Epidemiology of diseases in Malaysia

1. EPIDEMIOLOGY
OF DISEASES IN
MALAYSIA

9. VPDS (VACCINE
PREVENTABLE DISEASES )
• All infectious diseases which can be prevented
by vaccines are on a downward trend, in line
with the national and WHO target.
• No cases of polio, neonatal tetanus and
diphtheria.
• No large epidemics
• Measles and hepatitis B under control and on a
downward trend.

11. Childhood Immunisation Coverage, Malaysia 2003
BCG 99.00%
Triple & Double Antigen (3rd Dose) 85.40%
Polio Immunisation (3rd Dose) 94.90%
Measles Immunisation 75.50%
Hep B Immunisation (3rd Dose) 93.10%

14. WATER & FOOD BORNE
DISEASES
• A drop in the incidence rate of food and
water borne diseases such as typhoid,
cholera, para typhoid, hepatitis A and
dysentry since 10 years ago (1988-1997)
• Related to improvement of safe water
supply and better sanitation.
• However there is an increase of food
poisoning incidence.

16. CHOLERA
• Still a public health problem especially in
Sabah and the northern peninsular.
• Related to the use of contaminated water
during drought or water shortage.
• Sabah - GREG storm 1997
• Sarawak – use of contaminated rain water

17. TYPHOID
• Occurs in some states especially
Kelantan, Sabah and Terengganu.
• Big outbreak in Tawau 1997 due to the
use of contaminated river water (180
cases)
• Outbreak in Kota Baru, Kelantan
believed to be related to “sirap ais”.

18. HEPATITIS A
• Endemic in some states such as
Terengganu, Kelantan and Sabah.
DYSENTRY
• Most cases occurs at border areas in
Sabah, Sarawak, Kedah, Perlis, Perak
and Johor.

19. FOOD POISONING
• A big problem in institutions, schools
and factories.
• Related to unhygienic food
preparation.
• Mostly due to E. coli, Salmonella spp
and Staphyllococcus aureus.

20. AIDS/HIV

22. AIDS
• Abbreviation for Acquired Immune
Deficiency Syndrome.
• Infected persons will lose their natural
immune defence system and minor
infections will become life threatening
diseases.
• This person will usually die from serious
opportunistic infection or due to rare
cancers.

23. The Virus
• Identified in 1983/84.
• In 1986, given the name Human Immuno-
deficiency Virus (HIV) by ICTV.
• It is a retrovirus that belongs to a large
family of RNA lentiviruses.
• 2 types identified
– HIV-1,
– HIV-2.

24. Epidemiology of HIV/AIDS
• Currently more than 34.3 million people
with HIV worldwide.
• Malaysia –
– No cases before 1986
– end of 2003, 58012 accumulated cases.
• Malaysia majority are IDU’s, male &
Malays.

25. HIV/ AIDS
• Infected newborns - increasing
• Infected prostitutes - increasing
• Heterosexual transmission more nowadays
• Infection rate amongst blood donors ( 0.03-
0.06%)
• Sentinel surveillance sentinel – no obvious
trend

26. HIV and AIDS Estimates for the Western Pacific Region, 1999
Estimated HIV Estimated HIV Estimated
Country/area prevalence prevalence rate AIDS Status of epidemic
(age 15-49) (age 15-49) incidence
Cambodia 170 000 3.3% 10 000 Stabilizing; heterosexual
Expanding in selected areas;
Papua New Guinea 14 000 0.6% 150 heterosexual transmission
Malaysia 50 000 0.4% 900 Stable; mostly IDU
Expanding; IDU, heterosexual
Viet Nam 100 000 0.2% 3 700 transmission increasing rapidly
Singapore 3 000 0.1% >120 Stable
Australia 14 000 0.1% +/- 200 Declining; mostly homosexual
Expanding; mostly IDU;
China 500 000 <0.1% n/a heterosexual increasing
Hong Kong 3 700 <0.1% +/- 60 Stable
Japan 8 100 <0.1% +/- 200 Stable
Lao, PDR 1 400 <0.1% >50 Stable
New Zealand 1 200 <0.1% +/- 30 Declining; mostly homosexual
Philippines +/- 10 000 <0.1% >50 Slowly expanding; heterosexual
Korea, Republic 3 800 <0.1% +/- 30 stable
Total >876 200 <0.1% >>15 490

27. Trends in HIV/AIDS Reported
Selected countries 1989-1998
HIV/AIDS cases reported
New Zealand
9 000 Australia
Hong Kong
8 000 Japan
7 000 S. Korea
Singapore
6 000 Malaysia
Cambodia
5 000 Vietnam
4 000
3 000
2 000
1 000
0
110418 89 90 91 92 93 94 95 96 97 98

28. Trends in AIDS Reported Cases
Selected countries 1989-1998
AIDS cases reported
New Zealand
Australia
1 600 Hong Kong
Japan
1 400 S. Korea
Singapore
1 200 Malaysia
Cambodia
1 000 Vietnam
800
600
400
200
0
11050
7 89 90 91 92 93 94 95 96 97 98

33. VECTOR BORNE DISEASES
DENGUE/DHF
• Increasing number of cases and deaths due
to rapid urbanisation and industrialisation.
• Especially in Kuala Lumpur, Selangor,
Johor, Perak and Negeri Sembilan (urban
areas)
• Ratio of DF:DHF are 7-25 : 1
• Fatality rate DHF 0.2-0.4%

35. MALARIA
• Still a major problem in Sabah,
Pahang, Sarawak, Perak, Kelantan and
Johor.
• Main Agent - Plasmodium falciparum
• Especially amongst Orang Asli, land
settlers, soldiers and immigrants.

38. TUBERCULOSIS
Increasing trend, >50% new cases are
infectious
New cases - age 21-40 yrs.
-13% are imigrants (50% in Sabah, 15% in
WP,KL)
-cure rate 86% (1997)
Mortality increasing due to late treatment
and HIV/AIDS.

41. Survival Functions
1.2
1.0
.8
Ujian ELISA
.6
Tidak reaktif
.4
Cum Survival
Tidak reaktif
-censored
.2
Reaktif
0.0 Reaktif-censored
-200 200 600 1000 1400
0 400 800 1200 1600
INTERVAL

43. Non-Communicable Disease

45. Common Risk Factors of Lifestyle
Diseases
Share Predisposing Conditions:
– Hypertension
– Obesity (especially central obesity)
– Diabetes Mellitus
– Cancer
And Common Risk Factors:
– Tobacco
– Physical Inactivity
– Irrational Diet (especially high fat intake)
– Alcohol over-consumption

46. Adult Smoking (NHMS 3)
• 27.0% ever smokers
• 21.5% current smokers
• Higher amongst Malay (24.0%), rural
(32.3%), males (57.6%, females only
2.5%).
• Higher in Kelantan (31.7%), Pahang
(29.8%) and Sabah (29.3%). Lowest in
Penang (20.7%) - NHMS 2

47. Physical Inactivity
• NHMS 2 (20 minutes/day, 3x a week)
– 11.6% exercised adequately,
– 31.7% ever exercised
– Nearly 70% of Malaysians do not exercise
• NHMS 3 (WHO-stepwise questionnaire, <150
minutes/week of moderate physical activities & 60
minute/week of vigorous physical activities)
– 43.7% physically inactive
– higher in woman, older age, urban residence,
unemployed and housewife.

48. Irrational Diet (NHMS 3)
• Underweight (BMI <18.5kg/m2) - 8.5%
• Normal (BMI 18.5-24.9kg/m2) - 48.3%
• Overweight (BMI 25.0-29.9 kg/m2)-29.1%
• Obese (BMI 30kg/m2 & >) - 14.1%
• Overweight in 1996 16.6%, now 29.1%
• Obese in 1996 4.4%, 2002/2003 12.7% and
now 14.1%.

49. Alcohol (NHMS 3)
• 16.2% ever drank – age group between 70
– 74 years old (10.4%),
• 7.4% current drinkers
– Christians (25.6%),
• For current drinker the – senior officer /
prevalence was higher manager (24.8%), and
in; – married (7.9%).
– Sarawak state (15.0%), – tertiary level of
– in urban area (8.9%), education (13.7%).
– among males (11.8%), – earned RM 5000 and
– Chinese (23.8%), above per month
(16.3%)

50. Major NCD Diseases
• Hypertension - 29.9% 1996, 32.2% in 2006
• Cancer - 31,700 cases a year
• Diabetes Mellitus - 8.3% 1996, 11.6% in
2006.
• Injury

51. HYPERTENSION
Increase of cases due to;
•aging
•Smoking habit
•?life stressors
•? Excessive dietary salt intake

52. HYPERTENSION
• According to NHMS ’2006;
– Prevalence of 32.2%
• Self-reported 11.5%
• Previously undiagnosed 20.7%
• Higher in rural (36.9% vs 29.3%), Malays (33.9%
vs 32.4% vs 29.4%) >30 yrs, obese/overweight
• Amongst the hypertensive, 35.8% were previously
diagnosed. Among those who were previously
diagnosed, 87.7% were on treatment. Of those on
treatment, only 26.3% of their BP were under
control.

53. CANCER
One of 5 main cause of death since 20
years ago.
Incidence -150 per 100,000 pop. (31,700
cases a year), the cases and deaths due to
cancer are on the rise.
Related to lifestyle and the environment.

54. Burden of Cancer
• Incidence -150 per 100,000 pop. (30,000 case a
year)
• Prevalence – 90,000
• Incidence expected to rise with an increase of
aging population.
– >60 yrs
• 1957 4.6%
• 1990 5.7%
• 2020 9.8%
GCC Lim, 2002. Overview of Cancer in Malaysia. Jpn J Clin Oncology

55. Incidence by Gender
• No nationwide population-based cancer
registry. Data based on extrapolation.
• Survey between 1988-1990;
– Males 56.3 per 100,000
– Females 56.9 per 100,000
• Penang registry 1994;
– Males 115.9 per 100,000
– Females 119.7 per 100,000
GCC Lim, 2002. Overview of Cancer in Malaysia. Jpn J Clin Oncology

56. Racial Differences
• Noted in NPC & oral cavity cancer
• NPC amongst males by race;
– Malay 0.79 per 100,000
– Chinese 15.9 per 100,000
– Indian 1.1 per 100,000
• NPC amongst females by race;
– Malay 0.8 per 100,000
– Chinese 4.1 per 100,000
– Indian 0 per 100,000

57. Incidence by Type

58. Diabetes Mellitus – (NHMS3)
• Overall prevalence was 11.6%. Known
diabetes was 7.0%. Newly diagnosed
diabetes was 4.5%.
• Higher in the urban at 12.1% compared to
the rural areas at 10.5%.
• Between ethnicity, Indians have the highest
prevalence of 19.9% , followed by Malays
11.9% and Chinese 11.4%.

60. INJURY
Main cause of death and hospital
admission - MVA & fall.
Upward trend.

63. Diseases Due To Migration

66. Conclusion
• Malaysia is a country undergoing a health transition
• Improving socioeconomic status and aging
population leads to chronic & degenerative
diseases. Problems such as;
 Occupational diseases
 Chemical poisoning from industry and agriculture
 Diseases due to air pollution
 Work injury and MVA
 Disease related to urbanisation
• Trend of disease approaching those of developed
countries and yet unable to shake off the diseases of
developing countries. A double burden…………

67. TERIMA KASIH