IMR Bulletin July Oct 2002

Transcription

IMR Quarterly Bu letin
ISSN: 01274265
CONTENTS
From the Editor-in-Chief......................................................................................................................
1
Notice to contributors............................................................................................................................
1
ARTICLES
Kato's Self-scraping Method for Collection of Cervical Smear - A Client Friendly Device for the
Missed Opportunities
Dr. Abu Bakar Abdul Majid .....................................................................................................................
Pesticide Poisoning in Negeri Sembilan
Dr. Bernard Benedict.. ...................................................................................
.:........................................
EHRC - A Research Centre in Transition. Part 1: Change Management and Expanding Research
Paradigms in the Institute for Medical Research, IMR, Malaysia
Dr. Stephen Ambu, Mr. Jim Ireland, Mr. Brent Powis & Mr. Steve Tamplin.........................................
EHRC - A Research Centre in Transtion. Part 2: Human Resource and Expanding Research
Pasadigms in the Institute for Medical Research, IMR, Malaysia
Dr. Stephen Ambu, Mr. Jim Ireland, Mr. Brent Powis & Mr. Steve Tamplin.. ..............................
PlJBLISHED ABSTRACTS
Molecular Fingerprinting of Fusidic Acid and Rifarnpicin-resistantStrains of Methicillin-resistant
Staphylococcus Aureus (MRSA) from Malaysian Hospitals
A. Norazah, V. K. E. Lim, Y. T. Koh, Y. Rohani, H. Zuridah, K. Spencer, P. P. Ng &
A. G. M. Kamel.. ....................................................................................................
The Screening of Extracts from Goniothalamus Scortechinii, Aralidium Pinnatifidum and
Andrographis Paniculata for Anti-Malarial Activity Using the Lactate Dehydrogenase Assay
Mr. J. Siti Najila, A. Noor Rain, A. G. Mohamad Kamel, S. I. Syed Zahir, S. Khozirah, S. Lokman
Hakim. I. Zakiah & A . K. Azizol ..................................................................................
Regional Study of Nutritional Status of Urban Primary School Children. 3. Kuala Lumpur
E-Siong Tee, Swan-Choo Khor, Hoon-E~ROoi, Swee-Ing Young,
Ornar Zakiyah & Harnzah ZulkaJi.. ...............................................................................
The Role of Virological Surveillance of Dengue serotypes for the Prediction of Dengue Outbreak
Rbvindran Thayan, d4angalam Sinniah, F a t i m h Sonkcrim,
Satwant Singh &Mohamad Taha Arif.. ...........................................................................
Increased Levels of Interleukin-10 Reflect Desease Activity in Patients with Systemic Lupus
Eiyhernatosus
Azizah M. R., Ainol S. S., Kuak S. H., Kong N. C. T., Nomtaznah Y. & Rahim M. N ......................
Seroprevalence of Leishmaniasis Among Bangladeshi Immigrant Workers in Cameron Higlands,
Malaysia
Abdul Halirn A., Lokman Hakim S., Norashikin M., Yusri M. Y., Ahmad Dasuku A. G., Chong C. K.
ck Thcingam R. ........................................................................................................
Seroprevalence of Toxoplasma Gondii Antibodies in HIV Positive and Negative Patients Using the
Immunofluorescence Antibody Test (IFAT) Methods
!$hamilahHisham, Lokman Hakim S., Noor Aziart M. Y., Malkith K. & Yasri M. Y.. ......................
A Study on Cross Reactivity Between Sarcocystis Fusiformis Cystozoites Antigens and Toxoplasma
Gondii by Western Blot Technique
Nonnaznah Y. & Saniah K .......................................................................................................................
Schistosoma Spindale Cercaria Production and Shedding Periodicity in Indoplanorbis Exustus Snails
from Peninsular Malaysia
KIzisnasamy M., Chong N. L., Ambu S., J e f v J. & Inder Singh K.. ..........................................
Dcvelopnlent of a Saliva Based Assay for the Detection of Acctylcholincsterase (AChE) in Humans
Lee H. L., Grace Low., Ai Wei Tang & Nazni W. A .............................................................
Preliminary Surveillance and Positioning of Phlebotomine Sand Flies Breeding Sites in Penang,
Malaysia Using Global Positioning System
Khadri ShaharM., LeeH. L., AbuH.A., Mi1kahS.A. R. &AzahariA. H ...................................
Survey of Mosquito Larvae Distribution in Container Habitats Collected from Urban and Rural
Areas in Major Towns of Malaysia
Rohani A., Abdullah A. G., Ong Y. F., Saadiyah I., Zamree I. & Lee H. L.. ................................
Insecticide Resistance Status of Aedes Albopictus and Aedes Aegypti Collcctcd from Urban and
Rural Areas in Major Towns of Malaysia
Rohani A., Chu W. L., Saadiyah I., Lee H. L. & Phang S. M.. ........................: ........................
REPORTS
A Review of an Isolated Dengue Outbreak in Per& Tengah Health District, January 2002
S. Elangovan. R. M. Desa, R. A. Helmy & Z. M. Yusof.. .......................................................
A Study of Knowledge, Attitude and Behaviour on AIDSISTD Among Immigrant Workers in an
Indian Restaurant, Selangor Malaysia
Elang~vclnSubbinh.. ................................................................................................
Caries Status and Oral Health Awareness Among School Children in the Non-Fluoridated Area of
Endau Mersing
Dr. Mohamnzad Rashid Baharon.. ................................................................................
Evaluation of Food Safety in Market Place
Dr. R..Sawri Rajan.. .................................................................................................
Pengetahuan Sikap dan Amalan Tentang Bahaya Merokok Dikalangan Pelajar-pelajar Sekolah
Menengah di Kawasan Luar Bandar Kedah Dam1 Aman
DI: R. Sclrvri Rajarz ...................................................................................................
EDITORIAL BOARD
-
IMR Quarterly Bulletin No. 51/52: July/Oct.2002
From the Editor-in-chief
Tht: IMR Quarterly Bulletin successfully printed the combined issues of 49 and 50 for the year 2002 and it
has been distlibuted widely. The culrerll h u e combines volu111es number 51 a d 52, and represenlb h e 3d
and 4" quarter of the year 2002. These quarterly bulletins will continue to publish articles of interest which
will cater for various disciplines within the Ministry of Health Malaysia. The articles published in this issue
include original research findings, reports and abstracts of published scientific papers.
The IMR Quarterly Bulletin is a window of expression for the scientists, clinicians, public health
practitioners and policy makers within the Ministry of Health Malaysia and is offered at no cost. The
Bulletin creates an opportunity for researchers to make theirs findings known to people who can use these
information to develop better strategies for health programmes.
Recadenare also encouraged to send calendars of events from their respective institutions or societies, that
are is of relevawe tu be published irl he bulletin.
Notice to Contributors
The article should have the following sections: Brief introduction; Materials and methods; Results;
Dilscussion; Acknowledgements and References. Illustrations should be drawn clearly and not photocopied.
Care should be taken that illustrations do not exceed a maximum size of 12.0 x 18.5cm. The Editorial
Bolard reserves the right to arrange drawings and photographs in a manner so as to make a composite plate
to avoid undue wastage of space. References should be given in alphabetical order with the full title of the
journal.
The articles can be written in Bahasa Malaysia or in English with double spacing and submitted as a
typescript, on size A4 paper to Pn. Siti Rodziah, Unit Perpustakaan, Maklumat dan Penerbitan, Institute
Penyelidikan Perubatan or transmitted electronically to the following e-mail address: rodziah@imr.~ov.m~
It is assumed that all articles submitted for publication have the prior approval of their respective Directors.
Thie Editorial Board takes no responsibility for the accuracy of statements made by the author(s) and the
views expressed in the articles are not to be taken as that of the Institute for Medical Research or the
Ministry of Health Malaysia.
ARTICLES
-
Kato's Self-ScrapingMethod For Collection of Cervical Smear A Client Friendly Device For Thc Misscd Opportunities
Dr Abu Bakar Abdul Majid
Medical OfJicer of Health
Department of Health, District of Kuala Lnngat
INTRODUCTION
examination (Figurel) and cells are evenly
spread on one or more glass slides. Each slide
Cervical cancer is the second commonest female
cancer worldwide. In many countries this is the
commonest cause of death from cancer in
women(1). Since the introduction of the
Papanicolaou (Pap) smear in 1942, deaths from
cervical cancer have decreased. Case-control
sl.udies of women with invasive cervical cancer
have shown that, compared with normal control
typically contains thousands of cells. In order to
achieve an accurate diagnosis, we need to collect
sufficient numbers of the appropriate cells from
the appropriate areas. This collection should be
done accurately and discreetly in a professional
manner that avoids embarrassment and
subjects, fcwcr of the cases had prior Pap
discomfort to the patient and ensures an adequate
smears. A cohort study showed, after controlling
for socioeconomic differences between women
who enrolled in a screening program and women
who did not, that there was a decline in cervical
cancer mortality rates in the screened women
compared to an increase in rates in those not
screened. In Malaysia. Pap smear screening has
been provided for all family planning acceptors
since 1981. In 1999, a detection rate of 0.79%
was obtained in the country (2). The coverage of
collection of sample cells for the laboratory
examinations. There are various methods in use
with different types of cell collection devices for
the cervix. Two commonly used instruments in
primary care setting are the cervix brush and the
Aylesbury spatula. One type of instrument used
which has not been introduced in this country is
the Kato's self-scraping method.
Kato's self-scrapingmethod
Pap smear screening in this country, is however
1r:ss than 30% and far from satisfactory (3). It is
indeed our objective to have a further decrease in
the cervical cancer death rate, which can be
achieved, with an increase in the number of
women consistently receiving Pap smears. The
false-negative Pap smear rate, reported at
bletween 5% and 30%. may he a barrier to
dletection (4). To correct this, new regulations
and new technology have been introduced.
However, thousands of women have never
reccivcd a Pap smcar or receive it sporadically.
To reduce deaths from cervical cancer, lowering
the false-negative rate may not be as important
als having regular Pap smears
Methods used in taking cervical smears
Pap smears consist of cells removed from the
cervix, which are specially prepared for
microscopic examination. A gynecologist or
other health care provider removes the cells by
brushing or scraping the cervix during a pelvic
The instrument for Kato's Self-Scraping Method
designed by the Nagoya Preventive Medical
Institute, has been developed and adapted for
easy domestic use for the purpose of obtaining
the cervical smear. The Kato device consists of
a sponge attached to the end of a rod and a small
polyethylene container with 1 ml of 50% ethyl
alcohol for fixation of the specimen. Scraping
the uterine neck with the sponge collects the
cells required for the examination. The cells thus
collected are preserved and fixed by 50% ethanol
in an attached small-sized container as in Figure
2. Excellent results including the detection of
the early cancer have been obtained in Japan.
Several studies found this instrument easy to use
and capable of giving diagnostic results close to
those achieved with the gynecologist-prepared
specimens (5).
Procedure of Kato's self-scrapingmethod
This easy-to-use device is specially designed for
the purpose of taking personally the cervical
smear at home (see Figure 3). First, remove the
IMR Quarterly Bulletin No. 51/52: JuIy/Oct.2002
cap from the instrument and insert into vaginal
canal. Push the handle of the instrument to
expose the sponge part in full. Then, rotate the
handle 6 times and pull back the handle to store
the sponge. Remove the appliance from vagina.
Pour the fixing liquid into the sponge part and
replace the cap. Sent the instrument to the
laboratory/Health clinic for
subsequent
examination by the laboratory technologist.
Upon receipt at the laboratory, the sponge
applicator is removed and smeared evenly on a
glass slide, which is then fixed in 90% ethyl
alcohol and stained according to Papanicolaou.
concerned with socia1 justice, with fair
distribution of resources to protect, preserve and
restore health. As public health professionals, we
have an ethical duty to consider each patient or
client as an individual with her own unique life
situations, problems, requests and may not apply
to the our current policies. The degree to which
responsibility for health problems and their
solutions is shared by the individual and society
depends to some extent on the nature of the
recommendation, the privacy rights of the
individual, and the likelihood of success
associated with different approaches to assigning
responsibility to the individual or society.
Pap smear coverage among health staffs
Health staffs as the prime mover and motivators
of the screening program are expected to have
their smears taken regularly. A study done
among health staffs from the district of Kuala
Langat and Banting hospital revealed that 29.4%
have never taken a pap smear (Table 1). Midwife
and staff nurses have a good coverage of 87.5%
and 77.4% respectively but the doctors were only
33%. 41.7% of the community health nurses too
were not screened.
The Kato's self-scraping method of obtaining
cervical smears is empowering women and
women friendly. It thus gives a valuable
alternative in addition to the current available
methods of taking cervical smears
Reference
Symonds E.M, Symonds I.M. Lesions of the
cervix, in Essenlial Obstetrics and
Gynaecology, (27) 265-273. Churchill
Livingstone, 1998.
Factors on poor coverage of cervical smears
There are many factors that contribute to the
poor coverage of cervical smear. It ranges from
perceptions of allopathic medicine, knowledge,
socio-cultural values, attitudes, and to health care
systems and policies. A Population based study,
examining variations in cervical smear uptake
rates among 126 general praclices in United
Kingdom, found that cervical smear uptake rates
varied from 16.5% to 94.1% (6). Certain ethnic
groups with associated social deprivation such as
overcrowding were seen to have low uptake.
Rates were higher in general practices with a
female partner than in those without. It was
concluded in the study that general practices with
a female partner had substantially higher uptake
rates even after other factors were adjusted for,
suggesting that appointing a female partner may
help raise a practice's cervical smear uptake rate.
Malaysia, with its three main ethnic groups and
diverse, rich socio-cultural values and traditions
may offer additional factors that contribute to the
low coverage of pap smear in the country.
Discussion
Beneficence is the dominant ethical principle of
public health. Public health is inherently
Annual Report 1999. Ministry of Health,
Malaysia.
National Health and Morbidity Survey,
1996. Ministry of Health, Malaysia.
Foulks MJ. The Papanicolaou smear: its
impact un the polnotion of women's health.
J Obstet Gynecol Neonatal Nurs 1998 JulAug;27(4):367-73
Noguchi M, Nakanishi M, Ito Y, Nakaluta
T, Tamada M, Tsuji K: Mass screening for
cervical cancer by the self-obtained smear
method in solitary islands (2). J Aichi Med
Univ Assoc 7:203-209, 1979.
F A Majeed, D G Cook, H R Anderson, S
Ililton, S Bunn, C Stoncs. Using patient and
general practice characteristics to explain
variations in cervical smear BMJ 1994; 308:
1272-1276
IMR Quarterly Bulletin No. 5 1/52: July/Oct.2002
Pesticide Poisoning in Negeri Sembilan
Dr. Bernard Benedict
Principal Assistant Director, Occupational & Environmental Health Unit
Perak Health Department
ABSTRACT
1
A study of Acute Pesticide Poisoning in the State of Negeri Sembilan was done for a 4-year period. Indians had
the highest incidence rate of 95 cases/100,000 population in the 3rdyear. Overall, there were 350 cases (70%) of
suicide, 102 cases (20.4%) of accidental and 45 cases (9%)of occuparional poisoning. Paraquat was responsible
for most (59.8%) of the poisonings with fatality rate of 61.2%. Organophosphates were second (13.2%), with
fatality rate of 15.2%.
The causes for the poisonings were found to be preventable. The existing system of pesticide control should be
improved with better, effective health education involving the management, agricultural workers and better
enforcement of the legislation by the Government with primary health care approach.
INTKODU CTION
Up to one-third of world food production is lost
through biological contamination, degradation
caused by pests, insects, fungi, bacteria and
enzymes. Efforts to improve food safety will help
to reduce food losses1. Hence the continuing need
for crop protection and the control of diseasespreading rodents and pests is clea?. This can be
achieved by the use of pesticides, an important
beneficial input to agriculture and public health.
At least one million people each year are poisoned
by pesticides particularly agricultural workers and
their families due to misuse of pesticidesY.
In Malaysia, use of pesticides in public health
programmes are controlled by the Vector-Borne
Diseases Control Department of the Ministry of
Health Tn 1986, 44,145 clinical caws of malaria
occurred with 67 fatalities and increased to 65,283
cases in 1989 with 62 deaths due to cerebral
malaria. Filariasis accounted for 906 cases in 1986
but reduced to 659 cases in 1989. It is estimated
that some 150 million clinical cases of malaria
occur yearly in the developing countries,
schistosomiasis and filariasis each affect about 250
million peoplc mnually3. Hcncc pcsticidcs arc
essential for the control of the vectors of both these
diseases4.
Material and methods
Th1-oughout the wu~ldthe 111aju1ity of he w o ~ k
force is engaged in agriculture5 where pesticides
are extensively used6. In Malaysia, pesticides
continue to play an important role in the agriculture
sector, which employs about one-third of the total
labour force in the country. The plantation sector
alone employs more than 300,000 workers. Each
year 6.8 billion litres of diluted pesticides solution
are sprayed7. 'lhe average annual increase in
pesticide usage is between 15 to 18%'.
This paper aims to study the incidence of acute
pesticide poisoning in Negeri Sembilan for a 4-year
period, with respect to demography and related
variables of the victims, whether suicidal,
homicidal, accidental or occupational poisoning.
gathered from the Record Office of the Data were
Director of Medical and Health Services Negeri
Sembilan in Seremban by identifying all acute
pesticide poisoning cases admitted to the Medical
Wards and Paediatric Wards of Seremban Hospital
and to the four hospitals in the districts in Negeri
Sembilan for a 4-year period.
A common criteria for pesticide poisonings were
dctcrmincd:
Diagnosis obtained from case records.
(i)
Positive test for paraquat in urine, gastric
(ii)
lavage sample.
in gasuic
Posilive lvr urga~~uphuspl~orus
lavage specimens.
(iii)
History of specific type of poisoning,
identification of bottles or container or
poison brought by relatives.
(iv)
Classical clinical features:
Paraquat - mouth ulcers, jaundice, renal
and lung impairment.
Organophosphorus - pin-point pupils,
excessive salivation, muscle twitching and
abdominal pain.
Further data on the reasons for the poisonings were
extracted from the patients' case notes.
The data were analysed in relation to ethnic
distribution, sex, cause of poisonings (whether
suicidal, homicidal, occupational or nonoccupational accidental cases), the types of
pesticides commonly involved in hospital
admissions, and occupation of the patients.
Analysis of ale cause of poisoning showed suicide
and accidental exposure were the two most
common causes of poisoning (Fig.7). In the 3d
year, there appeared a substantial increase in the
number of cases of suicide.
During the 4-year period of study, the various
occupations of the victims of pesticide poisoning is
shown in Table 1. l'he rubber tapper1 estate
worker-occupation group (20.6%) together with the
student group (17.6%) account for 38.2% of cases.
Poisoning was least frequent in the armylpolice
group (0.6%). Twenty-five clinical records did not
indicate the occupation of the patient.
Result
DISCUSSION
Analysis of the data for the 4-year period indicate
the incidence of poisoning in five health districts in
Negeri Sembilan as shown in Fig. 1. Seremban and
Knala PilahIJempol health districts had higher rates
in the 4" year. The incidence rate for ethnic group
(Fig.2) was highest in Indians with 95 cases per
100,000 population in the 3rdyear, followed by the
Chinese 9 cases per 100,000 population in the ISt
year and 31d year, while for Malays it was 6 cases
per 100,000 population in the 4thyear.
Similarly, the morbidity rate for males being 26
cases per 100,000 population in the 3'* year was
highest (Fig.3).
The higl~estcase fatality rate of 43.38 occurred in
Seremban Hospital followed by Kuala Pilah
Hospital with 41.2%. The lowest case fatality rate
for the same period was in Jelebu Hospital with
16.7%(Fig.4).
The type of pesticide responsible for poisoning is
shown in Fig.5. 17.4% of the clinical records had
no information as to the name or type of pesticide.
Paraquat with 299 cases (59.8%) was responsible
for most of the poisonings, that appeared to be
lower in the 4" year than in the 3'* year, although
cases increased from 1"' to Yd year. 66 cases
(13.2%) of organophosphorus poisoning occurred,
majority in the 4" year. Glyphosate poisoning
accounted for 32 cases (6.4%) while
organochlorine compounds constituted 1.2% of the
poisonings. Chlorophenoxy herbicides and
carbamates each accounted for 5 cases (1%) of
poisoning.
The case fatality rate was highest (61.2%) among
patients poisoned by paraquat and was 5.7% in
those patients for whom no information as regards
the type of pesticide was available (Fig.6).
This present study was an attempt to study the
incidence of pesticide poisoning based on the data
gathered from the Record Office of the Director of
Medical and Health Services. On analysis, it was
seen that there were 500 pesticide poisoning cases
admitted to the five hospitals in Negeri Sembilan
for the 4-year period.
On observation of the individual years (Fig. 1) there
appeared an increase in incidence rate in Seremban
and TampidRembau health districts while it
decreased in Port Dickson and Jelebu districts. But
in Kuala PilahlJempol district there was a
substantial increase in the 31d year similar to
Seremban and TampiniRembau but an equal
decline in the 4" year.
The increase could be attributed to the opening up
of new Felda land schemes and expansion of thc
existing rubber and oil palm estates, together with
the increased agriculture based industry. This
expansion has increased the agriculture worker
population and therefore extensive pesticide usage.
Such areas clearly require urgent and priority
action to minimize the extent of the problem.
-
-
The decline m the morbldlty rate in Kuala
PilahIJempol in the 4" year could be attributed to
the "Safety Campaign" in pesticide usage launched
by the State Agriculture Department since Kuala
PilahlJempol and TampinIRembau districts have
the largest number of land schemes and more than
80% and 100% respectively of rural population.
The general decline in incidence rate in Port
Dickson and Jelebu Districts could be attributed to
patients by-passing their hospitals and going to
Seremban Hospital for supportive therapy
particularly in poisoning cases.
The Indians have an extremely high morbidity rate
(Fig.2) although constituting only 16.8% of the
total population in Negeri Sembilan as compared to
the contrasting Inw morbidity rate in Chinese, who
form 35.8% of the total population in the state.
This conforms to the several studies done in
~ a l a ~ s i a which
" ~ ~ observed that Indians formed
the predominant racial group and main work-forcc
in rubber and oil palm estates, where paraquat and
organophosphorus compounds are extensively used
repectively13. Poisoning can be common among
Indians working in cstates or their relatives with
the easy availability of pesticides especially
paraquat.
The incidcnct: rak among [he Malays was
comparatively low although they formed 47.1% of
the total population in Negeri Sembilan going in
line with similar findings observed in previous
studies10914.
This could be due to Islamic teachings,
which prohibits suicide, but why a gradual increase
could not be explained.
'Ihe morbidity rate in females gradually increased,
but in males the incidence rate declined slightly in
the 2"d and 4& year although a substantial increase
appeared in the 3"' year (Fig.3). In recent years
serious poisoning are more commonly associated
with males. A similar finding was noted by the
National Poisons Information Service, London,
which found an increased association with the
males15.
Among the hospital admissions, Seremban and
Kuala PilahIJempol districts had higher case
fatality rates while TampidRembau had a lower
case fatality rate (Fig.4), although the hospitals and
staff in these districts are better equipped to
manage the freqnent cases of pesticide poisoning.
This is probably because Seremban Hospital is the
only referral hospital in the state and there is a
spillover of patients from Rembau District, which
does not have a hospital. Furthermore patients
prefer to by-pass the hospitals in the districts and
seek immediate supportive therapy in Seremban
Hospital. Another contributing factor is the
problcrn of transport for these patients, who come
from distant rural areas and being admitted into the
hospital late and thus delayed supportive therapy is
instituted causing a high fatality rate.
Similarly, in Kuala Pilah Hospital, there is a
spillover of patients from Jempol district, the
largest district in the state without a hospital.
Poisoning cases here have a similar problem of
transport to the hospital considering the district's
vastness and the largest number of land schemes
being located here. Thus, late hospital admission
combined with delayed supportive therapy can
contribute to the high fatality rate.
In
TampinIRembau Health district, patients prefer to
go to the neighboring Melaka Hospital, thus the
Tampin Hospital bed occupancy rate is lower and
so better care is provided by the hospital and staff
to thcsc acutc cascs, thus a lowcr casc fatality ratc.
Paraquat poisoning accounted for 299 cases
(59.8%) (Fig.5) with a high case fatality rate of
61.2% (Fig.@, thus confil-rr~irlg~ht:findiug ul: Fuck
(1987)16. Reports and studies done locally have
also shown a high fatality rate for paraquat
poisoning'0"2. In this study it is possibly due to the
large quantities ingested with a suicidal intent.
Glyphosate, carbamates and organochlorine
compounds proved non-fatal confirming the
information given by hemi info".
The high case fatality rate for chlorophenoxy
herbicides and a case fatality rate of 5.7 % (Fig.6)
for patients whose clinical records did not show the
type of pesticide, indicates problems of therapy
when the physician is unable to classify the
pesticide and thus institute appropriate therapy.
It was observed that suicides were the commonest
cause of poisoning (70%) while accidental and
occupational exposure constituted 29.4% (Fig.7).
Amarasingham and Ti (1976) observed a similar
pattern where almost 82% of all cases of poisoning
admitted to hospitals were attempted suicide^'^.
Suicidal poisoning was due to quarrels, failure in
examinations and love affairs and ine employment
while accidental poisoning (20.4%) was mainly due
to mistaking pesticides for coffee or coca-cola,
accidental spillage and unsatisfactory and careless
storage.
Occupational-related poisoning (9%)
occurred due to faulty equipments, accidental
spillage or splashing and failure to use protective
devices.
All cases of pesticide poisoning could be analyzed
under 14 groups of occupations (Table 1). The
work force belonging to the agricultural sector
co~lstitutedappluximately 25% of the cases. Thest:
agricultural workers had an easy access to
pesticides because of the nature of their work and
easy availability of pesticides in their workplace18.
By decanting pesticides into containers, they
created a vulnerability to pesticide poisoning for
their family members and relatives". They were
also vulnerable to accidental or occupational
poisoning.
IMR Quarterly Bulletin No. 5 1/52: JulylOct.2002
The student-group (17.6%), the unemployed
(15%), the housewife (14.8%) and the labourergroup (12%) were also vulnerable to pesticide
puisu~iiugby nature or Lheir residence in estates
and the easy availability of pesticides. Ingestion of
pesticides for suicidal attempts was common in
students, housewives and the unemployed.
Accidental poisoning did occur sometimes in all
these groups.
Conclusion
In this study it has been established that acute
pesticide poisoning is a problem in Negeri
Sembilan as demonstrated by the increasing
number of cases. Although suicide was the leading
cause of acute pesticide poisoning, yet the number
of accidental and occupational cases too have also
risen. The number of hospital admissions have
been used as a measure of the problem, but, in
reality the true incidence of acute pesticide
poisoning must be far in excess of this number.
The main efforts to reduce the number of acute
pesticide poisonings, must centre around educating
the population at risk. Now our concern is to
prevent or minimize the hazards resulting from
pesticide usage and it is possible to reduce the
number of cases of acute pesticide poisoning by
proper
administration, supervision, health
cducation, safety observation, tighter legislatiuu
and enforcement. All concerned have vital roles to
play in reducing these incidences
References
1.
2.
3.
4.
5.
WHO. Our Planet our Health. Geneva:
WHO, 1989.
Ebert F, Harbison KD, Zenz C.
Occupational
Health
Aspects
of
Pesticides:
Clinical and Hygienic
Principles. In: Zenz C, ed. Occupational
Medicine: Principles and Practical
Applications. 2nded. Chicago: Year Book
Medical Publishers, Inc, 1988: 662-700.
Jeyaratnam J, De Alwis Seneniratne RS,
Copplestone JF. Survey of Pesticide
Poisoning in Sri Lanka. Bull WHO 1982;
60: 615 - 619.
The Department of Vector-Borne Diseases
Control, Ministry of Health, Malaysia.
Personal Communication.
WHO. Sixth report on the World Health
Situation 1973 - 1977, part one: global
analysis. Geneva: WHO, 1980: 147 - 148.
WHO. Informal Consultation on Planning
Strategy for the Prevention of Pesticide
Poisoning. Geneva, 25-29 November
1985.
The Department of Agriculture, Malaysia.
Personal Communication.
Mahathevan R. Pesticides Hazards in the
Tropics. In: Karik K, Lauri S, Matti T,
Suvi L, eds. Proceedings of the Regional
ILO-Finnish Symposium On Occupational
Health and Safety in East Africa.
Marangu, Tanzania 24 - 28 November
1986: 31 -41.
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Chemical Safety (IPCS). Brochure.
Chan KW, Cheong Izham KS. Paraquat
Poisoning:
A
Clinical
and
Epidemiological review of 30 cases. Med
J Malaysia 1982: 37: 227 - 230.
Wong KT, Ng TS. Paraquat Poisoning.
The Family Practitioner 1982: 5: 35 - 36.
Wong KT, Ng TS. Alleged Paraquat
Poisoning in Perak. Med J Malaysia 1984:
39: 52 - 55.
Ramasamy S, Nursiah MTA. A Survey of
Pesticide Use and Associated Incidences
of Poisoning n Peninsular Malaysia. J P1.
Prot Tropics 1988: 5: 1 - 9.
Tsoi WF, Kok LP. Self Poisoning in
Singapore. Main causative factors. Sing
Mccl J 1981: 22: 284 - 286
Lesley JO, Volan GN. The Epidemiology
and Prevention of Paraquat Poisoning.
Human Toxicology 1987; 6: 19 - 29.
Fock KM. Clinical
Features and
Prognosis of Paraquat Poisoning: A .
Review of 27 cases. Sing Med J 1987; 28:
53-56.
Canadian Centre for Occupational Health
and Safety. Glyphosate (record number
375). Cheminfo.
Amarasingham RD and Ti TH. A Review
of Poisoning Cases Examined by the
Department of Chemistry, Malaysia from
1968 to 1972. Med J Malaysia 1976; 30:
185 - 193.
EHRC - A Research Centre in Transition. Part 1.
Change management and expanding research paradigms in
the Institute for Medical Research (IMR), Malaysia
Dr Stephen Ambu ii, Mr James Ireland i, Mr Brent Powis iii and Mr Stephen ~ a m ~ l i n " '
Background
The First National Conference on Environmental
Health Research', was jointly sponsored, in April
1994, by the Ministry of Health (MOH) and the
Ministry of Science, Technology and Environment
(MOSTE). The meeting recommended that an
Environmental Health Research Centre (EHRC) be
established. A Task Force was formed to shape a
proposal Lhal Cabinet subsequently adopted, with
Health as the lead agency and IMR as the host
institution.
The Medical Ecology 1Jnit which had long heen in
the Service Division of IMR, was redesignated as
the EHRC in September 1996. An inter-agency
Environmental
Health
Research
Advisory
Committee was established under the chairmanship
of the Deputy Director General, Research and
Technical Services, MOH.
The starting point
IMR set out to transform the Medical Ecology Unit
into an interdisciplinary research team. EHRC was
set to emerge as a National Information 'Clearing
House' for Environmental Health Research and
was projected to ultimately have an international
role.
These evenls in Malaysia coincided with a 'New
Government Policy' (Dasar Baru) of strengthening
technical capabilities in the country. In early 1997,
EHRC qualified to broaden its scope, refurbish
laboratories and purchase equipment under t h s
policy. In April of the same year, WHO began
supporting this venture.
Making a place for EHRC in IMR
Medical Ecology arose after World War I1 from a
zoological background, with an expert team of
international scientists. The unit had studied natural
populations of small mammals, reptiles and
parasites for implications in human health. This
work was set deep in the forests of Malaysia and
was an expression of rigorous field o~iented
biological science.
Before its re-designation in 1996, Medical Ecology
had occupied a largely disused Museum building
dating back to 1928. Seven new laboratories were
refurbished and equipped after early 1997. EHRC
was taking its place in the IMR, with an
exceedingly broad and intersectoral brief. This
called for a shift towards team based
interdisciplinary and intcgrativc rcscarch. This
innovation was emerging amongst IMR peers who
were largely single discipline scientists.
The paradigms - a cunkxl fur clra~ge
In reaching for an intersectoral future, EHRC
needed to explore new paradigms of science.
'Paradigms' have to do with how people see and
work with the world around them. Shifting
paradigms generally entails profoundly unsettling
change. CoveyZhad this to say about the notion of
paradigms and people:
"Paradigms are inseparable from character. Being
is seeing in the human dimension. And what we see
is highly interrelated to what we are. We can't go
very far to change our seeing without
simultaneously changing our being and vice
versa.
"
Covey enunciated these principles for those who
would venture across paradigms:
"While individuals may look at their own lives ...
in terms of paradigms or maps emerging out of
their experience and conditioning, these maps are
not the territory ... The ... territory itself is
composed of 'lighthouse' principles that govern
hi~mnngrowth nnd h n p p i n ~ v r... The prinriples I
am referring to are ... 'fairness ... integrity and
honesty ... human dignity ... service ... quality or
excellence .., potential ... patience, nurturance and
encoarragement. "
One of the writers (Ireland) had worked as a
change agent amongst shifting paradigms since the
mid 1970s. He had been trained during the 1960s in
disciplinary science to research microbes in
particular settings. This was traditional science
requiring objectivity, controlled conditions and a
reduced number of predetermined variables to
study. This has sometimes been titled as
'the reductionist approach' to science. In this
paper, the writers prefer to respectfully term this as
'disciplinary science. ' It generally looks deeply at
parts of biophysical systems - less often broadly at
whole systems.
Environmental Health must work broadly with
wholc systcms. This is sometimes desc~ibedas 'rhe
holistic approach' to science. It entails a very
different way of looking at the world. Working
across disciplinary and holistic paradigms has
always bee11 difficult, because adherents of one
paradigm often struggle to understand the
approaches of the other. Miscommunication is
common and polarised debate often follows.
EHRC's transition to span the paradigms required
careful strategic management. Five criteria were
critical to this journey and a sixth supported the
process:
The prospect - an external support agency
(WHO) favouring change.
A simple analogy - to both differentiate and
dignify each paradigm.
A change management model - walking people
between paradigms.
People in EHRC changing - discovering new
paths with courage and fortitude.
A network - looking for mutuality with
stakeholders and collaborators.
A HRD strategy - which is written np
separately3in this issue of the EH Dialogue.
Five criteria for successful transition bv EHRC
The prospect - an external support agency
(WHO) favouring change
One of the writers (Tamplin) had a strong interest
in
promoting
'holistic'
approaches
to
environmental health in the region. The nurturing
of multidisciplinary problem-solving skills is
essential in building capacity to resolve
environmental health issues. Having supported
some of the early work of Ireland and Powis in the
Pacific, the writer was intrigued with the
possibilities. Could their approach extend across
cultures and into other settings? If so, could EHRC
sustain interest for long enough to reach maturity?
The circumstances in 1997, surroi~ndingthe EHRC
opportunity, seemed promising.
Three years later, evidence available to WHO
indicated that this initial optimism was justified.
The level oi individual and organisational shift in
EHRC had exceeded expectations. The team had
faced problems and, at times, the prospects of
failure had been very real. Interestingly, not all of
the stakeholders had always been aware of these
'problems' or 'prospects.' Some had been internal
to EHRC; a number of them had been external.
Some had been internal to Malaysia; a number of
them had been external. In almost every case, the
struggle between the two paradigms of science had
been evident.
A simple analogy - to both differentiate and
dignify each paradigm
For two decades one of the writers (Ireland) had
sought to show how the holistic paradigm of
science complemented disciplinary approaches. It
was never a case of eitherlor, it needed to be both equally valued and respected. Such dialogue had
either been by 'stoly telling ' or by 'walking people '
through experiences of a paradigm shift. The
second of these approaches was chosen with
EHRC.
By July 1999 it was time for the Centre to outline
its transition to peers in the IMR. Colleagues had
been watching EHRC emerge and needed to know
what lay behind the changes they saw. The Centre
was invited lo lun a Sirakgic Planning Workshop
with all Heads of Divisions plus invited guests.
Neither 'story telling' nor 'walking people' suited
this occasion. Pictorial analogy was chosen to
differentiate the paradigms. It was kept very
simple, in order to make the message clear. The
analogy (attributed first to C.S. Lewis4) was that of
a 'tool shed'.
Figure 1. The empty tool shed analogy in science
Figure 1 depicts an empty tool shed. The people
who are about to enter, are scientists on an
uncertain quest. This imagery is close to EHRC's
situation in September 1996, as the small team
contemplated their uncharted future in a near empty
building.
Figure 2. Looking at the beam
objective&.
- study its parts
Figure 2 depicts the scientists now inside the tool
shed with the door closed. The shed is darkened but
for a beam of light shining through a side window.
The investigators know there is a beam, because
their entry has raised dust into the air, which now
scatters the light. There is a pool of light on the
floor, with a shadow of the window frame that
remains steady. Then there are other irregularly
shaped shadows that occasionally move.
In this picture 'the beam' has become the object of
study. Our scientists are 'looking at the beam'. One
could study dust particles in the beam and
understand the dynamics of how they move and
scatter light. By looking at beams of light in this
objective way, disciplinary science has made
IMR Quarterly Bulletin No. 5 1/52: JulylOct.2002
staggering discoveries - the laser is a triumph of
such an approach.
to those of traditional disciplinary science. The
holistic paradigm is not superior or inferior to the
disciplinary paradigm it is simply different.
Notice in the analogy o t Figure 2, however, that
looking at the beam does not include standing in
the beam. That would be a quite different way of
doing science.
Bridging these paradigms has been a major change
management task. EHRC has dealt with an
expanding team, all of whom had backgrounds in
disciplinary science. Strategic planning needed to
be open, flexible, sensitive and inductive in order
to manage change.
Figure 3. Looking along the beam
inside out
- from
the
Figure 3 extends the 'tool shed' analogy to 'looking
ulong the beam.' Notice that our scientist is now
standing 'in the beam'. He has questions about
where the light is coming from and what it is doing
outside. This is a very different type of inquiry.
Good researchers always look along the beam to
find context for their work outside their
laboratories and libraries.
Our team in 'the tool shed' analogy will now notice
that 'the beam' is in fact coming from the sun.
There is a tree outside the window through which
the sun is shining. This accounts for the irregularly
shaped shadows on the floor. These shadows move
occasionally because breezes are passing through
the tree.
EHRC must always emulate Figures 2 and 3 in
doing disciplinary science. But Environmental
Health embraces much more than looking 'from the
inside out'.
Figure 4. Looking down the beam - seeing from
every angle
Figure 4 expands the scope enormously. In this
are still within 'the
fourth analugy uul scie~~lisls
beam' but now stationed in the helicopter. This
offers a new and very different perspective. For
them 'the beam' is now very broad and the
helicopter is infinitely manoeuvrable.
In Figure 4 picture our scientists can:
view 'the tnnl shed' (centre left foreground) at
the urban rural interface
rise high and take in the whole landscape looking at the big picture
l~uvzl ill any direction thus gaining multiple
perspectives of the landscape
descend to any part of the landscape to be close looking at the smaller picture
land to investigate and take samples or data back
to the tool shed for analysis.
This paradigm shift marks the broad intersectoral
perspeclive on science that characterises EHKC's
transition. It must be interdisciplinary and
integrative, and requires different intellectual tools
A change management model - walking people
between paradigms
In September 1996 one of the writers (Tamplin)
recognised the magnitude of this challenge. Having
agreed to supporl the transition, WHO advocated a
strategic planning and HRD partnership with the
WHO Collaborating Centre for Environmental
Health (WHOCCEH) at the University of Western
Sydney Hawkesbury.
A style of Strategic Questioning5had emerged from
WHO collaborative work6 in Fiji, during the early
1990s. It was a successful change management
model espousing values very close to Covey's
'light house principles'. Figure 5 illustrates the
model that was developed out of the Fiji experience
and has now provcd transfcrablc to EHRC.
Figure 5. Strategic Questioning - the ABCD
Model
Stratzgic questiuning lras guiclzcl EHRC
development in six monthly cycles since April
1997. The model works with single page outputs as
illustrated in Figure 6. The page is designed to take
the reader down the 'A' column, up the 'B'
column, down the 'C' column, across to 'D' and
then to 'E'.
Figurp 6. Tnyout nf thp Strnt~gir Qir~vtinning
output page
Answers to the 'B' question projected higher
purposes to a vision at team thinking out into the
future at six expanding levels of purpose. The
scope of this 'B' extends from the most immediate
purpose, through a hierarchy of the top of 'B'.
EHRC's hierarchy of purposes ranges 5 to 10 years
into the future and is illustrated in Figure 7 from
Cycle 7 of the strategic questioning process.
Figure 7. An example of 'B' from Cycle 7 of the
EZZRC strategic plan for mid 2000
Each of the seven strategic questioning cycles has
supported the EHRC team in using:
A. in the model - to reposition themselves among
stakeholders and collaborators.
B. in the model - to think long term and make
purpose clear as a pathway for change.
IMR Quarterly Balletin No. 5 1152: Juiy/Oct.2002
C. in the model - to plan activities flexibly for
the next cycle of moving towards 'B' .
D. in the model - to agree upon strategic
connections in order to gain benefits.
E. in the model - to predict indicators which
might show that strategies were working.
At the end of each cycle, EHRC and the
Collaborating Centre interacted with the
interagency Environmenlal Health Rcbea~ch
Advisory Committee, Malaysia. This has entailed
42 ABCD sheets, each with its action plan in the
'C'. Since April 1997, EHRC has planned a total of
118 activities ('Cs'), for which 84 outcomes hnvc
been reco~ded. More than 25 of the success
indicators outlined in 'Es' have begun to happen.
The complete set af ABCD sheets for Cycle 7 may
be viewed in ANNEX 4 of the relevant WHO
Mission Report7.
People changing in EHRC - on, new paths with
rnurage and fortitnde
EHRC began its journey in September 1996 with
one Head of Centre, two Research Officers, three
Medical Laboratory Technologists, one Junior
Tech~~ulogist,
t w u T~chnical Attendants and an
Artist. The individual Research Officers were
engaged in unconnected disciplinary research
topics.
By September 1999 the EHRC team had grown to
one Head of Centre, seven Research Officers, one
Laboratory Manager, seven Medical Laboratory
Technologists, two Junior Medical Laboratory
'Technologists,
two Technical Attendants and an Artist. Two
Research Assistants were also employed on a
temporary basis.
The three years of change had been multifaceted:
empty laboratories had been refurbished and
equipped;
the staff had undergone reorientation as an
interdisciplinary team;
EHRC had a shared vision for the future and a
new paradigm of science;
the whole team had bonded in a shared
experience of EH research;
newly arriving staff were being integrated into
this growing team.
The full story of this transillon appears m a case
study presented by the Head of EHRC in a WHO
training program in the Pacific during September
19998.
Acknowledgement of the EHRC Team:
Every member of the EHRC team
con&ibuted $0 she fransjtio~reflected here.
All are commended for their courage and
fortitude in the face nf perpetnal change The
following members of the team contributed
to the case study as narrators:
Dr Stephen Ambu9, Dr Mazrura Sahanijo,
Ms Mastura Abu Baku", Dr. Surnilru
Sithnmpamm12, Dr {yjen Benedictr3.
Ms S. Asmaliza Ismailfd, Ms Nurul I z a h
Ahmadj5, Ms Yit Yok NeongJ6, Ms Ushn
Devil:
Following are quotations from the Case Study,
which i2lustra&ehow Stmtq$e Questior~irrgworked
within the team. For a fuller account, a copy of the
Case Study may be requested from EHKC
Narrations by the head of EHRC
" I defer~miin~d
that Strategic Questionitzg must
involve the whole team. I wanted every one to have
a sense of belonging - research strcrtqies musf
emerge from the team. I wanted to engage every
one to the $dl extent of their capabiliv. My dream
was to have creative ideas conling 'bottom up'
from all the team members."
"Our past experience took on new meaning. It
[ABCDI gave us a way to redesign oi~goirzg
activities before we reached for new gwls and
objectives. We could focus on this new meaning
and extract valuable inforinntion. It gave us
freedom to npply thic. fn TWRC for 'rhe now' and
'the future'. The team grew in confideilce and
began speaking up as never before."
"This strategic plan was resource based because it
guided the way in which WHO auppul t ur$ufulJed.
Refining the 'B' was a dynamic process. Action
plans and strategic corznections were outlined in
the 'Cs'azd 'Ds' c s f ~ model
h~
D~sir~
OUtCiR'S
d
were projected in the 'Es'. Sta$f strcngthcning and
capacity building featured strongly."
"The purposes in 'B' were not flxed, neither were
they force driven. They were induced! The shifts
were information based, respondzag to curreirt and
emerging issues. The chalzges came naturally as
part of the cycle review. Targets were chnngi~zgin
real time!"
By early 1998 the team had seen opportunities
opening up, overseas experience had begun,
confidence and enthusiasm were growing am' we
had ~ ~ n f v c ha e' Nate crisis. TTPle tenin presented
well in the 1998 EH Forrim. But the experience
brought us down to earth. Some feedback was
IMR Quarterly Bulletin No. 5 1/52: JulyIOct.2002
encuuruging Dul sume peers wer-e criricul. The
audience comprised other government agencies
and laboratories. They told us we were
'reinventing the wheel!'
It was like looking in the mirror! We began to see
ourselves in context and knew we had a long way
to go. We knew we must develop the skill of
r~rpondingpnritiv~ly to rritirirm WP rtnrt~dhy
reshaping our purposes in 'B', to get in line with
national objectives. We had been over-confident in
Cycle 3(early 98), we took a knock in Cycle 4(late
98) and discovered who we truly were in Cycle 5
(early 99). The team came out of this experience
with a more mature outlook."
Narrations by foundation members of the team
1. Strategic Questioning (ABCD) began
"We heard that we were about to become part of
this new research centre. We looked to Dr Stephen
for guidance and support. He was our lifeline! We
were apprehensive because we lacked background
in EH and we were each single discipline based.
We had no answers, only questions: What do we do
with such lack of knowledge? How do we start?
Where do we go? What do we do to start
changing? How do we do it?"
"This was a transition for us - multidisciplinary to
interdisciplinary to interaction. We were learning
as we faced challenges. Independence changed to
interdependence; competence grew and confidence
came. We each managed ourselves as parts of the
team.
"
'our place' - we had a sense of belonging and
growing pride in that. The words we found for 'A'
gave us a strong sense of identity.
This was ours, we felt ownership and we wanted to
project EHRC into the future. Answering - 'A.
Where are we now?' - was a way of positioning
ourselves. We could make a stab at what might be
the way forward but also mention our limitations
and restrictions."
4. Answering the 'B' question - A six level
hierarchy of purposes looking out 5 - 10 years
"This was a hard time - getting the words - trying
to explain, yet having feelings of fear and
uncertainty. Could we achieve especially the top
part? The 'B' set our future direction. It was our
checklist and a guide for us. We had targets and
standards to achieve. It identified what we were.
Dr Srephen called it his 'road map' but for us it
was more. Each of the levels of the 'B' were linked
by the words 'Because we want to:' All of us
agreed to it! "
5. Interdisciplinary team work began - our
immediate purpose at the bottom of the 'B'
"Team work in the Semenyih Catchment was our
reality check. Some peers outside EHRC were
surprised to see us working on so many fronts in
one project. We had our ups and downs both as
individuals and as a team. We were all in a
learning process. We discovered that it was OK to
ask for help, to reach out, to admit mistakes - to
say sorry. Honesty became important. I f its not
working say so! I f its not done correctly say so!"
2. Mind mapping with the team
"Our first session brought about mind mapping. It
was a revelation to us! We could see the thoughts
of other people in the group - some had similarities
while others were opposing. As we worked with it,
connections grew. This was the beginnings of
'bonding'.
As individuals we were opening up ourselves and
exploring each other's needs. It was like 'guts
coming up'! We began to think of ourselves less this was part of our bonding. Our confidence grew
both individually and as a group. We were
becoming a team."
6. The haze crisis
"EHRC was just one year old when the haze crisis
struck (late 97). We were starting Cycle 2 of our
strategic plan and felt very unready.. . This brought
n r~nlirntinnthat W P nwded to define our role. It
was a blessing in disguise - without it we might not
have organised ourselves. It was a lesson to us."
7. A major paradigm shift
3. Answering the 'A' question - positioning
ourselves in the now
"We started with nothing in September 1996. There
were no facilities, no labs and we couldn't imagine
what the future held. Our worst nzonzents were
facing the unknown. For every challenge we were
starting something new. Sometimes it was hard to
see the direction... "
"Our mind mapping conversations were the
leading edge of change. EHRC began to feel like
"For some of us the big ideas were frightening especially the top of the 'B'(5 years out)! But
sonzelzow it also made things cleamt; We hud 10
deal with the worry - 'Can I cope?' And then just
follow the group until better feelings came and we
wanted to play our role, serve and get research
resulls. "
-
A network looking for mutuality with
stakeholders and collaborators
The support outlined above has enabled the EHRC
to make its transition from Medical Ecology to a
broad intersectoral and interdisciplinary research
team. The central theme of this transition has been
outward looking towards stakeholders and clients
in Health and other sectors of government industry
and community. EHRC is now functioning as a
Virtual Institute engaged in intcrscctoral rcscarch
activities, with the full support of the
Environmental
Health
Research
Advisory
Committee. By September 1999, stakeholders and
Networking
with
Non-Government
Organisations
Institute of strategies and International Studies
(ISIS)
Environmental Consulting Firms (ASMA, 'I'N J3,
MINCONSULT & GMP)
SUKOM
International Networking
World Health Organization
University of Western Sydney Hawkesbury
University of New South Wales
New South Wales Health Department
Fiji School of Medicine
Centre for Disease Control, Atlanta
Uuive~silyo l C o l u ~ ~ ~ b
011Cuio.
ia,
Conclusions
clients included the following.
Networking Within Health
IMR Interdivisional collaborators
Engineering
Environmental Health Unit
Public Health Institute
Food Safety Division
Occupational Health and Safety Unit
Networking Government
Health
*
Agencies
outside
Che~llist~y
Deparlmer~l
Meteorological Department
Economic Planning Unit
Department of Environment
Department of Occupational Health and Safety
Veterinary Department
Ministry of Agriculture
Ministry of
Science, Technology and
Environment
Several Malaysian Universities (UPM, UKM,
UM, USM)
This Strategic Questioning locates people where
they are at the beginning of the cycle, then offers
them major challenges, while supporting them as
they make their moves. 'l'he future is charted by
clear and unambiguous purpose statements, which
carry forward and are refined from cycle to cycle.
There is always scope to adjust these purposes in
the light of organisational learning (see 'EHRC - A
Research Centre in Transition. Part 2' which
follows this paper). Learning in this mode is always
inductive and grounded in real time. Environmental
management for health demands a culture of
organisational learning.
IMR Quarterly Bulletin No.51/52: JulyKlct.2lIl2
FiPare 7. An example d 'B' from Cyde 7 dthc EHRC strategic pho formid 2WO
IMR Quarterly Bulletin No. 51/52: JulyIOct.2002
EHRC - A Research Centre in Transition. Part 2.
Human Resource Development and expanding research paradigms in
the Institute for Medical Research (ZMR), Malaysia
...
...
Dr Stephen Arlbu ii, Mr James Ireland "I, Mr Brent Powis and Mr Stephen Tamplin "'
Introduction
Strategic planning within the Environmental Health
Research Centre (EHRC) has entailed a partnership
hetween the Centre and the WHO Collaborating
Centre for Environmental Health (WHOCCEH)
from the University of Western Sydney,
Hawkesbury Campus.
The nature of this partnership is outlined in the
preceding paper (EHRC - A research Centre in
Transition. Part 1). The need for a Human
Resource Development (HRD) strategy was
apparent from the first visit. This was woven into
Cycle 1 of the Strategic Questioning process and
planning began immediately.
A HRD strategy - to broaden thinking and
ground it in local experience
As one of the facilitators of this partnership, the
writer (Powis) was guided by both the philosophy
and experience of Senge (1990)' and Lessem
(1993)2. They advocate the need for organisations
deallng with complexity and change to become
'Learning Organisations.'
Peter Senge in his book 'The Fifth Discipline'
describes the five new 'component technologics'
which are converging to build organisations that
can learn. These will be the leaders of the future
who can manage change and continually enhance
thcir capacity to achicve.
In summarv the five include:
Personal Mastery - this is the organisation's
spiritual foundation where people are able to
realise the results that matter most to them.
Mental Models - these are entrenched
assumptions and images that effect the way we
see the world and how we take action.
Building shared vision - this involves the skills
of unearthing shared pictures that foster genuine
commitment.
Team Learning - this builds on the concept of
personal mastery and shared vision, via people
learning how to learn together. Within
organisations there is a need to master the art of
dialogue and discussion.
Systems Thinking - this is described by Senge
as the fifth discipline, fusing all five into a
coherent body of theory and practice. A systemic
worldview can result in change being driven at
all levels aligning people with a common
understanding of how the system works.
The EHRC staff recognised the need for a cultural
change within their organisation, one that
supported l l ~ e i ~tmusfu~~~ralion
fioin p w l y a
scientific research group to one that also embraced
holism. As identified by Senge this change can be
achieved by improving people's skills and
capabilities. This must produce new understanding
and awareness, resulting in shifts in attitudes and
beliefs.
To do this EHRC needed what Senge refers to as
'organisational architecture'. This includes a set of
theory, methods and tools which when used
together produce actionable knowledge. There
must also be an infrastructure incorporating staff
who are skilled in the use of those tools (Senge et
a1 1994)3. The path towards EHRC becoming a
learning organisation began with the 'shared
vision' which has been unfoldcd in Part 1 of this
account. This vision was then linked strongly to the
need to develop 'personal mastery' in those areas
identified as focal for EHRC action.
The development of the 'individual' while
maintaining and developing the 'whole team'
began with the selection of two priority
environmental health issues:
water pollution, treatment and health; and the
the impact of the haze on health.
These were issues and settings, which posed
immediate policy dilemmas for government,
requiring urgent research. The skills of the staff and
the profile of the staffing of the Centre were
reviewed using the ABCD model in the context of
these issues.
The HRD strategy that emerged as part of this
process, began with a group of research and
technical staff from EHRC spending one month at
the Collaborating Centre to improve their skills in
areas related the these two topics. Individuals were
counselled to determine their personal vision and
were then invited to link this to the emerging vision
of their team.
This initial development activity has been followed
by a series of training events:
training of all the staff at the Centre using
selected experts drawn from a range of
environmental health fields; and
a six month distance learning program in
environmental health research,
The distance learning program included Lwo one
week workshops facilitated by external experts.
There was a strong emphasis on all of the staff
developing a deep understanding of the holistic
nature of environmental health, and then exploring
the multiplicity of research methods available.
As the staff gained increasing confidence, several
indicated an interest in gaining higher research
qualifications. Currently four Research Officers are
undertaking research degrees in areas they have
chosen to develop their individual mastery.
Transfer of the skills in strategic management has
been the focus of considerable training of all the
staff and in particular the Head of the Centre. This
training has been constructed as part of the ongoing
daily activities of the staff. Staff are now familiar
and competent in using a range of change
management tools including the ABCD model, use
of mindmapping and metaphor and the
4P-change management model described by
Professor Valerie A Brown A04.
The human resource development approach
adopted by the Centre and supported by WHO is an
integral part of the change process. The concept of
a 'LearningOrganisation', which has been outlined
above, is captured in Figure 8. It is built on the
pillars of change in the Centre's values and vision.
At the same time new problem solving tools have
been tested and important issues regarding
organisational culture and systems have been
addressed. The model has been driven by plan
development with a dual focus on learning and
participation. This process is emergent in nature
and continuous in the ABCD Cycles described in
Part 1 of this account
Conclusion
This has been a bottom-up approach to change, in
which the EHRC team are all providing important
leadership and building strong ownership of the
change process. We now have a very different kind
of 'tool shed' to the one in Figure 1, Part 1 of this
account. Tt is open on all sides, so that people can
come and go.
The 'tool shed' is supporlcd by pillars (values5 and
vision6)rather than being bounded by 'brick walls'.
Disciplinary research is still practiced by some
members of the EHRC team. They identify with
Figure 3 in Part 1 of this account, so are finding
ways to 'look along the beam'.
Others in the EHRC team have embraced the
holistic paradigm and are learning to look down the
beam as in Part 1, Figure 4 of this account. This is
a very new research experience that entails
organisational
learning.
It uscs different tools to engage with stakeholders
in what is called action research. The data which
action research produces is sometimes quantitative
but more often qualitative.
Action research outcomes sometimes take longer to
achieve and often emerge as new organisational
models that are then applied and validated in real
life situations. Such models are destined to be the
machinery which will enable EHRC to express its
vision as outlined by Figure 7 in Part 1 of this
account.
EHKC is moving it towards a time when its vision
will:
'Equip Malaysia to be a steering force to
promote change in managing the environment
for health in the Asia Pacific.'
This vision is bold and the way is unchartered, so
EHRC is still discovering how to function as a
lcarning organization. Observers who are
accustomed to the ordered world of disciplinary
research will need to exercise patience as they wait
for this vision to take shape.
Figure 8 :A Learning Organisation approach to HRD in EHRC
PUBLISHED
ABSTRACTS
MOLECULAR FINGERPRINTING OF FUSIDIC ACID AND RIFAMPICIN-RESISTANT
STRAINS OF METHICILLIN-RESISTANTSTAPHYLOCOCCUS AUREUS (MRSA)
PROM MALAYSIAN HOSPITALS
A. Norazah, V. K. E. Lim, Y. T. Koh, M. Y. Rohani, H. Zuridah*, K. Spencer,
P. P. Ng and A. G. M. Kamel.
J. Med. Microbiology. Vol. 51 2002, p 1113-11 16
Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research,
Jalan Pahang, 50588 Kuala Lumpur,
* Hospital Umum Sarawak, Jalan Tun Abang Haji Openg,
93590 Kuching, Sarawak,
Hospital Queen Elizabeth. Jalan Mat Salleh.
88590 Kota Kinabalu, Sabah,
Hospital Alor Setar, Jalan Sultan Badlishah,
05.590 Alor Setar, Kedah and
Faculty of Allied Health Sciences, National University of Malaysia,
Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
Abstract
The emergence and spread of multiresistant methicillin-resistant Staphylococcus aureus (MRSA) strains,
especially those resistant to fusidic acid and rifampicin, in Malaysian hospitals is of concern. In this study
DNA fingerprinting by PFGE was performed on fusidic acid and rifampicin-resistant isolates from
Malaysian hospitals to determine the genetic relatedness of these isolates and their relationship with the
endemic MRSA strains. In all, 32 of 640 MRSA isolated from 9 Malaysian hospitals were resistant to
fusidic acid and rifampicin. Seven PFGE types (A, ZC, ZI, ZJ, ZK, ZL and ZM) were observed. The
comrnoncst typc was typc ZC, sccn in 72% of isolatcs followed by typc A, sccn in 13%. Each of thc othcr
type was type (ZI, ZJ, ZK, ZL and ZM) was observed in a single isolate. Each type, even the commonest,
was found in only one hospital. This suggests that the resistant strains had arisen from individual MRSA
strains in each hospital and not as a result of the transmission of a common clone.
THE SCREENING OF EXTRACTS FROM GONZOTHALAMUS SCORTECHZNIZ,
ARALZDZUM PZNNATZFZDUM AND ANDROGRAPHZS PANZCULATA FOR ANTI-MALARIAL
ACTTVTTY IJSINGTHE LACTATE DEHYDROGENASE ASSAY
M. J. Siti Najila, A. Noor Rain, A. G. Mohamad Kamel, S. I. Syed Zahir,
S. Khozirah, S. Lokman Hakim, I. Zakiah, A. K. Azizol.
Journal of Ethnopharmacology vol. 82 ,2002 , p. 239-242
Herbal Medicine Research Centre, Institute for Medical Research, Jalan Pahang,
50588 Kuala Lumpur, Malavsia.
Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aiiz,
Kuala Lumpur. Malaysia.
Infectious Disease Research Centre, Institute for Medical Research, Jalan Pahang,
50588 Kuala Lunzpur, Malaysia.
Forest Institute Research Malaysia, Kepong , Kuala Lumpur, Malaysia.
Abstract
Goniothalanzus scortechinii, Andrographis ~aniculataand Aralidium pinnatiJidunz were selected for the
study based on their ethnomedicinal values. They were screened tor anti-malarial activity towards
Plasmodium falciparum in vitro using the lactate dehydrogenase (LDH) assay. The crude extract of G.
scortechinii exhibited the most potent schizonticidal activity compared to the other extracts. It is effective
against both the chloroquine resistant isolate. Gombak A and the sensitive strain, D l 0 of Plasmodium
falciparum. Futhermore a better IC value was obtained against the resistant strain, (9 uglml) compared to
the sensitive strain, 40 uglml. When the crude extract was fractionated into 3 fractions, the chloroform
fraction yielded the best activity. exhibiting equipotency against both strains of parasite used; IC of 23.53
ug/ml against Gombalc A and 21.06 ug/ml against D10.
Keywords: Plasmodium falciparum; In vitro anti-malarial activity; Medicinal plants. Lactate
dehydrogenase assay.
REGIONAL STUDY OF NUTRITIONAL STATUS OF URBAN PRIMARY
SCHOOL CHILDREN. 3. KUALA LUMPUR, MA1,AYSTA.
E-Siong Tee, Swan-Choo Khor, Hoon-Eng Ooi, Swee-Ing Young,
Omar Zakiyah, and Hamzah Zulkafli.
Food and Nutrition Bulletin, vol. 23, no. 1 2002.
Abstract
A total of 5,995 children (7.8% of all 7- to 10-year-old primary school children in Kuala Lumpur),
randomly selected from 166 schools (97.6% of all schools), were measured for their weight height. The
analyses of all weqight height data, inch~dingthe cutoffs used for defining stunting, underweight. and
wasting and for thinness and over weight, were carried out as recommended by the World Health
Organization (WHO). The prevalences of stunting (height-for-age Z score < -2 SD), underweight (weightfor-age Z score < -2 SD) and wasting (weight-for-height Z score <-2 SD) among all the children studied
were 6.776, &. 1%, and 4.5%, respectively. Undelmutrition among boys was morc scrious than among girls
according to all three indicators. Because it was not possible to analyze the weight-for-height data for most
of the children above 8.5 years of age, body mass index (BM1)-for-age was used to determine the
prevalences of thinness and overweight for all children. Based on the reference data, the prevalence of
overweight (at or above the 95*' percentile) was 9.7% and '7.1% for boys and girls, respectively, and 8.4Yo
overall.
THE ROLE OF VIROLOGICAL SURVEILLANCE OF DENGUE SEROTYPES
FOR THE PREDICTION OF DENGUE OUTBREAK
Ravindran Thayan, Mangalam Sinniah, Fatimah Sonkerim,
Satwant Singh and Mohamad Taha Arif
Tlupical Biumeclicirie. Vul. 18. no.2 , p. 109 - 116, Dcc. 2001
Division of Virology, Institute for Medical Research, Kuala Lumpur, Malaysia.
Vector-Bonze Disease Control Unit, Ministry o f Health, Malaysia.
Director-General o f Health, Ministry of Health, Maluysia.
Abstract
Dengue infections are major public health problems in Malaysia. One of the important roles in the
pathogenesis of dengue is the involvement of virus factors whereby some serotypes or genotypes are
associated with an increased ability to cause infection. Thus it is important to conduct virological
surveillance of the dengue scluLype cvr~huosly.Reverse-iranscrip~dse pulymerase clrairl reacliun was
carried out on acute serum samples received from suspected dengue patients. The results revealed that
dengue 3 serotype has replaced dengue 2 serotype as the predominating serotype for the year 2001. This is
the most likely reason for the drastic increase in dengue cases. Hence, the development of a proactive
laboratory-based surveillance system is an important mode to provide an early warning of an impending
dengue fever epidemics. Such information will enable preventive measures to be carried out and enhances
the preparedness of various agencies.
INCREASED LEVELS OF INTEIWEUKIN-10 REFLECT DISEASE ACTIVITY IN PATIENTS
WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Azizah M.R. Ainol S.S., Kuak S.H., Kong, N.C.T.,
Normaznah Y. and Rahim M.N
Tropical Biomedicine. Vol. 18, no. 2, p. 131-136, Dec. 2001
Biotechnologv Centre, Institute for Medical Research, Kuala Lumpur, Malaysia.
Hospital Penang, Penmzg, Malaysia.
Faculty of Medicine, Hospital Unuversiti Kebangsaan Malaysia, Cheras, Selangor, Malaysia.
De,vurfrneni of Bio-Medicine, Faculty of Allied Sciences, Universiti Kebangsaan Mul~zysia,
Kuala Luinpur, Malaysia.
Abstract
The concentration of serum interleukin 10 (IL10) was determined in the serum of 134 Malaysian patients
with SLE attending the SLE Clinic of the Malaysia National University Hospital of Kuala Lumpur. Serum
IT 10 was measured by a commercial enzyme-linked immunosorbent assay (ELISA). We found a
significantly increased level of serum ILlO among the SLE patients as compared to the controls
(meanksem: 19.4+1.4pg/ml vs 5.9+).3pg/ml, p<0.05). Levels of ILlO was also significantly different in the
active compared to the inactive group (21+1.5pglml vs 8.51+1.0pg/ml) but no significant difference was
seer1 between lhe irractive versus the normal controls (8.5+1.0pg/ml vs 5.9+0.3pg/ml). Serum levels UP
ILlO correlated well with disease activity. We found a significant correlation of levels of ILlO with
fatigue, rash and joint affection, neurologic, renal and hematologic involvements (p<0.05). There was also
a significant positive correlation with levels of anti-ds DNA antibodies, and negative correlation with
complement C3 and C4. From this data we suggest that aside from the usual laboratory parameters in the
monitoring of patients with SLE, concentration of ILlO may serve as a new useful serologic indicator of
disease activity.
SEROPREVALENCE OF LEISHMANIASIS AMONG BANGLADESHI IMMIGRANT
WORKERS IN CAMERON HIGHLANDS, MALAYSIA
Abdul Halim A., Lokman Hakim S. ,Norashikin M., Yusri M. Y.,
Ahmad Dasuki A. G., Chong C. K. and Thangam R.
Tropical Biomedicine. Vol. 18, no. 2, p. 143-144, Dec. 2001
Parasitology Unit, Infectious Diseases Research Center, Institute for Medical Research,
Jalan Pahang 50588 Kuala Lumpur.
Cameron Highlands Health Ofice, Tanah Raja, Pahang, Malaysia.
Abstract
The main objective of this study was determine the seroprevalence of leishmaniasis among Bangladeshi
immigrant workers. Finger prick bloods were collected from Bharat Tea Plantation workers in Cameron
Highlands. Serum samples were analysed for anti-Leishmania antibody using Melotest Leishmaniasis Ab
ELISA kit (MELOTEC Biotechnology). Venous blood samples were also taken from those with
significant raised antibody titre for microscopic examination, culture and Polymerase Chain Reaction for
leishmaniasis. Out of 72 specimens analysed, 22.2% (0.D ratio 2 1.1) showed evidence of exposure to
Leislzlnania infection. Out of these, 5.6% (0.D ratio 2 2.5) showed very high antibody titre, 6.9% (1.5 5
0 . D ratio < 2.5) moderately elevated antibody titre and 9.7% (1.1 5 0 . D ratio < 1.5) low positive titre.
However, buffy coat straining, in-vitro culture and PCR failed to reveal the parasite. The positive results
for antibody test were probably due to past exposure to the parasite.
SERO~REVALENCEOF TOXOPLASMA GONDII ANTIBODIES IN HIV POSITIVE AND
NEGATIVE PATIENTS USING THE IMMUNOFLUORESCENCE ANTIBODY TEST (IFAT)
METHODS
Shamilah Hisham, Lokman Hakim S., Noor Azian M.Y., Malkith K. and Yusri M.Y.
Tropical Biomedicine. vol. 18, no. 2, p. 137-141, Dec. 2001.
Division of Parasitology, Institute for Medical Research (IMR),
50588 Jalan Pahang, Kuala Lumpur, Malaysia.
Abstract
A retrospective review of IFAT for Toxoplasma gondii results receive by the Division of Parasitology from
the years 1995-1997 was performed. A total of 2,554 serum samples were received and tested for the
presence of IgG Toxoplasma gondii antibodies. An IgG titer of 2 1:64 was considered as highly suggestive
of current toxoplasmosis. An overall prevalence of current toxoplasmosis was 26.3%. Prevalence of
current toxoplasmosis among the HIV positive and HIV negative patients were 31.3% and 24.3%,
respectively, (p < 0.001). The positive rate among HIV negative patients was highest among the Malays
(27.0%) followed by the Indians (25.6%), Chinese (21.4%) and others (19.8%), (p < 0.001). Similar trend
was noted among HIV positive cases with higher positive rates but the proportion of positive titer increased
significantly among the Malays (42.1%, p < 0,001), but not among the Indians (30.8%, p = 0.645), Chinese
(22.0%, p = 0.934, and others (24.3%, p = 0.82'1). Sigmiicantly more males had positive titers than iemales
(26.3% vs 21.8%, p = 0.024) among the HIV negative patients but not among the HIV positive patients
(311.8% vs 28.3%, p = 0.457). Prevalence of toxoplasmosis by age groups followed similar pattern
between the HIV positive and HIV negative cases. However, a sharper rise in antibody titers was observed
among HIV positive patients of the age groups 20-40 years old.
A STUDY ON CROSS REACTIVITY BETWEEN SARCOCYSTIS FUSIFORMIS CYSTOZOITES
ANTIGENS AND TOXOPLASMA GONDII BY WESTERN BLOT TECHNIQUE
Tropical Biomedicine. vol. 18, no. 2, p. 151-54, Dec. 2001.
Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
Abstract
Sarcocystis and Toxoplasma gondii are both cyst forming intracellular protozoa belonging to the family
Sarcocystidae that infect domestic and wild animals as well as man. The diagnosis and epidemiological
studies of the parasites mainly rely on serological techniques as the parasites are normally localized in the
blain, d d e t a l a d heart rnuscles. In view of the overlap in Ule geographical clislribulior~a d hush uf the
two parasites, highly specific serological techniques are needed for accurate diagnosis and epidemiological
studies of the parasites. The objective of this study is to examine antigenic cross-reactivity between the
two parasites using protein immunoblot (Western blot) technique. Results of the immunobolt showed that
antigenic fractions of approximately 25 and 28 kDa of the crude Sarcocystisfusifomis cystozoites antigens
cross-reacted with sera from mice immunized with T. gondii tachyzoites antigens and human T. gondii
positive serum. Due to the presence of antigenic cross-reactivity between the two parasites, highly specific
sernlngical techniques using purified antigens of appropriate developmental stage of the parasites shnuld he
developed for accurate diagnosis of the infections. DNA diagnosis of the parasites would be a better
alternative to serological techniques.
SCHISTOSOMA SPINDALE CERCARIA PRODUCTION AND SHEDDING PERIODICITY IN
INDOPLANORBIS EXUSTUS SNAILS FROM PENINSULAR MALAYSIA
misnasamy M., Chong N. L., Ambu S., Jeffery J andInder Singh K.
Tropical Biomedicine. vol. 18, no. 1, p. 65-74, June 2001
Environmental Health Research Centre (Medical Ecology), Institute for Medical Research,
Jalan Pahang, 50588 KuaIa Lumpur, Malaysia
School of Biological Sciences, University Science Malavsia, 11800 Penang, Malaysia.
Department of Parasitology and Medical Entomology, F a c u l ~of Medicine, UniversiQ1Kebangsann
Malaysia, P.0 Box 12418, 50778 Kuala Lumpur, Malaysia.
Abstract
Schistoma spindale cercariae production and shedding periodicity were studied in the snail host,
Indoplanorbis exustus in both laboratory and field conditions of peninsular Malaysia.When I. exustus snails
were exposed to S, spindale cercariae in the laboratory, it was found that the prepatent death (PDR) was
the highest (100%) among the snails that were exposed to both 5 and 6 miracidialsnail. Mean duration of
infection (MDI) was observed to be higher (60 days) among the snails which were given 3 miracididsnail,
when compared to that observed in the other groups of snails. S. spindale was found to exhibit a diurnal or
phototactic subperiodicity, releasing more number of cercariae during the day light hours as compared to
the night hours. During the day time, the maximum shedding of cercaria (82.4%) was recorded between
0900 and 1200 hours, peaking at 1030 hours, and declining from then onwards.The influence of source of
miracidia was also studied in the laboratory. Observation on the periodicity of cercarial shedding indicated
that the shedding increased from 0900 hours and 1200 onwards, peaking at 1400 hours and declined from
1800 hours. Temperature did not have any relationship on shedding periodicity.When wild and domestic
animals were exposed to S. spindale cercariae in the laboratory, it was found that in the large animals, the
parasites were found to mature within 30 days, with matured worm with ova found in goats. In the other
animals, the worms attained maturity later (within 2-3 months). A 100% infection was observed in four of
the species, namely, Macaca fascicularis, Meriones unguiculatus, Cavea porcellus and Oryctolagus
cuniculus. More then 40 species of water plants, including the yam (Colocasia esculaenta), pondweed,
yellow burhead, Asiatic eelgrass, the common knotweed, and ferns such as Ludwigia hjwsop$olia and L.
prostrata, were found associated with the snail habitats in the study area.
DEVELOPMENT OF A SALIVA BASED ASSAY FOR THE DETECTION OF
ACETYLCHOLINESTERASE (AChE) IN HUMANS
Lee H. L., Grace Low, Ai Wei Tang and Nazni W. A.
Tropical Biomedicine. vol. 18, no. 1, p. 79-83, June 2001
Medical Entomology/I~fectiousDisease Research Centre, Institute for Medical Research,
Jalan Pahang, 50588 Kuala Luinpur.
International Medical University, Kuala Luinpur.
Abstract
Cholinesterase is a group of enzymes involved in nerve transmission. The detection of acetylcholinesterase
(AchE) activity has long been established through blood investigations. The aim of this study was to
devise a non-invasive method to obtain the activity of acetylcholinesterase (AchE) in humans. Through a
macro assay using Ellman's method, a significant amount of acetylcholinesterase (AchE) has been detected
in saliva. Furthermore, the enzyme was also detected in micro assay of saliva. A preliminary baseline
acetylcholinesterase (AchE) test kit can be developed in the future.
PRELIMINARY SURVEILLANCE AND POSITIONING OF PHLEBOTOMINE SAND FLIES
BREEDING SITES IN PENANG, MALAYSIA USING GLOBAL POSITIONING SYSTEM
Khadri Shahiu hI., Let: H. L., Abu H. A., Milkall S. A. R. a d A~allluiA. H.
Tropical Biomedicine. vol. 18, no. 1, p. 85-88, June 2001.
Infectious Disease Research Centre (Medical Entomology), Institute for Medical Research,
Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
School of Biological Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
Vector R o r n ~D i v ~ n vControl
~
Progmmme. Jnlon Cend~msnri,M h i v t y of H ~ n l t h ,
50584 Kuala Lumpur, Malaysia.
Abstract
Twenty four out of a total of 500 cowshed in Seberang Perai Utara (412), Barat Daya (62) and Timur Laut
(26) districts of Penang were surveyed for sand flies by adult catch using modified CDC light-traps. The
locations were marked with a GPSHI model (GARMIN). At Timur Laut district, out of 26.9% surveyed
85.7% of it was positive with sand flies. At Barat Daya district, out of 12.9% surveyed, 37.5% of it were
found to be positive with sand flies, whereas at Seberang Perai Utara, out of 2.2% surveyed, 22.2% of it
were found to be positive with sand flies. Both Phlebotomus and Sergentomyia spp. that were caught at
these cowsheds were identified. The traps were also set up at a sandy beach and one in a rnwshed at Poknk
Machang area of Seberang Perai Utara district. No anthrophophilic activity of sand flies was experienced
at both BLC setup. Marking study sites with the GPS was satisfactory and reliable. As a result of using
GPS, there were no difficulties of relocating these traps especially in difficult areas.
SURVEY OF MOSQUITO LARVAE DISTRIBUTION IN CONTAINER HABITATS
COLLECTED FROM URBAN AND RURAL AREAS IN MAJOR TOWNS OF MALAYSIA
Rohani A, Ahdlillah A . G., Ong Y. F., Saadiyah I., Zamree I. and Lee H. J ..
Tropical Biomedicine. vol. 18, no. I, p. 41-49, June 2001.
Divisior~uf Medic~dEnmnulugy, Instime for Medied Research, Jdun Pahung.
50588 Kuala Lumpur, Malaysia.
Abstract
Immature mosquitoes were collected from a wide variety of artificial containers. Most samples were
collected from waste tyres and water holding containers located in residential urban or rural areas or at
commercial tyres company The most dnminant mosquito larvae cnllected were Aedes olhopirtllr fnllowed
by Culex quinquefasciatus and Armegeres sp., whereas only very low number of containers were positive
for Ae. aegypti larvae. Waste tyres are a well known major breeding site of both Ae. albopictus and Ae.
aegypti. This was followed by discarded plastic containers and tins. It was observed that both Ae.
ulbupictu~and Ae. uegypri p ~ e l e ~ ~
clcllr
e d wakr lur uviposiliuri. Cx. quinyuefu~ch~us
larvae were ~ U U I
breeding mainly in muddy water.
I ~
INSECTICIDE RESISTANCE STATUS OF AEDES ALBOPICTUS AND AEDES AEGYPTI
COLLECTED FROM URBAN AND RURAL AREAS IN MAJOR TOWNS OF MALAYSIA
Kohani A., Chu W. L., Saadiyah l., Lee H. L. and Phang S. M.
Tropical Biomedicine. vol. 18, no. 1, p. 29-39, June 2001.
International Medical Entomology, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur.
International Medical University, Sesama Centre, Plaza Commonwealth, Bukit Jalil,
57000 Sri Petaling, Kuala Lumpur, Malaysia.
Institute of Biological Sciences, Univei-sityof Malaya, 50603 Kuala Lumpur, Malaysia.
Abstract
Current mosquito control efforts rely heavily on the use of public health and household insecticides.
Despite the wide usage of insecticides for so many years, very few reports are available on the
susceptibility/resistance status of the vector species in Malaysia. In the this study, WHO adult and larval
bioassay were used for the detection of resistance in field mosquitoes. The most effective insecticides to
adults in descending order was malathion > permethrin > DDT for both Ae. aegypti and Ae. albopictus. In
the case in the larval stages the most effective insecticide for larviciding in descending order was temephos
> malathion > permethrin > DDT for both Ae. aegypti and Ae. albopictus, The enzyme microassay data
revealcd that the ficld strains had 2-5 timcs elcvatcd lcvcls of cstcrascs compared to the laboratory strain in
both the adults and larvae. This explains the high level of insecticides tolerance in the field strains
compared to the laboratory strain.
REP
TS
A Review of an Isolated Dengue Outbreak in Perak Tengah Health District, January 2002
S. Elangovan, R. M. Desa, A. R. A. Helmy and 2. M. Yusof
Environmental Health Focus l(1) 2003:58-63
Perak Tengah District Health Department,
Seri Iskandar, 32600 Bota, Perak
Introduction : An outbreak of dengue occurred at Taman Parit Jaya, Parit during January to February
2002. A total of 13 people were infected. The last episode of dengue outbreak was in February 1992.
Findings Their ages varied from 10 years to 62 years. There were 8 males and 5 females. Only one person
was an Indian and the rest were Malays. The mean age was 30 years. All of them stayed in Taman Parit
Jaya. The notification time after onset of symptoms varied from less than 1 day to 14 days. The mean
notification time was 5.7 days. All of them were admitted to a nearby government hospital. Three of them
were referred to a government specialist hospital. Four of them were positive of 1gM. Aedes survey done
inside and just outside the houses was not significant. There was massive breeding in the nearby "no man's
land" where the residents have been dumping their garbage.
Summary : the attitude of the community regarding cleanliness and disposing of garbage is important. The
community must be civic minded and not self-centred
Conclusion : This dengue outbreak was contained because of remedial action taken by the local
community, local town council, fire brigade and village safety committee. Inter sectoral collaboration and
community participation are important ingredients to a successful public health program.
A Study of Knowledge, Attitude and Behaviour on AIDSISTD Among Immigrant Workers in an
Indian Restaurant, Selangor Malaysia.
Elangovan Subbiah
Perak Tengah District Health Department,
Seri Iskandar, 32600 Bota, Perak
Objective : To determine the level of knowledge, attitude, practice and behaviour among immigrant
workers in a restaurant regarding HIV, AIDS and STD.
Method : All immigrant workers in an Indian restaurant were personally interviewed with a pretested
questionnaire.
Results : 36 immigrant workers with mean age 32 years were intervied, 83% were Indians and 97% had
heard of AIDS, 67% said it was caused by germs but only 11% were confident that it was virus. 34% had
poor knowledge on AIDS. 89% agreed that it can spread, 91% said it can cause death. 97% said it can be
prevented. All agreed that AIDS can be prevented by not indulging in high risk behaviours with prostitutes,
hon~osexualsand drug addicts. 67% agreed that condom usage can prevent AIDS, 71% agrced there was no
cure for AIDS. 83% would give up high risk behaviours if one of their closest partners had AIDS. 94% said
they would not indulge in sexual relationship with their partners if they had AIDS. 75% had sexual
experience before working here. 20% had multiple sexual partners, 3% indulge in homosexual activities,
14% never used condoms. None were treated for STD. None were intravenous drug addicts. 71% would
give up their indiscriminate sexual activities after knowing about AIDS.
Discussion and Conclusion : management must co-operate in giving time off to immigrant workers to
attend more health education talks. Periodic screening for HIVISTD must be routinely done in view of their
high risk behaviours here.
(THIS REPORT WILL BE PUBLISH IN THE INTERNATIONAL MEDICAL RESEARCH JOURNAL)
Caries Status and Oral Health Awareness Among School children in
the Non-Fluoridated Area of Endau Mersing
Dr. Moharnmad Rashid Baharon
Government Dental Clinic, 86800 Mersing,Johor
Objectives: The objectives of this study were to determine the pattern of caries status of 16-year-old
schoolchildren in Endau Mersing and also to assess the oral health awareness among students.
Methodology: This was a cross-sectional study, involving 103 16-year-old schoolchildren in Endau
Mersing. The study comprised oral health examinations and self-administered questionnaires.
Main findings: The prevalence of caries of 60% among the subjects in the non-fluoridated area of Endau
Mersing was higher compared to 40% the subjects in the fluoridated area of Mersing. Subjects who lived in
the non-fluoridated area had also experienced more caries compared to the subjects who lived in Mersing
(mean DMFX 2.16). Most of the subjects knew
the factu~sh i 1 caused dental caries and gum diseases. However, only one-third of all subjects knew the
importance and benefits of water fluoridation as well as knowledge on how to control and prevent dental
and gum diseases.
Conclusion: It is clear that the number and percentage of children who have never experienced dental
decay has increased in the area that is fluoridated but this is not the case in the area that has not yet been
fluoridated. Thus, great effort must be made to improve the coverage of water fluoridation especially in
nnn-affluent areas. The public should be well informed about the benefits of water fluoridation as well as
the knowledge to control and prevent oral diseases.
Evaluation of Food Safety in Market Place
Dr. R. Sawri Rajan
Jabatan Kesihatan Daerah Kuala Muda, Sungai Petani, Kedah
(Reported in 2001)
Introduction
(b) Specific hazards in the environment
Wet markets are very common in this country.
However safety aspects with regards to food
safety has not been evaluated in these markets. In
year 2000, a Healthy Markct placc projcct was
carried in the District of Kuala Muda, Sungai
Petani, Kedah with the Central Sungai Petani
Market identified as the initial study site. The
aim of the project was to identify problems with
regards to food safety so that necessary actions
could be taken to rectify them. Health officers
from the State Health office carried out
inspection and evaluation of the market.
Poultry was sold life to the consumers. These
poultry were then slaughtered and dressed within
the stall in marketplace. Blood and waste (faeces
and urinc) matcrial from thcsc birds would scrvc
as a source of pathogenic organism.
Initial findings
Ice production was also carried out within the
mlilketylace. As t l ~ e i ~
poduction was d w ~ e
within the stalls, their production was found to
unhygienic.
Initial inspection by the health officers revealed a
number of problems. The problems identified
were grouped into the following categories;
Overflowing garbage bins- were found to not
only attract flies but also wild rodents and stray
animals. These pest also serve to pollute the
environment with their waste material but also
serve as a vector for parasites and bacteria that
are harmful to the consumers.
(c) Beautt@ation
(a) General cleanliness
Feedback from traders and cnnsi1mers indicate
that they were unhappy with the general
cleanliness of the market. Due to improper
disposal of the garbage, the market place was
infested with wild rudenls, stray clogs and cats.
These stray animals roam freely without
restriction and feed off the garbage and discards
from the traders.
The floor of the market place was also found to
be constantly wet with water dripping from
poorly setup stalls that drained wastewaters onto
the floors. These wastewaters collect into cracks
and potholes found in the floor, posing a danger
as a source of infection.
The market was also found to lack basic facilities
for the management staff to rest or carry out their
duties. Toilets were also found to be poorly
maintained with many of them not in working
conditions. This again could be a potential
source of pathogenic organisms.
The infrastructure of the market was found to be
inadequately maintained. Aside from cracks and
holes in the flooring, the walls were found to be
dirty with a need of a fresh paint. Drains within
the compound were also found to be broken
down and clogged with trash as well
decomposing organic material from the various
stalls in the market. These clogged drains not
only emit a foul and obnoxious odour but serves
as a breeding ground for pathogenic organisms.
Recommendations
Arising from the survey, it was agreed that a
proper set of guidelines needed to be created so
that inspection would be done thoroughly and
objectively. The guidelines would also aid in
identifying all hazards that poses a threat to food
safety as well as assisting in evaluating the
overall condition of the market. This would
enable necessary actions to be taken.
The first attempt at drafting a national level
standard guidelines for o hcalthy markct was
attempted at a national conference held at Park
Avenue Hotel, Sungai Petani from 22 - 24
November 2002. The guidelines spell out the
IMR Ouarterlv Bulletin No. 5 1/52: JuIv/Oct.2002
parameters as well as the scoring to be used
during inspection. A format for the evaluation
was also drafted. The evaluation formats
prepared were in the form of a checklist and
consists of several parts. The format takes into
account these following items;
(a) Market Baseline
(b) Basic Amenities and structure of
the market building
(c) Safety and cleanliness control of
the market
(d) Beautification and enlivenmcnt of
the market
(e) Control of vectors, vermin and
stray animals
(f) Control of food safety and
cleanliness of food
(g) Comments of investigating officer
(h) Evaluation rate
Formats used were separate for the evaluation of
vegetables and fruits, meat and poultry, fish and
fish products and sundry.
List of evaluation forms
Market Evaluation Format - Annex C
Vegetables and fruits - Annex E
Mcat and poultry - Annex F
Fish and fish products - Annex G
Sundries - Annex H
Stall - Annex I
Hawker - Annex J
Pengetahuan, Sikap dan Amalan Tentang Bahaya Merokok Di kalangan Pelajar-Pelajar
Sekolah Menengah di Kawasan Luar Bandar Kedah Darul Aman
Dr. R. Sawri Rajan
Jabatan Kesihatan Daerah Kuala Muda, Sungai Petani, Kedah
(Dilaporkan pada 2001)
Ringkasan
Satu kajian telah dijalankan di Sekolah
Menengah yang terletak di kawasan luar bandar
dalam daerah Kuala Muda, Kedah D m 1 Aman
untuk mengetahui tahap pengetahuan sikap dan
amalan tentang kesan buruk akibat merokok.
Seramai 120 pelajar daripada tingktan 1 hingga
tingkatan 5, dipilih secara random. Lebih ramai
dipilih daripada tingkatan 4 dan 5 oleh kerana
pandangan pihak guru ialah lebih ramai merokok
di tingkatan tingkatan tersebut.Semua pelajar
adalah daripada bangsa Melayu. Kajian telah
menunjukkan bahawa 30 daripada 120 pelajar
tidak merokok. 46% daripada yang dikaji
mcnghisap 1 batang rokok sehari mai~akala
16.9% menghisap 2 hingga 3 batang rokok
sehari. 3% menghisap lebih daripada 10 batang
rokok.
76.2% daripada yang merokok
mempunyai ahli keluarga yang merokok.
Diantara ahli keluarga tersebut, bapa pelajar
adalah 56.2% manakala lain lain ahli keluarga
adalah kurang daripada 14%
70% pelajar
mengatakan kawan yang merokok adalah
pengaruh utama. 30% merokok untuk mengawal
perasaan manakala 23 3%mengatakan bahawa
mereka nle~okuk iipabila Irlerasa marah dan
2 1.5% kerana suka mengambil risiko. 34.6%
merokok apabila ada rakan merokok manakala
30% merokok apabila berseorangan.
Cuma 28.5% pelajar tahu bahawa asap rokok
mengandungi karbon monosida. 83% pelajar
tidak dapat menamakan satu pun bahan kimia
yang ada didalam asap rokok. Cuma 23.1%
tahu tentang nikotina dan sifat penagihannya.
96.9% pelajar tidak tahu tentang kumpulan
perokok. Pengetahuan tentang kawasan larangan
merokok adalah 97.7% dan 89.2% daripada
pelajar yang dikaji ingin menghentikan tabiat ini
untuk menjaga kesihatan. Intervensi awal di
sekolah boleh membantu pelajar hentikan tabiat
merokok.
Pengenalan
Rokok adalah satu hasil tembakau, iaitu
tumbuhan yang dipanggil "Nicotiana Tabacum".
Selain daripada America dan China, Malaysia
juga menghasilkan tembakau secara besarbesaran. Cerut, rokok daun, beedi, snuff, sentel,
tembakau paip adalah lain-lain hasil tembakau
ynng digunakan oleh orang ramai. Kadang
kadang mengikut kawasan tinggal atau keadaan
ekonomi dan taraf kehidupan.
Persediaan Hasil Tembakau
Terdapat 2 jenis rokok utama iaitu rokok putih
dan rokok kretek atau rokok cengih. Ada juga
rokok yang berpenapis dan dan rokok
bermenthol di pasaran.
Tembakau yang
digunakan untuk mengeluarkan pelbagai hasil
tenlbakau adalah diproses mengikut cara cara
yang berbeza. Dikatakan terdapat 1000 jenis
perasa bagi rokok.
Dianggarkan untuk menghasilkan rokok, 700
bahan kimia yang berlainan digunakan untuk
memproses tembakau. Ada diantaranya bahanbahan tersebut boleh memabukkan.
Kesan Merokok
Ramai yang merokok disebabkan oleh
keseronokan atau keenakan yang dirasai.
Keseronokan ini berpunca daripada:
Ketenangan sementera
Ketenangan sosial
Kepuasan fizikal (sedutan 1menghisap)
Tabii
Status social
Gaya
Budaya
Cma kelum dari resahm, bosan dan
jemu
Kawal Diri
Sahabat Karib
Pengaruh Media Masa
Tabiat merokok dapat dilihat di mana-mana
sahaja tanpa mengira agama, budaya, kaum dan
tempat. Golongan dewasa mahupun remaja
sama-sama terlibat dalam tabiat ini. Masalah ini
semakin berleluasa di kalangan pelajar sekolah
walaupun kerajaan telah melancarkan kempen
anti merokok sejak lebih tujuh tahun lalu.
Masalah ini juga lebih ketara di kalangan pelajar
lelaki berbanding pelajar perampuan. Tabiat
merokok ini telah meningkatkan morbiditi dan
angka kematian di kalangan perokok. Semakin
Seramai 120 orang pelajar daripada tingkatan
satu hingga tingkatan lima telah dipilih secara
raw& dan mereka telah dihimpunkan di dalam
dewan sekolah. 100% adalah terdiri daripada
bangsa melayu dan mereka telah diberikan
borang soal selidik. Setiap soalan yang
awn1 mcrokok dijadikan sebagai tabiat, semakin
Lerkalidung di c L ~ l bu~ang
a ~ ~ ~ ilu telaI1 di~e~angkau
cepat kesan ke atasnya dapat dirasai dan semakin
sukar untuk dihentikan. Di negara-negara
membangun masalah merokok membawa kesan
sosial dan ekonomi selain daripada menjejaskan
kesihatan.
Dalam Kajian Kesihatan dan Mobiditi
Kebangsaan 1996, didapati bahawa peratusan
untuk mudah difahami oleh pelajar. Selepas
keterangan diberikan, pelajar telah diminta untuk
menjawab soalan di dalam borang soal selidik
tanpa meniru dari sesiapa. Proses menjawab
telah diselia oleh guru-guru sekolah dan pegawai
dari Pejabat Kesihatan. Soalan yang tidak
herkaitan atanpnn tidak holeh dijawah minta
dikosongkan ruang berkenaan. Selepas semua
pelajar selesai menjawab, borang telah dikutip
dan dinawa ke Pejabat Kesihatan di mana
pcnduduk di atas umur 18 tahun yang sedang
jawapan dianalisa.
Hasil Kajian
merokok adalah 24.8% dan yang telah merokok
sebnayak 30.6%. Peratusan lelaki yang merokok
secara keseluruhan adalah 49.2% berbanding
3.5% bagi perempuan. Terdapat perokok yang
berumur diantara 12 hingga 18 tahun iaitu
sebanyak 16.7% dan daripada jumlah tersebut
30.7% adalah lelaki manakala perempuan 4 8%.
Perratusan penghisap rokok yang cuba berhenti
dalam masa setahun adalah 43.3% dan purata
bilangan usaha adalah sebanyak 3.3 kali. Purata
Kajian menunjukkan bahawa peratusan pelajar
menghisap rokok kurang daripada tiga batang
rokok sehari. Ini bermakna meraka belum
k~tagihterhadap rnkok tetapi hanya mmghiwp
kerana gaya. Pengaruh daripada ahli-ahli
keluarga amat tinggi terutama daripada sepupu
dan abang. Pengetahuan tentang risiko kepada
rokok yang telah dihisap adalah 13.3 batang.
kcbil~alalladalah linggi di kalanga~pelajill yang
Dalam kajian yang sama didapati bahawa tabiat
merokok adalah tinggi di negeri Pahang,
Kelantan dan Sabah terutama di kawasan luar
bandar dan di kalangan kaum melayu. Satu
kajian telah dirancang di daerah Kuala Muda di
mana pengetahuan, sikap dan amalan dalam ha1
tabiat merokok dapat memheri kesan hnrnk di
kalangan pelajar sekolah menengah di kawasan
luar bandar. Sekolah yang telah dipilih ialah
Sekolah Menengah Jeniang, Kuala Muda, Sungai
tidak merokok berbanding pelajar yang merokok.
91.4% daripada pelajar ingin berhenti daripada
tabiat merokok kerana mahu menjaga kesihatan
mereka walaupun 63.4% sahaja memerlukan
bantuan luar untuk berhenti merokok.
Peningkatan pengetahuan tentang bahaya
merokok dikalangan ibubapa boleh membantu
Petani Kedah Darul Aman.
ruerlgu~angkar~
yeugauli ~ ~ ~ e ~ udik kala~~gan
uk
Metodologi
Satu borang soal selidik berbentuk "Self
Administered Questionnaire" telah disediakan
bagi tujuan kajian. Sekolah Menengah Jeniang di
daerah Kuala Muda telah dipilih lintuk kajian ini
Kesimpulan
remaja. Kesedaran yang tinggi tentang bahaya
merokok tehadap kesihatan di kalangan pelajar
dapat membantu pelajar untuk berhenti daripada
merokok. Kesedaran ini perlu wujud dalam diri
setiap pelajar dari peringkat awal sebelum
mereka menjadi ketagih terhadap tabiat
merokok
2.
3.
4.
Merokok Boleh Mengakhibatkan Kanser.
Menyedut Asap RokolE Boleh Datangkan Asma.
IMR QuarterIy Bulletin No.51/52:July/OctUnn
ImTidak Memkok
I
~erokok
Pelajar yang tidak merokok &pat menjawab lebih soalan dengan betul berbanding dengan pelajar merokok.
33.3% pelajar yang tidak merokok dapat me7 jawapan &ngan b e d berbanding 23.7% daripada
pelajar memkok. Begitu juga bagi 6 jawapan yang betut dimana pelajar tidak mmkok c a w i m 48.2%
manakalan pelajar sedang merokok mencatat 40.9%.
Rajah 14: Keperim Bantuan Pihak Kemjasn U n M Berhenti
Merokok
Daripada 93 pelajar, 63.4% rnemerlukan banman kerajaan untuk menghentikan tabiat memkok manakala
36.6% tidak memerlukan banuntuk berhenti merokok.
EDITORIAL BOARD
EDITORIAL BOARD
Advisor
Dr. Lye Munn Sann
Editor-in-chief
Dr. Stephen Ambu
Editors
Dr. Ng Kok Han
Dr. Azizah Radhi
Dr. Fuzina Noor Hussein
Dr. Sumitra Sithamparam
Dr. Raden Shamila Hisan
Cik Nur Ain Meskam
Encik Salleh Ismail
Secretary
Puan Siti Rodziah Othman
Editorial Assistant
Cik Zyafydah binti Moharnad Zin
Published by
Institute for Medical Research
Jdan Pahang
50588 KUALA LUMPUR
Tel:
Fax:
03-26986033
03-26937367
Bangunan IMR - 1901
Bangunan IMR - 1928
Bangunan IMR -
Diterbitkan oleh:
Institut Penyelidikan Perubatan,
Jalan Pahang,
50588 Kuala Lumpur,
Malaysia.
Tel : 03-2698 6033
Fax : 03-2693 7367
e-mail: [email protected]

IMR Bulletin July Oct 2002

Transcription

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