Rural Malaysia Research Articles

Identification of Rickettsial Infections (Rickettsia sp. TH2014) in Ctenocephalides orientis Fleas (Siphonaptera: Pulicidae)

Rickettsia felis (Rickettsiales: Rickettsiaceae) is an emergent human pathogen that causes febrile illnesses in various parts of the world. This study describes the identification and growth characteristics of a R. felis-like organism (designated as Rickettsia sp. TH2014) cultured from Ctenocephalides orientis fleas in rural Malaysia. In this study, culturing of rickettsiae from filtered triturated flea lysates was performed in Aedes albopictus C6/36 cells. Cytopathic effects were observed from one of the samples 4 d post-inoculation. Electron microscopy revealed actively replicating intracytosolic coccobacillary organisms in the rickettsia-infected cells. Sequence analysis of amplified citrate synthase (gltA) gene fragment shows complete match of the rickettsia with Rickettsia sp. Rf31 in Southeast Asia, and 'Candidatus Rickettsia senegalensis' strain PU01-02 in Africa. The whole-genome sequence of Rickettsia sp. TH2014 was determined and assembled. The estimated genome size and guanine + cytosine content of the rickettsia are 1.37 Mb and 32.9%, respectively. The high values of average nucleotide identity and tetra-nucleotide signature correlation index obtained from pairwise genome comparison study suggest the identification of the rickettsia as R. felis. The whole-genome single-nucleotide polymorphism analysis demonstrates close genetic relatedness of the rickettsia with R. felis and Rickettsia asemboensis. However, based on sequence analyses of rickettsial genes (16S rDNA, gltA, ompB, and sca4), Rickettsia sp. TH2014 is found to be distinct from R. felis and R. asemboensis. The sequence analyses reveal that Rickettsia sp. TH2014 is highly similar to 'Ca. Rickettsia senegalensis' detected in fleas from Africa, Asia, and North America. Further investigation to provide insights on pathogenic potential and transmission dynamics of the rickettsia is warranted.

Socio-Environmental Factors and Tuberculosis: an Exploratory Spatial Analysis in Peninsular Malaysia

Spatial pattern of tuberculosis (TB) describes the environmental variation of the disease. Controlling the disease is not only depends on bio-medical method, but there is also a need to explicitly understand socio-environmental contexts which include the elements of people, space and time. A spatial exploration of local TB dynamic in Malaysia’s perspectives is necessary since earlier studies were limited in addressing these contexts. This paper discusses a general spatial pattern of TB distribution pattern in Peninsular Malaysia for a ten-year period from 2005 to 2014 and its general possible correlation with socio-environmental factors in 2010. Geographical information system (GIS) and correlation analysis are fundamental techniques used to explore the local pattern of TB distribution and the relationship. Data on annual TB cases and state map were collected from the Ministry of Health and the Department of Rural and Country Planning Malaysia respectively. The overall spatial pattern of TB cases has shown increasing trends and concentrating in five states, including Selangor, Johor, WPKL, Kelantan and Kedah, even though there is no specific pattern in the area. This study suggests that the majority of the cases have occurred in the urban states, having high-medium incomes and populous areas.

Prehypertensive State, Mild Hypertension, Metabolic Syndrome and Cardiovascular Risk Factors among Young Adults in Rural Malaysia

Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines. Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched controls in rural Malaysia. Methods: 484 (four hundred and eighty four) subjects attending primary care clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, agematched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had prehypertension and 53.7% had mild hypertension. Mean values compared to age-matched controls for MAP were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG 4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI, FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension. The data suggests that hypertension in young adults is secondary to metabolic syndrome.

Making sense: Experiential engagements with ethnographic photographs

This article examines the role of embodied and performative knowledge in the museum environment, with a particular focus on ethnographic photographs. The study is based on the return of several hundred ethnographic photographs from the Sarawak Museum to Indigenous communities in rural Malaysia, where they had been taken by museum photographers from the early 1950s onwards. Aside from the oral narratives that emerged during the discussions and interviews, contextual knowledge was provided in embodied form. The return of the photographs to people in the source communities prompted the re-enactment of activities, re-telling of stories and production of cultural heritage to which the photographs referred. Such embodied knowledge, defined as knowledge preserved through performance and embodied activities, relates to the multi-vocal narratives about objects that museums are increasingly trying to include in their exhibitions. In this article I argue for a greater and more experimental use of sensory means to convey information about artifacts to museum audiences. Keywords:Ethnographic photographs, Photography, Embodied knowledge, museum archives, Sarawak, Southeast Asia

Risk perception of cardiovascular diseases among individuals with hypertension in rural Malaysia

ObjectiveDespite various efforts, hypertension remains poorly controlled, thus allowing cardiovascular disease (CVD) to impact the health burden worldwide. Patients’ perception of risk may contribute to this scenario. The present study...

Social support and care arrangements of older people living alone in rural Malaysia

ABSTRACTMalaysia has an ageing population and an increasing number of older people who live alone. This study explores the social support and care arrangements of older people living alone in rural Malaysia. The study took a qualitative approach: semi-structured interviews were conducted with a purposive sample of Malay (N = 20) and Chinese (N = 20) Malaysians aged over 65. Five cross-cutting themes were identified through a thematic analysis: degrees of aloneness; relationships and social support; barriers to social support; and future illness, care and death. All participants said they lived alone; living arrangements, however, were often complex. For Malays, most support came from nearby adult children and relatives, whereas Chinese participants, who less frequently had adult children living locally, emphasised support from friends and neighbours. Emigrant adult children's assistance was mostly informational and financial, instrumental assistance was either substituted for money, or provided solely during periods of ill-health. Physical decline, limited telephone use, inadequate transportation and fears of crime were barriers to social support. Participants avoided thinking or talking about future care needs. These findings have implications for Malaysian old age policy, which is currently focused on supporting families to care for older relatives. Child migration and a growing preference for a period of independent living in old age may require policies and resources directed at older people as individuals to support their own efforts to remain independent, active and age ‘in place’.

Prevalence and risk factors of Blastocystis infection among underprivileged communities in rural Malaysia.

To determine the prevalence and risk factors of Blastocystis among underprivileged communities living in rural Malaysia. This cross-sectional study was conducted among 253 participants aged between 1 and 85 years. Stool samples were examined using Wheatley's trichrome stain after in-vitro cultivation in Jones' medium to detect the presence of Blastocystis. Information pertaining to the demography, socioeconomic and environment were collected using pre-validated questionnaires. The total prevalence of Blastocystis infection was 40.7%. The multiple logistic regression analysis revealed that age ≥15 years (OR=2.72; 95% CI=1.47-5.04) and presence of infected family members (OR=8.56; 95% CI=4.47-16.38) were the significant risk factors associated with blastocystosis in these communities. Blastocystosis is revealed through this study to be still prevalent among Orang Asli communities in rural Malaysia. The two main approaches that should be implemented by the public health authority in battling this infection would be the screening of other family members and giving treatment to the infected individuals. Moreover, it is imperative for health education on good personal and food hygiene practices are provided in order to reduce the morbidity and transmission of Blastocystis infection among the Orang Asli in their communities meaningfully.

Digitally enabled affordances for community‐driven environmental movement in rural Malaysia

AbstractThe immense environmental challenges facing society today have necessitated a research effort toward exploring digitally enabled solutions for environmental problems. Only limited research exists today to inform our understanding on how technology could assist groups of individuals in cultivating collective commitment and engaging in actions for environmental sustainability. By presenting an in‐depth case study of a social media‐enabled grassroots environmental movement in rural Malaysia, this paper aims to illuminate and understand an underresearched phenomenon of community‐driven environmental sustainability. This study makes 2 contributions: (1) we draw on the perspective of technology affordances to shed light on both the enabling power and unintended consequences of social media in the pursuit of environmental sustainability; and on that account, (2) we contribute rich, empirically informed insights toward understanding the underresearched phenomenon of digitally enabled, community‐driven environmental sustainability.

'Just sisters doing business between us': gender, social entrepreneurship and entrepreneurial resilience in rural Malaysia

As part of a large-scale effort to examine the effectiveness of the Malaysian '1Azam' (literally '1Resolution') poverty reduction and eradication program through entrepreneurship education and support, this paper centres on Sabah, on the island of Borneo (also considered one of the poorest states in Malaysia). Our focus is an 'informal rural social cooperative' of more than 20 women entrepreneurs led by 48 years old homemaker turned entrepreneur 'Annie'. Employing a broad narratological framework to collect and analyse stories of lived experiences, we built a large textual data record of 'Annie's Co-op' for a period of 12 months. The 'thick' findings indicate that within their rural business venture, the participants play important roles as breadwinners for their families and as social entrepreneurs for their community; acting as one unit they demonstrate not just strategies of resilience but also a spirit of social duty despite barriers and challenges to their entrepreneurialism.

Does more education always lead to better health? Evidence from rural malaysia.

Background. Education is usually associated with improvement in health; there is evidence that this may not be the case if education is not fully utilised at work. This study examines the relationship between education level, occupation, and health outcomes of individuals in rural Malaysia. Results. The study finds that the incidence of chronic diseases and high blood pressure are higher for tertiary educated individuals in agriculture and construction occupations. This brings these individuals into more frequent contact with the health system. These occupations are marked with generally lower levels of education and contain fewer individuals with higher levels of education. Conclusions. Education is not always associated with better health outcomes. In certain occupations, greater education seems related to increased chronic disease and contact with the health system, which is the case for workers in agriculture in rural Malaysia. Agriculture is the largest sector of employment in rural Malaysia but with relatively few educated individuals. For the maintenance and sustainability of productivity in this key rural industry, health monitoring and job enrichment policies should be encouraged by government agencies to be part of the agenda for employers in these sectors.

Study of Coronary Risk Factors in Rural Malaysia Population

Coronary artery disease (CAD) is the global leading cause of death for both men and women. Risk factors for CAD have been studied extensively and subsequently preventive and treatment mea- sures have been prioritized globally. Nevertheless, the prevalence and mortality rate of CAD remains high. We attempted to identify the most common of the well-known risk factors for developing CAD in a rural population in Malaysia using a retrospective cross-sectional, hospital- based study from January, 2010 to June, 2011. Smoking was the most important independent risk factor for the entire male population (non- female smokers in population). In the population studied, smoking remains the most important health factor in development of CAD.

Prevalence and associated risk factors of Giardia infection among indigenous communities in rural Malaysia.

This study was carried out to investigate the prevalence and risk factors of Giardia infection among indigenous people in rural Malaysia. Faecal samples were collected from 1,330 participants from seven states of Malaysia and examined by wet mount and formalin-ether sedimentation methods while demographic, socioeconomic and environmental information was collected using a pre-tested questionnaire. The overall prevalence of Giardia infection was 11.6% and was significantly higher among those aged ≤ 12 years compared to their older counterparts. Multivariate logistic regression identified age of ≤12 years, lacking of toilet at household, not washing hands before eating, not washing hands after playing with animals, not boiling water before consumption, bathing in the river, and not wearing shoes when outside as the significant risk factors of Giardia infection among these communities. Based on a multilocus genotyping approach (including tpi, gdh and bg gene sequences), 69 isolates were identified as assemblage A, and 69 as assemblage B. No association between the assemblages and presence of symptoms was found. Providing proper sanitation, as well as provision of clean drinking water and proper health education regarding good personal hygiene practices will help significantly in reducing the prevalence and burden of Giardia infection in these communities.

Epidemiology of intestinal polyparasitism among Orang Asli school children in rural Malaysia.

BackgroundThis cross-sectional study aimed to investigate the current prevalence and risk factors associated with intestinal polyparasitism (the concurrent infection with multiple intestinal parasite species) among Orang Asli school children in the Lipis district of Pahang state, Malaysia.Methods/Principal findingsFecal samples were collected from 498 school children (50.6% boys and 49.4% girls), and examined by using direct smear, formalin-ether sedimentation, trichrome stain, modified Ziehl Neelsen stain, Kato-Katz, and Harada Mori techniques. Demographic, socioeconomic, environmental, and personal hygiene information were collected by using a pre-tested questionnaire. Overall, 98.4% of the children were found to be infected by at least one parasite species. Of these, 71.4% had polyparasitism. The overall prevalence of Trichuris trichiura, Ascaris lumbricoides, hookworm, Giardia duodenalis, Entamoeba spp., and Cryptosporidium spp. infections were 95.6%, 47.8%, 28.3%, 28.3%, 14.1% and 5.2%, respectively. Univariate and multivariate analyses showed that using an unsafe water supply as a source for drinking water, presence of other family members infected with intestinal parasitic infections (IPI), not washing vegetables before consumption, absence of a toilet in the house, not wearing shoes when outside, not cutting nails periodically, and not washing hands before eating were significant risk factors associated with intestinal polyparasitism among these children.Conclusions/SignificanceIntestinal polyparasitism is highly prevalent among children in the peninsular Malaysian Aboriginal communities. Hence, effective and sustainable control measures, including school-based periodic chemotherapy, providing adequate health education focused on good personal hygiene practices and proper sanitation, as well as safe drinking water supply should be implemented to reduce the prevalence and consequences of these infections in this population.

Nutritional outcomes related to household food insecurity among mothers in rural Malaysia.

During the past two decades, the rates of food insecurity and obesity have risen. Although a relationship between these two seemingly-paradoxical states has not been repeatedly seen in men, research suggests that a correlation between them exists in women. This study examines nutritional outcomes of household food insecurity among mothers in rural Malaysia. A cross-sectional survey of low-income households was conducted, and 223 households with mothers aged 18-55 years, who were non-lactating, non-pregnant, and had at least one child aged 2-12 years, were purposively selected. A questionnaire was administered that included the Radimer/Cornell Scale, items about sociodemographic characteristics, and anthropometric measurements. Of the households, 16.1% were food-secure whereas 83.9% experienced some kind of food insecurity: 29.6% of households were food-insecure, 19.3% contained individuals who were food-insecure, and 35.0% fell into the 'child hunger' category. The result reported that household-size, total monthly income, income per capita, and food expenditure were significant risk factors of household food insecurity. Although there was a high prevalence of overweight and obese mothers (52%) and 47.1% had at-risk waist-circumference (> or = 80 cm), no significant association was found between food insecurity, body mass index, and waist-circumference. In conclusion, the rates of household food insecurity and overweight and obesity were high in the study population, although they are looking paradoxical. Longitudinal studies with larger sample-sizes are recommended to further examine the relationship between food insecurity and obesity.

The rural bite in population pyramids: what are the implications for responsiveness of health systems in middle income countries?

BackgroundHealth services can only be responsive if they are designed to service the needs of the population at hand. In many low and middle income countries, the rate of urbanisation can leave the profile of the rural population quite different from the urban population. As a consequence, the kinds of services required for an urban population may be quite different from that required for a rural population. This is examined using data from the South East Asia Community Observatory in rural Malaysia and contrasting it with the national Malaysia population profile.MethodsCensus data were collected from 10,373 household and the sex and age of household members was recorded. Approximate Malaysian national age and sex profiles were downloaded from the US Census Bureau. The population pyramids, and the dependency and support ratios for the whole population and the SEACO sub-district population are compared.ResultsBased on the population profiles and the dependency ratios, the rural sub-district shows need for health services in the under 14 age group similar to that required nationally. In the older age group, however, the rural sub-district shows twice the need for services as the national data indicate.ConclusionThe health services needs of an older population will tend towards chronic conditions, rather than the typically acute conditions of childhood. The relatively greater number of older people in the rural population suggest a very different health services mix need. Community based population monitoring provides critical information to inform health systems.

Recollections of My Time in Malaya (1945–1956) Part 2

Recollections of My Time in Malaya (1945–1956) Part 2 * J. M. Gullick Jelebu The Jelebu district, shut off behind a range of hills and isolated from the rest of Negri Sembilan, was comparatively unimportant. We had no one to send there and for a week or two after our first arrival it was left to its own devices. However, two items of news from Jelebu brought it to attention. First, the Undang of Jelebu, Dato’ Abdullah, had died—from natural causes and at a considerable age—in August 1945. It would be necessary to elect a successor without the long period of wrangling, which usually delayed such an election for months or even years, as the new Undang would be required as one of the necessary signatories to the treaty that MacMichael would bring to Negri Sembilan in November. Secondly, the local MPAJA, deeply suspicious of the local administration, had removed all the records, including the essential land registers, from the District Office and had destroyed them. This was a serious blow to the machinery of administration (though throughout Malaya the land registers were closed and would remain so for months). As there was no one else available, Calder asked me to visit Jelebu and take temporary charge in addition to my duties in Seremban. I set off on 23 September 1945. The roads throughout Negri Sembilan were in surprisingly good condition. The Japanese had not done much to maintain them, but the pre-war PWD had done a good job. I had no difficulty in getting the aged Humber Hawk which I used for my journeys up the steep and winding road to the Bukit Tangga pass. At the top I paused to admire the magnificent view of Negri Sembilan stretching away to the Malacca Strait—everyone pauses there, including the dozen police who were to be ambushed by the MPAJA and massacred there in December 1949. At Kuala Klawang, the district headquarters, I found the Malay District Officer (I think his name was Baba) at his house. We went together to the District Office, which was literally stripped clean of every scrap of paper it had ever contained. I remember that when I asked the DO for a list of his staff I had to tear a leaf from my notebook so that he could write the names on it. He was quite positive that the MPAJA had burnt the missing land registers. The Japanese had used the District Office as their headquarters and the MPAJA had deemed it necessary to destroy everything in it in case it should be Japanese. This was the second major loss of records suffered in Negri Sembilan at this time; the other was the loss of the greater part of the State Secretariat files in Seremban. In that case the Kempeitai, who had used part of the building, sent a military fatigue party under a sergeant to burn their records before the arrival of British troops, and the [End Page 53]sergeant, uncertain as to what was intended, burnt almost everything in that wing of the Secretariat building—again a pointless destruction of irreplaceable records. To return to Jelebu—it was plain that the entire district administration had come to a halt and the District Officer was obviously very apprehensive for his own safety. Kuala Klawang itself is a small trading centre, and the main Chinese settlement is Titi, a tin-mining centre a few miles away. I felt that I should see—and be seen at—Titi. So the DO, protesting faintly, got into the car and we went off to Titi. Here the MPAJA were established at the police station and were flying their ‘Tiga Bintang’ flag (3 stars—one for each of the main communities of Malaya) at the flagpole. L. K. L. Siaw in his Chinese Society in Rural Malaysia: A Local History of the Chinese in Titi, Jelebu, published in 1983 almost 40 years after these events, presumably relied on local Titi traditions—somewhat vainglorious—in describing the foundation of a communist republic at Titi which remained defiant until the arrival of a battalion of British troops brought it to an end. This is pure fiction...

Investigating the Effects of Amanah Ikhtiar Malaysia’s Microcredit Programmes on Employment in Rural Malaysia

The creation of either self-employment or wage-earning job opportunities is considered one of the more effective strategies for sustainable poverty alleviation. The Malaysian government promulgated a national plan for poverty eradication in its Vision 2020 agenda by emphasizing full employment. However, the classic trickle-down effects of large-scale industrialization policies can hardly be expected to reach the bottom-most tier of a country’s poorest group. Instead, more precise tools such as microcredit loans and socio-economic support services would better address hardcore poverty. This paper employs a cross-sectional design with a stratified random sampling method to examine the impact of Amanah Ikhtiar Malaysia’s (AIM) microcredit programmes for women on employment generation at the client, household and community levels in rural Peninsular Malaysia.

Population aging in rural Malaysia

Population aging, a term used to refer to the continuous increasing of older population in a population structure, is becoming a global phenomenon. The purpose of this article is to describe the growth of older population and analyze its barriers to lifelong education programs in rural Malaysia. Utilizing data from a survey on 214 respondents aged 60 and above in rural areas in Malaysia, this study reveals that all of the older persons in the survey are categorized as from lower social economic status. In-depth interviews data shows that there are a lot of barriers to these older persons to be involved in lifelong education. These barriers include gender, education level, marital status, poverty, and health status. The government is facing problems to influence older persons to participate in the lifelong education programs in rural Malaysia.

Obesity Definition Differences and Association with Coronary Artery Disease in a Rural Malaysia Population

Obesity, defined conventionally by Basal Mass Index (BMI), is associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death. However, not all obese people are affected by metabolic disturbances and a subset of normal BMI individuals suffer from metabolic syndrome (MetS). Although these phenotypes have been recognized by researchers, there is a paucity of data for obese people without MetS (MHO) (MetS+/Obe-). This study examined the prevalence of different definitions of obesity and their association with Coronary Artery Disease (CAD) in a Malay rural population. Method: The group, an 18 month cross sectional, hospital based study, comprised 408 patients who were nonsmokers, age 20 and above, both gender and all races. We used differing definitions of obesity based on BMI, the consequences of obesity by these different definitions and ethnic associations. Results: In patients with BMI ≥ 25, ≥ 27, and ≥ 30, the percentages of MHO were 15.4, 10.8 and 5.7% respectively. Obese, metabolic abnormal groups (MetS+/Obe+) (MOO) defined at BMI ≥ 25 (1.92, CI =1.16-3.17), ≥ 27 (1.94, CI=1.18-3.17) and non-obese, metabolic abnormal group with BMI<30 (MetS+/Obe-) (MONO) (1.71, CI=1.04-2.80) were significantly associated with CAD. Conclusion: Obese, metabolic abnormal groups (MetS+/Obe+) (with obesity defined as BMI ≥ 25, ≥ 27) and metabolic abnormal group (MetS+/Obe-) with BMI <30 (with obesity defined as BMI ≥ 30) were significantly associated with CAD but obese metabolic normal subjects (Mets+/Obe-) (MHO) with BMI <27 were not significantly associated with CAD.

Effects of Demographics, Metabolic Factors, and Obesity on Lipid Parameters in a Patient Population of Rural Malaysia

Effects of Demographics, Metabolic Factors, and Obesity on Lipid Parameters in a Patient Population of Rural Malaysia