paper reports on a study on endangered indigenous Semang group of Orang Asli of Peninsular Malaysia, with the main focus on the Semang Kensiu sub-group of Orang Asli of Lubok Legong, Baling. It presents findings of the study on language choice based on 225 word lists conducted on the Semang Kensiu Orang Asli community in the northern state of Kedah, Malaysia. The Semang are the smallest group of Orang Asli sub groups in Peninsular Malaysia, and are classified under the Northern Aslian group (Benjamin, 2012). Their language belongs to Mon-Khmer language. They comprise only 3.2% of the Orang Asli population (JHEOA (1994)). JHEOA, 2008 statistics show that the total population has decreased to 2.6%. Some Orang Asli groups have suffered physical, cultural and language extinction over the last century. Wazir Jahan Karim (2001) notes that some groups of Orang Asli have experienced a demographic crisis, disappearing while others disperse into smaller groups and eventually assimilate with Malay or other Orang Asli communities. She expresses concern about the future of Semang languages due to this discouraging pattern of population growth. Burenhault (2001) also reported the threatened status of the Semang language. This is further supported by the findings of the study conducted by Fazrul Azmin Zakaria (2010) which state that the Semang Kensiu's language is at 2.25 on the scale of the UNESCO's Level of Endangerment suggesting that the Semang Kensiu's language is considered to be ‘severely endangered’ language under the UNESCO classification (2007).

Allele frequencies of human platelet antigens in Banjar, Bugis, Champa, Jawa and Kelantan Malays in Peninsular Malaysia.

The major aims of this study are to characterise and compile allelic data of human platelet antigen (HPA)-1 to -6 and -15 systems in five Malay sub-ethnic groups in Peninsular Malaysia. HPAs are polymorphic glycoproteins expressed on the surface of platelet membranes and are genetically differentiated across ethnogeographically unrelated populations. Blood samples were obtained with informed consent from 192 volunteers: Banjar (n = 30), Bugis (n = 37), Champa (n = 51), Jawa (n = 39) and Kelantan (n = 35). Genotyping was done using polymerase chain reaction-sequence specific primer method. In general, frequencies of HPAs in the Malay sub-ethnic groups are more similar to those in Asian populations compared with other more distinct populations such as Indians, Australian Aborigines and Europeans. This study provides the first HPA datasets for the selected Malay sub-ethnic groups. Subsequent analyses including previously reported HPA data of Malays, Chinese and Indians revealed details of the genetic relationships and ancestry of various sub-populations in Peninsular Malaysia. Furthermore, the comprehensive HPA allele frequency information from Peninsular Malaysia provided in this report has potential applications for future study of diseases, estimating risks associated with HPA alloimmunization and for developing an efficient HPA-typed donor recruitment strategy.

Diet and Physical Activity in Relation to Weight Change among Breast Cancer Patients

This study aimed to provide an overview of lifestyle changes after breast cancer diagnosis and to examine the relationship between dietary and physical activity changes with weight changes in breast cancer patients. Women with breast carcinomas (n=368) were recruited from eight hospitals and four breast cancer support groups in peninsular Malaysia. Dietary and physical activity changes were measured from a year preceding breast cancer diagnosis to study entry. Mean duration since diagnosis was 4.86±3.46 years. Dietary changes showed that majority of the respondents had decreased their intake of high fat foods (18.8-65.5%), added fat foods (28.3-48.9%), low fat foods (46.8-80.7%), red meat (39.7%), pork and poultry (20.1-39.7%) and high sugar foods (42.1-60.9%) but increased their intake of fish (42.7%), fruits and vegetables (62.8%) and whole grains (28.5%). Intake of other food groups remained unchanged. Only a small percentage of the women (22.6%) had increased their physical activity since diagnosis where most of them (16.0%) had increased recreational activities. Age at diagnosis (β= -0.20, p= 0.001), and change in whole grain (β= -0.15, p= 0.003) and fish intakes (β= 0.13, p= 0.013) were associated with weight changes after breast cancer diagnosis. In summary, the majority of the women with breast cancer had changed their diets to a healthier one. However, many did not increase their physical activity levels which could improve their health and lower risk of breast cancer recurrence.

The question of questions in Malaysian English

This paper examined the forms that interrogatives and tag questions can take when used by young Malaysian speakers of English language in oral communication. It offers a description of the features for both question forms as produced by the respondents compared to those of Singapore English (SE) and Standard British English (SBE). The influence of domains and the issue of mother tongue interference in relation to the subjects’ usage of such features will also be investigated. Data were obtained through interviews with 19 Malaysian English (ME) speakers from three major ethnic groups in Peninsular Malaysia and via the recording of six conversations. The results showed various distinctive forms and features of questions in ME used by the speakers. Their usage is found to have a certain link to the domains of conversation. Further analysis revealed that mother tongue interference at the grammatical level, particularly in the case of Malay and Cantonese, plays a major role in determining the structure of ME interrogatives and tag questions as well as the subjects’ unvarying use of the rising intonation as regards the latter. As a result of this interference, ME tag questions used are found to be confined to four forms whilst both the structure of wh- and polar interrogatives experience reduction in the system of tense, auxiliary and operator when used by the subjects.

Population Genetic Structure of Peninsular Malaysia Malay Sub-Ethnic Groups

Patterns of modern human population structure are helpful in understanding the history of human migration and admixture. We conducted a study on genetic structure of the Malay population in Malaysia, using 54,794 genome-wide single nucleotide polymorphism genotype data generated in four Malay sub-ethnic groups in peninsular Malaysia (Melayu Kelantan, Melayu Minang, Melayu Jawa and Melayu Bugis). To the best of our knowledge this is the first study conducted on these four Malay sub-ethnic groups and the analysis of genotype data of these four groups were compiled together with 11 other populations' genotype data from Indonesia, China, India, Africa and indigenous populations in Peninsular Malaysia obtained from the Pan-Asian SNP database. The phylogeny of populations showed that all of the four Malay sub-ethnic groups are separated into at least three different clusters. The Melayu Jawa, Melayu Bugis and Melayu Minang have a very close genetic relationship with Indonesian populations indicating a common ancestral history, while the Melayu Kelantan formed a distinct group on the tree indicating that they are genetically different from the other Malay sub-ethnic groups. We have detected genetic structuring among the Malay populations and this could possibly be accounted for by their different historical origins. Our results provide information of the genetic differentiation between these populations and a valuable insight into the origins of the Malay sub-ethnic groups in Peninsular Malaysia.

60 Prevalence of premature ejaculation and its associated factors

60 Prevalence of premature ejaculation and its associated factors

TRENDS IN DELAYED AND NON-MARRIAGE IN PENINSULAR MALAYSIA

The marriage pattern in Malaysia has changed dramatically since the 1940s. The general trend is one of increasing age at marriage and non-marriage. Between 1970 and 2000, the singulate mean age at marriage among men and women increased about three years each, from 25.5 years and 22.0 years to 28.8 years and 25.3 years, respectively. During the same period, the proportion of never married among those aged 30–34 doubled from 12 per cent to 25 per cent among males and from 6 per cent to 12 per cent among females. This paper uses data from population censuses to examine the trends and correlates of delayed marriage for the three main ethnic groups in Peninsular Malaysia. Data from sample surveys are also used to shed some light on contemporary marriage behaviour. Malaysia has made great strides in socio-economic development that benefited all segments of society. However, the effects of socio-economic development on marriage postponement and non-marriage have been stronger for non-Malays than for Malays. This can probably be explained by socio-cultural and religious practices.

Growth behavior of itchgrass (Rottboellia cochinchinensis) in Peninsular Malaysia

A glasshouse experiment was conducted at University Putra Malaysia, Serdang, to study the growth pattern of itchgrass collected from 13 locations. The itchgrass was either associated with crops or found along roadsides in six infested estates located in Johor, Kedah, Pahang, Perak, Perlis and Selangor. Significant differences between populations were observed in all variables except in time to seedling emergence. Cluster analysis of the data classified the populations into three major groups. The first group comprised populations from Johor, Pahang and Perak found in association with banana, cocoa and oil palm plantations, or along the roadsides. The second group comprised populations from Kedah, Perlis and Selangor found in association with maize, upland rice, rubber, sugar cane and tobacco plantations. The third group was a distinct population found only along roadsides at Padang Kartong, Perlis. Principal component analysis was performed to determine the growth characteristics that separated the groups. The results showed that plant height, number of leaves, number of seeds/plant, secondary culm diameter and the weight of 100 intact or dehulled seeds were the most significant characteristics that differentiated the groups. The study provided strong evidence of the existence of three itchgrass groups in Peninsular Malaysia.

Socio-economic development and mortality patterns and trends in Malaysia

Morality in Peninsular Malaysia has reached a level that is quite similar to that prevailing in the low mortality countries. This article systematically documents changes in mortality levels and differentials in Malaysia over time and relates these to changes in development indicators and health-related policies. Remedial measures undertaken by the authorities including the expansion of hospital and health services into the estates, together with a comprehensive malaria-eradication program, improvements in sanitation laws, and increased provision of public utilities and education, resulted in beriberi being eliminated and the incidence of malaria, typhus, and smallpox being greatly reduced by the time of World War II. The gain in life expectancy over the period of 1957-1979 was greatest for the Malay, the most significant period being 1957-1967, which saw the introduction of rural health programs. The infant mortality rate and the neonatal and post-neonatal rates declined substantially for all ethnic groups in Peninsular Malaysia for the same time period. Although the lower infant mortality of the Chinese can be explained by their advantageous socioeconomic position the same reason cannot explain the lower decline in infant mortality levels of the Indians. Much still needs to be done to narrow, if not to eliminate, the existing mortality differentials of different groups in the country. Overall, the quality of life of the general population can be further enhanced by reducing the high mortality level of disadvantaged groups.