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AIMST UNIVERSITY

Faculty of Medicine
MBBS PROGRAMME
Year 3 & 4
Batch (19)

Log Book

COMMUNITY MEDICINE
NAME

: TEELAN

A/L CHANTHIRA SEEKARAN

REG NUMBER

: 1300886

BATCH

: 19

POSTING FROM

: 19

; GROUP: D

TH

APRIL 2016 TO 13TH MAY 2016

YEAR

III

CERTIFICATE
This is to certify that
TEELAN CHANTHIRA SEEKARAN

ID NO.

1300886

Has attended the clinical postings in Community Medicine


from 19th April to 13th May and conducted community survey
as shown in this log book.

________________
_________________
Course Coordinator

Head of Department

(DR. INN KYNN KHAING)

(ASSOC. PROF DR. KYI KYI SEIN)

TABLE OF CONTENT
N

TITTLE

O
1 The Objectives Of Community Medicine Posting,
2

Community Survey (Community Diagnosis)


Report on Community Survey

PAGE NO
36
7 102
7 85

Report on Health Camp

86 88

Report on Focus Group Discussion

89 -102

Clinico-Social Case Study

102-122

Case 1

102-105

Case 2

106-108

Case 3

109-111

Case 4

112-116

Case 5

117-121

Appendix
Appendix 1
Appendix 2

122 - 132
133 138
139- 140

Appendix 3
5

Reference

141-142

I.

THE OBJECTIVES OF COMMUNITY MEDICINE POSTING:

At the end of the posting, the student shall be able to:


Describe the concept of Public Health and its relevance to the National Health Goals and the Vision of
the Ministry of Health
Describe the Health Care Delivery System
Describe Malaysias National Health Programs with emphasis on Family Health Development
(including Maternal and Child Health, Nutrition, School Health, Adolescent Health, HIV/AIDS, Mental
Health, Care of Children with Special Needs, Care of the Elderly Disease Control, Environmental
Health, Occupational Health and Food Quality Control
Describe the National Surveillance System and the Health Management Information System
Describe the Principles and Practice of Food Quality Control in relation to the Food Act 1983 and Food
Regulations.1985
Identify the Environmental and Occupational Hazards at workplace and their control in relation to the
Occupational Health and Safety Act 1994
Describe the importance of Water Quality and Sanitation to human health in relation to law and
regulations governing it.
Describe the principles of Health Education and Promotion and its importance in wellness and Disease
Prevention and Control
Describe the principles of Disease Outbreak Investigation, Control and Management.
Describe the principles of Research Methodology

The 1 month program will have the following broad divisions

Survey for Community Diagnosis


Clinico-social case studies
Visits to places of public health importance
Posting to Klinik Kesihatan
Posting to Office of the District Health Officer.
(The details are given in the Schedule).

Objectives of Community Diagnosis Survey


Describe the concepts, principles and methods of a Community Diagnosis in a field setting.
Gather, understand and present secondary data.
Develop and use data collection tools like questionnaires and other forms of field observation tools in
community settings.
Explore issues of culture, religion, ethnicity and their impact on health of the community.
Appreciate ethical issues involved in Community Diagnosis.
Plan and implement appropriate community intervention strategies for community education, health
promotion and health screening

The specific competencies to be gained during the posting are:


Selected competency
1. Obtain health related data about

Selected CD experience
Teams gather qualitative and quantitative data from

social and cultural environments,

secondary sources and interviews

growth and development factors,


needs and interests
2. Analyze social, cultural, economic

Students analyze many factors that impact health

and political factors that influence

within the community.

health.
3. Apply principles of community

Students work with community members to plan a

organization in planning programs.

community forum where they facilitate issue selection

4. Communicating health and health

and future steps for community action.


Students interview members of the community and

education needs, concerns and

service providers to learn about the perceptions of each

resources.

group and the assets and needs identified. Students

5. Demonstrate both proficiency and

Impart Health education to select community.


Students present their findings in a comprehensive CD

accuracy in oral and written

document

presentations.
6. Apply appropriate research

Community diagnosis involves both quantitative and

principles and methods in community

qualitative research in a real community setting

diagnosis.
7. Assess the merits and limitations of

Students must discern the merits and limitations of each

qualitative and quantitative research

type of data.

methods
Objectives of the Clinico-Social Case Study
Able to elicit history of a given problem, with reference to the agent, the host and the environmental
factors.
In the given case explain the interaction of the factors leading to the present status of the individual.
Draw a plan for managing the individual describing the actions under various levels of prevention.
Describe the remedial actions to be taken at the family and community level.
Activity:
You will be given a case of public health importance.
Take a detailed clinic-social history.
Especially pay attention to how the condition started, developed and progressed to the present state.
Elicit history on the treatment seeking behaviour, the decision making process and the expenditure
involved.
Prepare a plan of action for improving the health condition.

II. COMMUNITY SURVEY (COMMUNITY DIAGNOSIS)


A. REPORT ON COMMUNITY SURVEY
Approach
Our community survey site was selected by Assoc. Prof Dr. Leela Anthony Joe. Before conducting the survey, a few of
our group mates lead by our group leader met the village head, En. Azman, to discuss with him regarding our intentions of
conducting a community survey and also a medical health camp. He was very supportive and happy to receive us. He
provided basic information about the village like the total number of families, their main occupation, and where most of
the houses were located. He also offered help for our medical camp by providing the community hall for our use, and to
also set up a tent outside the hall for us.

Introduction
Group D of MBBS Batch 19 had been having our community diagnosis posting for 4 weeks. In second week of our
posting, which was from 25th April 2016 to 29th April 2016, we had conducted a field survey in Kampung Baru Thye Eng,
Bedong, Sungai Petani, Kedah. It is about 2.19 KM (3 minutes drive) away from AIMST University, Kedah and 5.46 KM
(10 minutes drive) from Hospital Sultan Abdul Halim, Kedah. From the village, 165 villagers (36 households) took part
in our survey. The majority of the villagers are Indians (56.4%), followed by Malays (40.0%), and Chinese (3.6%)

Location of the Kampung Baru Thye Eng, Bedong, Sungai Petani, Kedah.

Source: Google Earth

Sketch diagram of Kampung Baru Thye Eng.

Our survey comprised the following categories:

(a) Demographic data


Demographic information on the household number, occupants of the house, basic information of the
villagers such as name, age, gender, ethnicity, religion, marital status, occupation, education, household
income per month and type of family are assessed.

(b) Environment sanitation and housing variable


Sanitation refers to the condition related to public health, especially the provision of clean drinking water
and adequate sewage disposal. Housing variable is about the physical space, environment including the
electricity supply, number of rooms and type of house that a family lives in.
In this section, five subtitles are made to categorize the variables into housing, latrines, solid waste disposal,
water supply and electrical supply.

(c) Maternal care


Malaysia has a high standard of medical care, including antenatal care (ANC). However, to achieve the full
life-saving potential that ANC promises for women and babies, four visits providing essential evidence
based interventions, a package often called focused antenatal care are required. Essential interventions in
ANC include identification and management of obstetric complications such as preeclampsia, tetanus toxoid
immunization and identification and management of infections including HIV, syphilis and other sexually
transmitted infections (STIs). ANC is also an opportunity to promote the use of skilled attendance at birth
and healthy behaviours such as breastfeeding, early postnatal care, and planning for optimal pregnancy
spacing. Questions regarding maternal care in the survey are only targeted on married women of
reproductive age (15-49 years old) who last pregnancy was less or equal to 3 years, except the questions of
age during first pregnancy, number of pregnancies, the year of last pregnancy and practice of family
planning which are directed to all maternal women.

Family planning is assessed through the use of contraceptive methods. Questions regarding family planning
in the survey are directed towards all maternal women.

Child immunization status is evaluated according the immunization schedule of Malaysia. Questions
regarding child immunization status in the survey are only directed towards maternal women of

reproductive age (15-49 years old) who have children of 2 years old or below. The coverage and complete
immunization status of the children of 2 years old or below is assessed.

(d) Nutritional assessment


Nutrition tends to be one of the most important factors for growth. It represents the scientific quantity of
food and its relation to health. Nutrition in general consists of the basic nutrients such as carbohydrates,
proteins, fats, and the micronutrients like vitamins and minerals.
Nutritional assessment of the villagers was aimed at the respondent, with enquiries regarding any food
allergy present, meals skipped and many more. The meals eaten by respondent and their family members the
day before were also recorded. Salty food and oily food intake was also noted.

(e) Morbidity and health seeking behaviour


Acute (within the last 3 months) diseases are taken into account for the assessment of physical well-being
and to assess outbreak in the village.
Health seeking behaviour is one of the important components in getting good medical care and treatment in
a community. Examples of healthcare services available in Malaysia are modern medication
(hospitals/clinics), traditional healers, and others. Type of medical practitioner and medical institutions of
choice of the villagers are assessed.
Unhealthy habits such as smoking, alcohol consumption and drug abuse are evaluated as these habits can
significantly affect morbidity.

(f) Chronic diseases


Chronic diseases (more than 6 weeks consecutively) such as diabetes mellitus, hypertension,
hyperlipidemia, asthma, chronic kidney disease, stroke, cardiovascular disease and other chronic diseases
are assessed.

Objectives of the community survey

To study the method of conducting a survey.

To learn the benefits and restrictions of qualitative and quantitative research methods.

To analyse social, cultural, economic and political factors that influence health.

To learn the method of using SPSS software to build the questionnaire, to record the data as well as to
analyse the data.

To formulate a questionnaire on the basis of assessing the health status of the people in Kampung Baru
Thye Eng.

To identify health related issues which are common in Kampung Baru Thye Eng.

To explore issues of culture, religion, ethnicity and their impact on health of the community.

Methodology
Preparation before the survey:
Before conducting the survey in Kg.Baru Thye Eng, we were to prepare a set of questionnaire which
comprises of the following:

a) Demographic variables

e) House conditions

b) Environmental sanitation and housing variables

f) Nutritional assessment

c) Latrines

g) Morbidity and health seeking behaviours

d) Solid waste disposal

h) Mortality

i) Chronic disease

k) Child immunization

j) Maternal care

One week before conducting our survey, the group leader, event managers for the health camp, secretary and
treasurer for the health camp had visited the village to get a rough idea of how it looks like. They spoke to the
headman of the village, En. Azman and managed to gather some information.
The event manager came up with a map of the village and had divided the households to smaller sections. There
are a total of 36 households which participated in our survey. Approximately 5 households were surveyed by
each subgroup for the total of 3 days spent for field survey
We have also borrowed some tools that were needed during the survey (5 weighing scales, 3
sphygmomanometers). The tools were all checked and were set to the same discrepancy to avoid any errors
during the survey. We practiced among each other to get used with the tools so that there would not be any
mistakes when examining the respondents. We shared the equipments among each subgroup. Everyone was
asked to bring their own stethoscope.
During the survey:
The villagers who participated in our survey were fully aware of the purpose of the survey and voluntarily
participated in it. The questionnaire did not contain any words or sentences that could be offensive to the
respondents (villagers). Wherever and whenever explanations were needed, we provided them
We took three days to complete the survey. Pictures were taken during the survey as proves. For the focus group
discussion, we gathered those respondents who were involved and had an interview session with them during
our medical camp. The results are all recorded in our log books.
Once the survey was successfully completed, the data was converted to the Statistical Package for Social
Science (SPSS) version 22.0. The data was analysed and conclusions were drawn from the results obtained.

Number of family members in


Frequency
the household
One family member
1
Two family members
8
Three family members
3
Four family members
8
Five family members
5
Six family members
4
1)
More than six family
7
members
Total
36
DEMOGRAPHIC DATA, ENVIRONMENTAL SANITATION & HOUSING

Percentage
2.8
22.2
8.3
22.2
13.9
11.1

100.0

NUMBER OF PEOPLE IN THE HOUSEHOLDS INTERVIEWED

Table (1): Number of family members in studied household in Kampung Baru Thye Eng
The results above do not represent the whole population of the village.
This is because some of the houses were abandoned; some refused to take part in the survey thus the
information obtained cannot represent the total number of family members in Kampung Baru Thye Eng.

AGE OF VILLAGERS

Figure (1): Histogram showing the age of villagers


The graph shows that the study population in Kampung Baru Thye Eng has a mean age of 34.41 years old and a
standard deviation of 22.5. Median age is 31. The age distribution seems to be of normal distribution.

Dependency ratio =

Children (0-14 years) + Elderly (65 years and above)

Adults (15 to 64 years)


41 + 19
Dependency ratio =

x 100%

105

In this survey, total dependency ratio is 57.1%.


The dependency ratio is an indicator that can be used to estimate the economic burden of a family. The average
dependency ratio of household in Kampung Baru Thye Eng is in an unhealthy state because the number of
individuals who are economically inactive outnumbers the active ones.
According to the World Bank, the age dependency ratio in Malaysia in year 2014 was 44 to 100 people. In
comparison with the dependency ratio from this survey, there is around 13% difference from the national level.
The difference may be due to small sample size. The dependency ratio of the village indicates there is an
increase in burden on the active part of the population.
GENDER OF VILLAGERS

Figure(2) Pie chart showing sex of family members


The sex of respondents of Kampung Baru Thye Eng is almost equal which male is of 53.33% while female is of
46.67%
RACE OF VILLAGERS

Figure (3): Pie chart showing race of family members

The highest racial percentage of respondent are Indians at 56.36%, follow by Malays at 40.00% and the least is
Chinese at 3.64%
RELIGION OF VILLAGERS

Figure (4): Pie chart showing religion of family members


The highest religion percentage is Hinduism 56.97%, follow by Islam at 39.39% and the least is Buddhist at
3.64%.

MARITAL STATUS OF RESPONDENTS

Figure (5): Pie chart showing marital status of respondent


The percentage of married person is the highest at 50.30%, follow by singles at 45.45%, and widowed ones at
3.64%.

OCCUPATION OF RESPONDENTS

Figure (6): Pie chart showing occupation of family members


The percentage of respondents working in non-government bodies, unemployed and are students are almost
equal at 23.6%, 24.2%, and 24.2% respectively. Respondents who are self-employed amount at 9.7%. The
percentage of the retired and those working other occupations are the same at 7.3% each. Respondents working
in government sectors are the least, only at 3.6%.

EDUCATION OF RESPONDENTS

Figure (7): Pie chart showing education level of family members


The percentage of respondents who completed their education up to secondary level is 39.39%, while
completed up to only primary level was at 35.76%. Percentage of respondents who completed education up to
other level is 20.61%. The least amount of respondents completed up to tertiary education, only at 4.24%.

TYPE OF FAMILY STRUCTURE

Figure (8): Pie chart showing type of family


The main type of family in Kampung Thye Eng is nuclear family which constitutes 72.22% although

two-parent families are becoming less common in many parts of world. In 2014, there were 7 million
household in Malaysia and the percentage of nuclear family was 70.3% (resource from Malaysia
Population and Family Survey 2014, LPPKN Economic Planning unit). Malaysians prefer nuclear family
because it is an autonomous unit, free from control of elders. Children are more close to parents and there
is less chance of in-laws conflict. Extended family is also common in Kampung Baru Thye Eng which
constitutes 25.00%.They share the household responsibilities such as cooking, cleaning and organizing
the entire family. Other types of family such as lone parent family have the least percentage which is
2.78%. Usually the single parent may feel overwhelmed by the responsibility of taking care of children,
in order to maintain a job and at the same time keeping up with the bills and household chores.

FAMILY INCOME PER MONTH

Figure (9): Bar chart showing monthly family income


The statistics above describes about the total monthly income of the villagers. The sample is taken from those
who having the money earning ability and sum up for that particular house which is 36 of them (n=36). Based
on the statistic, most number of families in Kampung Baru Thye Eng have an income which is within RM501 to
RM1000. There are 12 of them which is 33.33%. This is followed by income within RM1501-RM2500 and is
found in 11 houses (30.56%).There are 7 family with the income within RM1001 RM1500 which account for

19.44%,follow by 4 family(11.11%) with income less than RM500 and lastly 2 family with income exceeding
RM2500.This small portion only accounts for 5.56%.

TYPE OF HOUSE

Figure (10): Pie chart showing type of house


In summary, there are 25 (69.44%) village houses and 11 (30.56%) single-storey houses in Kampung Baru Thye
Eng.

TYPE OF HOUSE MATERIAL

Figure (11): Pie chart showing type of materials house is built up by


There are 16 (44.44%) houses that are made up of brick and wood, 12 (33.33%) houses are made up of brick
and the remaining 8 (22.22%) houses are made up of wood.
NUMBER OF ROOMS

Figure (12): Bar chart showing number of rooms in a house


The houses in Kampung Baru Thye Eng have number of rooms ranging from 1 to 7. The most number of rooms
are 3 which is found in 17 houses (47.22%), followed by 2 rooms which is in 10 houses (27.78%) and 4 rooms
in 6 houses (16.67%).The least one is 0 rooms,1 room, and 7 rooms and all 3 of them share equal number of
house which is 1 house (2.78%) each.

PRESENCE OF KITCHEN IN HOUSES


Although there are some houses in this world that dont have kitchen, fortunately all the 36 houses in Kampung
Baru Thye Eng have kitchens in the house.

CLEANING OF HOUSE

Figure (13): Pie chart showing frequency of house cleaning


The villagers in Kampung Baru Thye Eng also care for their house cleaning status. Most of the households,
which are 32 of them will clean their houses daily .This contributes to about 88.89%.
3 villagers clean their houses weekly which accounts for 8.33%. Only 1 villager (2.78%) cleans the house every
fortnightly.

NUMBER OF LATRINES

Figure (14): Bar chart showing numbers of latrines in the house


Normally all the houses are equipped with latrines. 27 out of 36 houses in Kampung Baru Thye Eng have only
one latrine in their house which accounts for 75%. 6 houses (16.67%) have 2 latrines inside the house and there
are also 3 houses (8.33%) which have no latrine.

TYPE OF LATRINES

Figure (15): Pie chart showing types of latrine in houses

The most used type of latrine in this village is septic tank in which it is at 88.8%. This is because Malaysian
government rules are that to have Septic tanks in each household. However there will be a few that is missed
which led to 5.6% of households to be still using bucket latrine and another 5.6% to use other methods for
example disposing their waste disposals into soil or just onto the ground and then burying it.

FREQUENCY OF CLEANING LATRINE

Figure (16): Bar chart showing frequency of cleaning the latrine


58.3% of the villagers clean their latrines daily whereas the second highest frequency of cleaning the latrine is
once a week at 16.7%, followed by twice a week at 13.9% and lastly, three times a week at 8.3%. The
household which cleans their latrine every day is because their spouses are housewives. However for those who
cleans only once a week, it is because both husband and wife are working adults.

GARBAGE DISPOSAL

Figure (17): Pie chart showing method of disposing the garbage


The most frequented method to dispose the garbage is via open burning, which accounts for about 77.8%. This
is because it is the most convenient, easy, and cheapest method for the villagers to dispose their garbage.
Second most common way is by dumping whether it is into the river or by the roadside. This is due to their lack
of consideration due to lack of education and for their convenience. Lastly, only 2.8% throw by others method
for example, into waste bins in the neighbouring garden or by burying them.

WATER SOURCE
All of the households have a constant water supply from running pipe water.

METHOD OF WATER TREATMENT

Figure (18): Pie chart showing method of water treated for drinking purpose
The water for drinking purposes are most often boiled before drinking by which the pie chart shows us that
91.43% of the total household of 36 chose boiling of the water. However there are 5.71% which chose other
methods which encompasses chemical treatment and other traditional ways. Lastly, only 2.86% of household
uses filtration method for treating the drinking water.

QUALITY OF WATER
Water quality
Colour
Clarity
Smell
Taste

Frequency

Percentage
32
14
36
32

91.4%
40.0%
100.0%
91.4%

Table (2): Quality of water in households


The above table shows that the villagers in Kampung Baru Thye Eng receive water with good quality where
91.4% has no change in water colour, 100% has odourless water, 91.4% water is tasteless and only 40% of the
total number of 36 households do not receive clear water in which some may be only slightly cloudy but not
dirty.

WATER SUPPLY INTERRUPTION

Figure (19): Pie chart showing interruption of water supply


Based on the charts above, not more than half of houses in Kampung Baru Thye Eng (approximately 41.67%)
complained of interrupted water supply. The remaining 58.33% of houses are satisfied with the water supply.

FREQUENCY OF INTERRUPTION

Figure (20): Pie chart showing frequency of water supply interruption

Fortunately, 19 out of 20 houses (95%) claimed that the water interruption rarely occurred. Overall, villagers in
the kampong are satisfied with the current water supply.

MONTHLY WATER BILL

Figure (21): Bar chart showing monthly water bill


19 households out of 36 in Kampung Baru Thye Eng have monthly water bill exceeding RM30 which accounts
for 52.78% of total houses. Only 4 houses have monthly water bill less than RM10. Despite of the low
socioeconomic status of villagers, the expenditures spent on water utility is quite high. However, most
respondents claimed that the water are only for domestic uses and deny any wasting of water. This might
attribute to the number of family members in the houses.

TYPE OF ELECTRICITY SUPPLY

Figure (22): Pie chart showing electric supply to households


Based on the pie chart above, 91.67% of houses in Kampung Baru Thye Eng are equipped with continuous
electrical supply. Only 5.56% have cut off electric supply.

FREQUENCY OF ELECTRICAL SUPPLY DISRUPTION

Figure (23): Bar chart showing frequency of electrical interruption


From the bar chart above, three houses or 8.33% of all total households were experiencing electrical cut off.
Two out of three houses described the electrical cut off only occurred rarely whereas only one house
experienced the electrical cut off frequently. In conclusion, the electrical supply to Kampung Baru Thye Eng is
consistent.

MONTHLY ELECTRICAL BILL

Figure (24): Bar chart showing monthly electric bill


Based on the bar chart above, 58.82% of houses from Kampung Baru Thye Eng are having electrical bill
ranging between RM21-60. This is followed by 32.35% of houses and 8.82% of houses with electrical bill range
from RM61-100 and more than RM100 respectively. Most houses have moderate electrical consumption as
their houses are not equipped with heavy energy usage appliances such as air-conditioner or water heaters.

VARIABLE RELATIONSHIPS

a) Sex and education


Sex of respondent * Education Crosstabulation
Education
Sex of respondent

Male

Primary

Secondary

32

36

17

88

36.4%

40.9%

3.4%

19.3%

100.0%

27

29

17

77

35.1%

37.7%

5.2%

22.1%

100.0%

59

65

34

165

35.8%

39.4%

4.2%

20.6%

100.0%

Count
% within Sex of respondent

Female

Count
% within Sex of respondent

Total

Total

Count
% within Sex of respondent

Tertiary

Others

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

.590a

.899

Likelihood Ratio

.589

.899

Linear-by-Linear Association

.193

.661

N of Valid Cases

165

Pearson Chi-Square

a. 2 cells (25.0%) have expected count less than 5. The minimum expected count is 3.27.

Ho: There is no relationship between sex and education level


HA: There is relationship between sex and education level
Chi-square value : 0.590
p value = 0.899 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between sex and education
level

b) Sex and occupation


Sex of respondent * Occupation Crosstabulation
Occupation

Sex of

Male

respondent

Count
% within Sex of

Total

Govern

Non-

Self-

Unempl

Retir

Stud

Othe

ment

governm

employe

oyed

ed

ent

rs

ent

26

12

12

21

88

3.4%

29.5%

13.6%

13.6%

8.0

23.9

8.0

100.

0%

respondent
Fem

Count

ale

% within Sex of

13

28

19

77

3.9%

16.9%

5.2%

36.4%

6.5

24.7

6.5

100.

0%

respondent
Total

Count
% within Sex of

39

16

40

12

40

12

165

3.6%

23.6%

9.7%

24.2%

7.3

24.2

7.3

100.

0%

respondent

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

14.833a

.022

15.222

.019

Linear-by-Linear Association

.075

.784

N of Valid Cases

165

Pearson Chi-Square
Likelihood Ratio

a. 2 cells (14.3%) have expected count less than 5. The minimum expected count is 2.80.

Ho: There is no relationship between sex and occupation


HA: There is relationship between sex and occupation
Chi-square value : 14.833
p value = 0.022 (<0.05), it is significant
Since p value is < 0.05, null hypothesis is rejected. There is relationship between sex and occupation

c) Religion and Education

Religion of respondent * Education Crosstabulation


Education
Primary

Secondar

Total

Tertiary

Others

y
Religion of respondent

Islam

Count
% within Religion of

22

27

13

65

33.8%

41.5%

4.6%

20.0%

100.0%

66.7%

33.3%

0.0%

0.0%

100.0%

33

36

21

94

35.1%

38.3%

4.3%

22.3%

100.0%

59

65

34

165

35.8%

39.4%

4.2%

20.6%

100.0%

respondent
Buddh

Count

% within Religion of
respondent

Hindu

Count
% within Religion of
respondent

Total

Count
% within Religion of
respondent

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

3.502a

.744

4.664

.588

Linear-by-Linear Association

.230

.631

N of Valid Cases

165

Pearson Chi-Square
Likelihood Ratio

a. 6 cells (50.0%) have expected count less than 5. The minimum expected count is .25.

Ho: There is no relationship between religion and education level


HA: There is relationship between religion and education level
Chi-square value : 3.502
p value = 0.744 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between religion and
education level.

2) MATERNAL CARE & CHILD IMMUNISATION


AGE DURING FIRST PREGNANCY

What is your age during first pregnancy?


Sample size
Mean

15
23.20

Std. Deviation

4.039

Minimum

19

Maximum

36
Table (3): Summary statistics of maternal age (in years) during first pregnancy
Based on the summary statistics, the mean age during first pregnancy is 23.2 years old. The standard deviation
of age during first pregnancy is 4.04. Minimum age was 19 years, while the maximum age was at 36 years of
age. The total number of respondents was 15

NUMBER OF PREGNANCIES HAD

Figure (25): Bar graph showing number of pregnancies


Based on the bar graph given, the highest number of pregnancies of women in Kampung Baru Thye Eng is 4
and 5 whereas the lowest number of pregnancies is 6.
CURRENTLY PREGNANT
Based on the data gathered, there were no ladies currently pregnant in Kampung Baru Thye Eng.
LAST PREGNANCY

Figure (26): Pie chart showing period of time (in years) between last pregnancy and now.
Based on the pie chart above, 13.3% of mothers had their last pregnancy within one to three years while the
remaining 86.7% of mothers had their last pregnancy more than three years ago.

NUMBER OF CHILDREN

Figure (27): Bar graph showing number of children in each family.


Based on the bar graph above, majority families had a total of 4 children in their families, followed by two,
three and five children.

PREVIOUS MISCARRIAGE HISTORY

Figure (28): Pie chart showing occurrence of miscarriages during previous pregnancies.
28.6% of mother had miscarriages during the previous pregnancies, while the remaining 71.4% of mothers had
no reported miscarriages during previous pregnancies.

NATURE OF MISCARRIAGE
Based on the data collected, all miscarriages that occurred among the mothers of Kampung Baru Thye Eng were
natural.
FAMILY PLANNING

Figure (29): Pie chart showing practice of family planning.


73.3% of families practice family planning while the remaining 26.7% do not practice family planning.

FAMILY PLANNING METHOD

Figure (30): Pie chart showing methods of family planning.


18.2% of villagers use oral contraceptives, injections and abstinence each as a method of family planning. 9.1%
of villagers use physical barrier while the remaining 36.4% of villagers use other methods of family planning.

ANTENATAL CARE VISITS

Figure (31): Bar graph showing antenatal care provider during recent pregnancy.
33.3% of the mothers had their antenatal care from the government hospital while the remaining 66.7% of the
mothers had their antenatal care from the government health clinics.

REGULAR ANC VISITS


Based on the data collected, all mothers of Kampung Baru Thye Eng went for regular antenatal follow ups.

COMPLICATIONS DURING LAST PREGNANCY

Figure (32): Pie chart showing complications faced during last pregnancy
The pie chart above shows that 80% of the respondents did not face any complications during their last
pregnancy while 20% of them had complications during their last pregnancy.

TYPE OF COMPLICATIONS FACED, IF ANY

Figure (33): Bar graph showing types of complications faced during last pregnancy.
The above bar chart shows that highest frequency of 2 mothers of this village had other problems whereas one
of them had hypertension and another had anemia during her last pregnancy.

IMMUNISATION DURING PREGNANCY

Figure (34): Pie chart showing immunization taken during last pregnancy.
The above pie chart shows that 73.33 % of the respondents had immunization whereas 26.67% of them had no
sorts of immunization during their last pregnancy
LOCATION OF CHILD DELIVERY

Figure (35): Pie charts showing place of delivery of last child.


The above pie chart shows that 93.33% of them delivered their last child at the government hospital whereas
6.67% of them delivered their last child at an alternative birth center.
FULL TERM OR PRETERM DELIVERY

Figure (36): Pie chart showing preterm or full term child delivery
The chart above shows that 93.33 % of babies delivered by mothers of this village were full term babies
whereas 6.67 % of them were preterm babies.

METHOD OF CHILD DELIVERY

Figure (37): Pie chart showing method of delivery of the child.


The above chart shows that 73.33% of the mothers delivered their child via spontaneous vaginal delivery. 20 %
of them went through caesarean section and 6.67 % delivered their child by assisted delivery.

COMPLICATIONS DURING/AFTER DELIVERY

Figure (38) Bar graph showing complications faced during or after delivery.
The above chart shows that 10 of them did not face any complications. One of them had prolonged labor while
3 of the mothers had other complications during or after the delivery.
NUMBER OF IN HOUSE CARE BY STAFF NURSE

Figure (39): Bar graph showing number of times of in-house care by the staff nurse
The bar chart shows that the highest number of in- house care provided was 7 times whereas there were also
some mothers who did not receive in-house care by the staff nurse
BREASTFEEDING STATUS OF MOTHER

All the mothers breastfed their child.

PROBLEMS FACED DURING BREASTFEEDING, IF ANY


There were no problems faced by the mothers during breastfeeding.
EXCLUSIVE BREASTFEEDING PERIOD

Figure (40): Bar graph showing period of exclusive breastfeeding


Diagram above shows that 8 of the mothers breastfeed their children for 6 months and more whereas 7 of them
breastfeed for less than 6 months.

COMPLETION OF IMMUNISATION SCHEDULE

Figure (41): Pie chart showing completion of immunization according to schedule.


Majority of children (92.86%) had their immunization completed to date while the remaining 7.14% did not
complete their immunization.
IMMUNISATION STATUS

Immunization history

Household Number
At birth BCG
At birth Hep B
1 month Hep B
2month DPT
2month IPV
2month HIB
3month DPT
3month IPV
3month HIB
5month DPT
5month IPV
5month HIB
6month Hep B
12month MMR

Responses
N
Percent
3
5.0%
4
4
4
4
4
4
4
4
4
3
3
3
3
3

6.7%
6.7%
6.7%
6.7%
6.7%
6.7%
6.7%
6.7%
6.7%
5.0%
5.0%
5.0%
5.0%
5.0%

Percent of
Cases
42.9%
57.1%
57.1%
57.1%
57.1%
57.1%
57.1%
57.1%
57.1%
57.1%
42.9%
42.9%
42.9%
42.9%
42.9%

18month DPT
18month IPV
18month HIB

2
3.3%
28.6%
2
3.3%
28.6%
2
3.3%
28.6%
Total
60
100.0%
857.1%
Table (4): Immunization status for children less than or equal to 2 years of age.

Based on the table above, all four children are vaccinated from BCG at birth until 3 month HIB; 3 are
vaccinated from 5th month DPT until 12th month MMR whereas only 2 out of the four children are immunized
from 18th month DPT until 18th month HIB.
VARIABLE RELATIONSHIPS
a) Age of first pregnancy and education

Education * What is your age during first pregnancy? Crosstabulation


What is your age during first pregnancy?
23
Education

Primary

Count
% within Education

Secondary

83.3%

16.7%

100.0%

66.7%

33.3%

100.0%

11

15

73.3%

26.7%

100.0%

Count
% within Education

Total

Count
% within Education

Total

>24

Chi-Square Tests
Asymptotic
Significance (2Value
Pearson Chi-Square
Continuity Correction

Likelihood Ratio

df

sided)

Exact Sig. (2-sided) Exact Sig. (1-sided)

.511

.475

.014

.905

.533

.465

Fisher's Exact Test


Linear-by-Linear Association
N of Valid Cases

.604
.477

.490

15

a. 3 cells (75.0%) have expected count less than 5. The minimum expected count is 1.60.
b. Computed only for a 2x2 table

.462

Ho: There is no relationship between age of first pregnancy and education level
HA: There is relationship between age of first pregnancy and education level
Chi-square value : 0.511
p value = 0.475 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between age of first
pregnancy and education level.

b) Number of pregnancies and miscarriages during previous pregnancy


Number of pregnancies you had * Did you have any miscarriages during your previous pregnancies? Crosstabulation
Did you have any miscarriages during
your previous pregnancies?
Yes
Number of pregnancies you

had

Count
% within Number of
pregnancies you had

>4

Count
% within Number of
pregnancies you had

Total

Count
% within Number of
pregnancies you had

No

Total

20.0%

80.0%

100.0%

33.3%

66.7%

100.0%

10

14

28.6%

71.4%

100.0%

Chi-Square Tests
Asymptotic
Significance (2Value
Pearson Chi-Square
Continuity Correction

df

Likelihood Ratio

Exact Sig. (2-sided) Exact Sig. (1-sided)

.597

.000

1.000

.290

.590

.280
b

sided)

Fisher's Exact Test


Linear-by-Linear Association
N of Valid Cases

1.000
.260

.610

14

a. 3 cells (75.0%) have expected count less than 5. The minimum expected count is 1.43.
b. Computed only for a 2x2 table

Ho: There is no relationship between number of pregnancies and miscarriages


HA: There is relationship between number of pregnancies and miscarriages

.545

Chi-square value : 0.280


p value = 0.597 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between number of
pregnancies and miscarriages.

c) Number of children and practice of family planning

Number of children * Do you practice any family planning? Crosstabulation

Do you practice any family planning?


Yes
Number of children

Count
% within Number of children

Count
% within Number of children

Total

Count
% within Number of children

No

Total

71.4%

28.6%

100.0%

75.0%

25.0%

100.0%

11

15

73.3%

26.7%

100.0%

Chi-Square Tests
Asymptotic
Significance (2Value
Pearson Chi-Square
Continuity Correction

Likelihood Ratio

df

sided)

.024a

.876

.000

1.000

.024

.876

Fisher's Exact Test


Linear-by-Linear Association
N of Valid Cases

.023

Exact Sig. (2-sided)

Exact Sig. (1-sided)

1.000

.662

.880

15

a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 1.87.
b. Computed only for a 2x2 table

Ho: There is no relationship between number of children and family planning


HA: There is relationship between number of children and family planning
Chi-square value : 0.024
p value = 0.876 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between number of children
and family planning

3) NUTRITIONAL ASSESSMENT
HISTORY OF FOOD ALLERGY AMONG RESPONDENTS

Figure (42): Bar chart showing enquiry about history of food allergy in respondents (n =36)
Based on the 36 households respondents/ head of family that we interviewed in Kampung Baru Thye Eng, only
4 of them were allergic to food or any substance, which is 11.1% of the total respondents. 32, or 88.9% of the
respondents do not suffer from any kind of allergy.

TYPE OF FOOD ALLERGY, IF PRESENT, AMONG RESPONDENTS


Type of food allergy
Chicken

Frequency
1

Medicine
Seafood

1
2

Total

4
Table (5): Type of food allergy in respondents (n=36)

Out of the 4 people suffering from allergy, 2 of them, or 50.0% of the total, are allergic to seafood. 1 person
(25.0%) is allergic to medicine, while the other (25.0%) is allergic to chicken.
NUMBER OF MEALS TAKEN BY RESPONDENTS IN A DAY
Number of meals taken per day

Frequency

Percentage

Less than three meals


Three meals
More than three meals

6
21
9

16.7
58.3
25.0

Total

36

100.0

Table (6): Number of meals taken per day (n=36)


Out of the 36 respondents, 6 of them (16.7%) take less than 3 meals per day, 21 of them (58.3%) take 3 meals
per day, and 9 of them (25.0%) take more than 3 meals per day.

MEAL OFTEN SKIPPED

Figure (43): Bar chart showing the meals often skipped, if any, among respondents (n=36)
Out of the 36 respondents, 25.0%, or 9 of them usually skip breakfast. 13.9%, or 5 of them, usually skip lunch.
However, 61.1%, or 22 of them usually dont skip any meals. None of the 36 people do skip dinner.
POULTRY/FISH CONSUMPTION IN A WEEK

Figure (44): Pie chart showing the number of times respondents eat poultry/fish in a week (n=36)

Out of the 36 respondents, 2.8% or 1 of them usually wont eat poultry or fish at all. 11.1% or 4 of them usually
eat once in a week. 16.7% or 6 of them eat twice a week. 25%, or 9 of them, usually thrice in a week. 13.9% or
5 of them eat 4 times a week, and 30.6% or 11 of them eat every day in a week.
VEGETABLE CONSUMPTION IN A WEEK

Figure (45): Bar chart showing the number of times respondents eat vegetables in a week (n=36)
Out of the 36 respondents, 2.8% or 1 of them eat vegetables once a week. 16.7% or 6 of them eat vegetables
twice a week. 8.3% or 3 of them eat vegetables thrice a week. 11.1% or 4 of them eat vegetables 4 times a week.
5.6% or 2 of them eat vegetables 5 times a week. 55.6% or 20 of them eat vegetables every day in a week.
DESSERT/SNACKS/FAST FOOD CONSUMPTION IN A WEEK

Number of desserts/fast food in a week

Frequency

Percentage

None
Rarely
Often

14
18
4

38.9
50.0
11.1

Total

36

100.0

Table (7): Number of times respondents eat desserts/snacks/fast foods in a week (n=36)
Out of the 36 respondents, 38.9 % of them do not eat dessert or snacks or fast food at all.50.0% of them rarely
eat dessert or snacks or fast food. 11.1% of them often eat dessert or snacks or fast food in a week.

BREAKFAST FOR YESTERDAY

Type of food

Frequency

Bread with milk or porridge


9
Nasi lemak (with or without coffee)
6
Roti canai with other types of food or drinks
5
Noodles with milo or tea
4
Biscuit with tea or coffee
3
3
Thosai
Fried rice, rice and egg, rice and sardine
3
Drinks such as tea, milo
2
None
1
Total
36
Table (8): Types of food for breakfast yesterday (n=36)

Percent
25.0
16.7
13.9
11.1
8.3
8.3
8.3
5.6
2.8
100.0

Out of the 36 respondents, 25% of them had bread with milk or porridge for breakfast yesterday. 16.7% of them
had nasi lemak with or without coffee, 13.9% of them had roti canai with other types of food or drinks, 11.1%
of them has noodles with milo or tea, 8.3% of them had biscuit with tea or coffee, 8.3% of them had thosai,
8.3% of them had fried rice, rice and egg, rice and sardine, 5.6% of them had drinks only such as tea and milo
while 2.8% of them do not have their breakfast at all.
LUNCH FOR YESTERDAY

Type of food
Frequency
Percent
Rice with meat (fish or chicken) or egg
19
52.8
14
Rice with meat and vegetables
38.9
2
Rice
5.6
1
Rice with vegetables
2.8
Total
36
100.0
Table (9): Types of food taken for lunch yesterday (n=36)

5.6 2.8

Rice with meat (fish or chicken) or egg


Rice with meat and 52.8
vegetables
38.9

Rice

Rice with vegetables

Figure (46): Pie chart showing types of food taken for lunch yesterday (n=36)

Out of the 36 respondents, 52.8% of them had rice with meat or egg for lunch yesterday. 38.9% of them had rice
with meat and vegetables, 5.6% of them had rice only while 2.8% of them had rice with vegetables.
DINNER FOR YESTERDAY
`
Type of food

Frequency

Percent

16
Rice with meat (fish or chicken) or egg
44.4
13
Rice with meat and vegetables
36.1
4
Bread or Burger
11.1
2
Noodles
5.6
1
Thosai
2.8
Total
36
100.0
Table (10): Types of food taken for dinner yesterday (n=36)

16
13

4
2

Rice with meat (fish or chicken) or egg

Bread or Burger

Thosai

Figure (47): 3D Bar chart showing the types of food taken for dinner yesterday (n=36)
Out of the 36 respondents, 44.4% of them had rice with meat or egg for dinner yesterday. 36.1% of them had
rice with meat and vegetables. 11.1% of them had bread or burger. 5.6% of them had noodles while 2.8% of
them had thosai.

TYPE OF COOKING OIL USED

Figure (48): Bar chart showing the type of cooking oil used by the respondents (n=36)

Out of the 36 respondents, 32 of them or 88.9% use vegetable based oil for cooking while remaining 4 of them
or 11.1% use animal based oil for cooking.
CONSUMPTION OF ANY NUTRITIONAL SUPPLEMENTS
Number of people taking
nutritional supplements
Yes
No
Total

Frequency

Percentage

3
33

8.3
91.7

36

100.0

Table (11): Number of times respondents taking any nutritional supplements (n=36)
Out of 36 respondents, 33 of them or 91.7% do not take any nutritional supplements while remaining 4 of them
or 8.3% take nutritional supplements.
TYPE OF SUPPLEMENTS TAKEN

Figure (49): Pie chart showing the type of supplements taken by the respondents (n=36)

Out of 3 respondents who are taking nutritional supplements, 1 of them or 33.3% takes fish oil. 1 of them or
33.3% takes Pharmaton vitamin tablets and remaining 1 or 33.3% takes herbal yeast food supplement and
chicken essence.

NUMBER OF TEASPOONS OF SUGAR INCLUDED IN BEVERAGES/FOOD IN A DAY


Number of teaspoons of sugar in
beverages/food in a day
Less than four
Four
More than four
Total

Frequency

Percentage

29
4
3

80.6
11.1
8.3

36

100.0

Table (12): Number of teaspoons of sugar in beverages/food in a day by respondents (n=36)


Out of 36 respondents, 29 of them or 80.6 % use less than 4 teaspoons of sugar in beverages in a day. 4 of them
or 11.1% use exactly 4 teaspoons of sugar in beverages in a day. 3 of them or 8.3% use more than 4 teaspoons in
beverages in a day.
RESPONDENTS INTEREST IN EATING SALTY FOODS
Interest in eating salty foods

Frequency

Percentage

Yes
No

12
24

33.3
66.7

Total

36

100.0

Table (13): Interest of respondents in eating salty foods (n=36)


Out of 36 respondents, 12 of them or 33.3% like to eat salty foods while remaining 24 of them or 66.7% do not
like to eat salty foods.

IF YES, HOW MANY TIMES PER WEEK

Figure (50): Bar chart showing the number of times salty food intake in a week (n=36)
Out of 36 respondents, 12 of them like salty food. 5 of them or 41.7% like to eat salty foods once a week.
Another 5 of them like to eat salty foods twice a week. Remaining 2 of them or 16.7% like to eat salty foods
thrice a week.

RESPONDENTS INTEREST IN EATING OILY FOODS

Interest in eating oily foods


Yes
No
Total

Frequency

Percentage

18
28

50.0
50.0

36
Table (14): Interest of respondents in eating oily foods (n=36)

100.0

Out of 36 respondents, 18 of them or 50% like to eat oily foods. Remaining 18 of them or 50% do not like to eat
oily foods.

IF YES, STATE HOW MANY TIMES PER WEEK

Figure (51): Bar chart showing the number of times oily food intake in a week (n=36)
Out of 36 respondents, 18 of them like to eat oily foods. 4 of them or 22.2% likes to eat oily foods once a week.
Another 4 of them or 22.2% likes to eat oily food twice a week. 5 of them or 27.8% likes to eat oily food thrice
a week. Remaining 5 of them or 27.8% likes to eat oily foods every day.

VARIABLE RELATIONSHIP

a)

Sex of respondent and meal often skipped

Meal often skipped * Sex of respondent Crosstabulation


Sex of respondent
Male
Meal often skipped

BREAKFAST

Count
% within Meal often skipped

LUNCH
NONE
Total

44.4%

55.6%

100.0%

40.0%

60.0%

100.0%

17

22

22.7%

77.3%

100.0%

11

25

36

30.6%

69.4%

100.0%

Count
% within Meal often skipped
Count
% within Meal often skipped

Female
4

Count
% within Meal often skipped

Total

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

1.664a

.435

Likelihood Ratio

1.638

.441

Linear-by-Linear Association

1.603

.205

Pearson Chi-Square

N of Valid Cases

36

a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is 1.53.

Ho: There is no relationship between sex of respondent and meal often skipped
HA: There is relationship between sex of respondent and meal often skipped
Chi-square value : 1.664
p value = 0.435 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between sex of respondent
and meal often skipped.

4)MORBIDITY AND HEALTH BEHAVIOUR


ENQUIRY ON HEALTH MORBIDITY

Morbidity in last 3
months
Yes
No
Total

Frequency
Percentage
8
21.1
28
78.9
36
100.0
Table (15): Enquiry on morbidity in last 3 months

Eight respondents which are 21.1% of the community have reported that they have suffered from acute diseases
in last 3 months. However, 78.9% of them have denied that they have suffered from any disease in last 3
months.

TYPE OF MORBIDITY

Types of morbidity in last 3


months
Frequency
3

Percentage
50.0

Communicable Disease
Non Communicable
3
50.0
Disease
Total
6
100.0
Table (16): Enquiry on types of morbidity in last 3 months
50% of them reported that they have suffered from communicable disease and other 50% suffered from noncommunicable disease.

ENQUIRY ON SEEKING MEDICAL CARE FOR MORBIDITY

Figure (52): Bar graph showing response on seeking medical care for morbidity
The figure showed that 75% who have suffered from acute disease in last 3 months had sought for health care
by answering YES and other 25% did not. Those respondents who did not seek health care had other reasons
like lack of money, no transport facilities and lack of time.

ENQUIRY ON HEALTH CARE SERVICES ATTENDED

Figure (53): Bar graph showing type of health care services utilized for illness

Based on the bar chart above, three respondents who suffered from any acute illness consecutively for six weeks
preferred to go to Klinik Kesihatan, while two of them went to private hospital or clinic. The residents prefer to
go to Klinik Kesihatan because it is near the village and also cheaper compared to travelling to the Government
Hospital which is located at the town. Traditional medical healers are least visited probably due to higher trust
on certified doctors and understanding of their symptoms prompt them to choose wisely.

DIAGNOSIS OF ILLNESS

Figure (54): Pie chart showing the types of diagnosis of illness


Based on the pie chart above, the most common illness among the residents here are respiratory tract infections.
Every other diagnosis based on their symptoms shows equal distribution among the residents with one person
affected with a certain illness. The other illnesses accounts for 14% each.

COMPLIANCE WITH TREATMENT RECEIVED

Compliance with treatment


received
Yes
No
Total

Morbidity for 6 weeks


consecutively or more
Yes
No
Total

Frequency

Percentage

7
1
36

87.5
12.5
100.0

Frequency

Percentage

14
22
36

37.1
62.9
100.0

Table (17): Enquiry on the compliance on treatment received


Among all residents who are affected by acute illnesses, only one opened up on not taking regular treatment for
his illness. The rest claims to be compliant in taking their treatment. The reason given by the one person for not
taking regular treatment is because of ignorance. He does not think medications are needed to treat his illness
and continues to work without them.
MORBIDITY FOR 6 WEEKS OR MORE

Table (18): Enquiry on the morbidity for 6 weeks consecutively or more


Based on the table, it is clear that the number of residents suffered with any disease consecutively for 6 weeks
or more is only 37% when compared to the majority of the residents who is healthy from any illnesses.

TYPE OF MORBIDITY FOR 6 WEEKS OR MORE

Table (19): Enquiry on types of morbidity for consecutively 6 weeks or more

Out of 14 people who are suffering with chronic illnesses, only 1 is suffering with communicable disease while
12 of them are suffering with non-communicable disease which is about 85% of total residents with chronic
illnesses.
SEEKING MEDICAL CARE FOR ILLNESS

Types of morbidity 6 weeks


consecutively or more
Communicable Disease
Non Communicable Disease
Others
Total

Frequency

Percentage

1
12
1

7.1
85.7
7.1

14
Figure (55): Bar graph showing enquiry on seeking medical care for illness

100.0

Of all of those suffering with a disease, only 2 residents claim to not seek health care for their illnesses while all
the other 12 have attended medical care to treat themselves which accounts to 85.7% of those affected. The
reason given by one out of 2 residents to not seek medical attention is due to lack of money for follow up
treatments. The other reason given by the remaining resident is other than that of lack of money, lack of time or
transport.

LOCATION OF HEALTH CARE SEEKED

Figure (56): Bar graph showing enquiry on the place to attain health care for the illness

Based on the bar chart above, majority of the residents who suffered from any illness consecutively for six
weeks prefers to go to Government hospital for treatments which is 46.15%. Klinik Kesihatan attributes to
38.46%. While the rest go to private hospital/clinic where the percentages of it is 15.38%. The residents prefer
to go to the Government hospital because it is near the village and also cheaper compared to private clinics.
DIAGNOSIS OF ILLNESS

Figure (57): Pie chart showing enquiry on the diagnosis of the illness.

The diagnosis of the illness among those who suffered from any illness consecutively for 6 weeks or more is as
shown above. The highest number of illness affecting the population is hypertension which accounts for 6
person, attributing to 42.86% followed by people suffering with diabetes mellitus alone, or diabetes mellitus
with hypertension. This accounts for 2 people for each diagnosis, each at 14.29% respectively. The rest
consisting of angina, slipped disc, asthma, blurring of vision and loss of hearing attribute to 7.14% that is 1
person for each disease respectively.

REGULAR TREATMENT FOR ILLNESS

Figure (58): Bar graph showing the regularity of the treatment taken for the illness
Out of 14 of them who are suffering from illnesses, 10 of them do take regular treatment which attributes to
71.43% of the total population, and 4 of them do not take regular treatment which attributes to the remaining
28.57%. There are four people who do not take treatment regularly. The person who is suffering from diabetes
mellitus and hypertension stated her reason of not taking medication regularly is due to the reason that she
forgets to consume it sometimes. Next, the person who is having asthma gives the reason that she feels that
MDI is troublesome. Then the person who is having blurring of vision and loss of hearing decided to ignore her
illness. The last one is who is suffering from hypertension said they take the medication only when symptoms
arises.
MEDICAL CHECK-UP FOR ILLNESS

Figure (59): Bar graph showing enquiry on medical-check up for this illness.

Out of 14 respondents who suffer from chronic diseases, there are 12 of them who do go for medical check-up
for their illness. There are 2 of them who did not go for medical check-up.
FAMILY MEMBERS WITH DISEASE IN LAST 3 MONTHS
Family members suffering from
any disease in last 3 months
Yes
No
Total

Frequency

Percentage

7
29

19.4
80.6

36

100.0

Table (19): No. of family members suffering from any disease in last 3 months
Based on the table above, it shows that 19.4 % of the villagers had family member(s) who had fallen sick in the
past 3 months. There is 80.6 % of the family member(s) who did not fall sick during the past 3 months.

TYPE OF ILLNESS SUFFERED

Figure (60): Pie chart showing type of illness they suffered


Based on the pie chart above, among the family members who were sick during the past 3 months, noncommunicable disease shows a higher rate of incidence which is 71.4%, while communicable disease has an
incidence rate of 28.6%. Of all the family member of the respondents who fell sick in the last 3 months, each of
them seek medical healthcare for their illness.

HEALTH CARE CENTER VISITED

Enquiry on Health Care Center Visited


Klinik Kesihatan

Government Hospital

Private Hospital

14%

29%

57%

Figure (61): Pie chart showing enquiry on healthcare center visited


Based on the pie chart above, 1 villager which is 14.3 % of the total is seeking health care in the private
hospital, 2 of them which is 28.6% are seeking health care in klinik kesihatan and 4 of them which is 57.1 % are
seeking health care from the government hospital. It is obvious from here that the most preferred choice is to the
government hospital.

DISEASES DIAGNOSIS

Figure (62): Bar graph showing the diagnosis of illness


From the bar chart above, 2 villagers has suffered from hypertension and 2 villagers from Diabetes Mellitus.
The rest of respondents suffered from fever, trauma, hypercholesterolemia, heart diseases and respiratory tract
diseases, each disease affecting one person each. Thus, we can say that the most common illnesses suffered
among the residents here are hypertension and diabetes mellitus.

REGULAR TREATMENT FOR ILLNESS

Figure (63): Bar graph showing regular treatment taken for illness
Out of 7 respondents who suffered from chronic diseases, 6 of them take regular treatment for their illness. So
we can say majority of them are compliant to medications given. The one person who did not take regular
treatment for their illness is because the doctor had stopped the medications.

FAMILY MEMBERS PASSED AWAY

Figure (64): Bar graph showing enquiry on family member passed away last year
Based on the chart above, it shows that 11.1% of villagers have had one of their family members passing away
last year while 88.9% of them have none of their family members who passed away last year.

AGE OF DEATHS FOR THE PAST ONE YEAR IN KAMPUNG THYE ENG
Out of four households who gave mortality conditions in last year, it was found that the death occurred in the
age group of 0 to 6 year in one household and the three households had mortality in the age group of more than
60 year.

CAUSE OF DEATHS FOR THE PAST ONE YEAR IN KAMPUNG BARU THYE ENG

Figure (65): Pie chart showing cause of death of villagers for the past one year
The pie chart depicts the cause of death of the villagers who had died in the past one year. It is a continuation
and elaboration of the previous pie charts depicted above and serves as an explanation as to the reason for the
villagers untimely passing. According to the data, 1 villager had died of cardiovascular disease/heart attack,
accumulating a total of 0.61% of the total villagers. Also, only 2 villagers had died of old age, accumulating a
total of 1.21% of the total villagers. Another 1 villager had died due to a road traffic accident, accumulating a
total of 0.61% of the total villagers.

SECTION (F) BP AND BMI


BMI CATEGORY

Figure (66): Pie chart showing BMI category of respondents


The pie chart shows the Body Mass Index of the residents of Kampung Baru Thye Eng. Although it clearly
depicts half of the population in that are of normal body weight, it is important to note than almost the other half
of the population are overweight which is approximately 47.44%. This can easily relate to the incidence of
cardiovascular related diseases among the population. Among the population also lies 2.56% which is
equivalent to 2 members of the population who are under the category of underweight.

BP CATEGORY

Figure (67): Pie chart showing blood pressure category of respondents.

The pie chart clearly describes the overview of the blood pressure status among the residents of Kampung Baru
Thye Eng. What is important to gather from here is the amount of residents suffering from hypertension which
is 30.53% of the whole population. This means that the majority of the population which is about 69.47% are of
within the normal blood pressure level. Though it may seem like a small percentage of them suffering with
hypertension, it is important to know that the risk factors to increase this percentage is abundant in the area
especially since half of the population are overweight. Thus this condition can easily be the catalyst for more
cardiovascular related problem that this village already suffers from.

VARIABLE RELATIONSHIPS
a) Age and BMI

Age* BMI Category Crosstabulation


Age
40 years
BMI category

Underweight

Count
% within BMI category

Normal weight

Overweight

Total

50.0%

50.0%

100.0%

17

22

39

43.6%

56.4%

100.0%

11

26

37

29.7%

70.3%

100.0%

29

49

78

37.2%

62.8%

100.0%

Count
% within BMI category
Count
% within BMI category

>40 years
1

Count
% within BMI category

Total

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

1.706a

.426

Likelihood Ratio

1.717

.424

Linear-by-Linear Association

1.647

.199

Pearson Chi-Square

N of Valid Cases

78

a. 2 cells (33.3%) have expected count less than 5. The minimum expected count is .74.

Ho: There is no relationship between age and BMI


HA: There is relationship between age and BMI
Chi-square value : 1.706
p value = 0.426 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between age and BMI.

b) Sex and BP

Sex of respondent* BPCategory Crosstabulation


Sex of respondent

Total

Male
BPcategory

Hypertension

Count
% within BPcategory

Normotensive

20

29

31.0%

69.0%

100.0%

32

34

66

48.5%

51.5%

100.0%

41

54

95

43.2%

56.8%

100.0%

Count
% within BPcategory

Total

Count
% within BPcategory

Female

Chi-Square Tests
Value

df

Asymptotic

Exact Sig. (2-

Exact Sig. (1-

Significance (2-

sided)

sided)

sided)
Pearson Chi-Square

2.501a

.114

Continuity Correctionb

1.840

.175

Likelihood Ratio

2.555

.110

Fisher's Exact Test


Linear-by-Linear Association
N of Valid Cases

.123
2.475

.087

.116

95

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 12.52.
b. Computed only for a 2x2 table

Ho: There is no relationship between sex of respondent and BP


HA: There is relationship between sex of respondent and BP
Chi-square value : 2.501
p value = 0.114 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between sex of respondent
and BP.

c) Race and BMI

Race of respondent* BMI category Crosstabulation

Race of respondent
Malay
BMI category

Underweight

Count
% within BMI category

Normal weight

Count
% within BMI category

Overweight

Count
% within BMI category

Total

Count
% within BMI category

Chinese

Total
Indian

0.0%

50.0%

50.0%

100.0%

13

24

39

33.3%

5.1%

61.5%

100.0%

14

21

37

37.8%

5.4%

56.8%

100.0%

27

46

78

34.6%

6.4%

59.0%

100.0%

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases

7.010a

.135

4.148

.386

.308

.579

78

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .13.

Ho: There is no relationship between race of respondent and BMI


HA: There is relationship between race of respondent and BMI
Chi-square value : 7.010
p value = 0.135 (>0.05), it is not significant
Since p value is > 0.05, null hypothesis is accepted. There is no relationship between race of respondent
and BMI.

d) Occupation and BP

Occupation* BPcategory Crosstabulation


Occupation

Total

BPcatego

Hypertensi

Count

ry

on

% within

Governme

Non-

Self-

Unemploy

Retire

Stude

Other

nt

governme

employ

ed

nt

nt

ed

14

29

6.9%

10.3%

17.2%

48.3%

13.8

0.0%

3.4%

100.0

BPcatego

ry
Normotensi

Count

ve

% within

20

17

14

66

1.5%

30.3%

9.1%

25.8%

7.6%

21.2%

4.5%

100.0

BPcatego

ry
Total

Count
% within

23

11

31

14

95

3.2%

24.2%

11.6%

32.6%

9.5%

14.7%

4.2%

100.0

BPcatego

ry

Chi-Square Tests
Value

df

Asymptotic Significance (2sided)

Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases

16.480a

.011

20.562

.002

.084

.772

95

a. 7 cells (50.0%) have expected count less than 5. The minimum expected count is .92.

Ho: There is no relationship between occupation of respondent and BP level


HA: There is relationship between occupation of respondent and BP level
Chi-square value : 16.480
p value = 0.011 (<0.05), it is not significant
Since p value is < 0.05, null hypothesis is failed to be accepted. There is relationship between
occupation of respondent and BP level.

DISCUSSION ON COMMUNITY SURVEY


Demographic Data

The number of population that we obtained in Kampung Baru Thye Eng is not accurate because some villagers
were not in their house. And some of them refused to cooperate when interviewed. As a result, the outcome of
the survey is not accurate.
Based on the Figure 1, the adolescence group has the largest number of population. Senior citizen also shows a
better life expectancy and survival into the old age. This corresponds to the population pyramid pattern of
Malaysia due to the advancement and expansion of national healthcare service. The total dependency ratio in
Kg.Rusa is 57.1%. The total dependency ratio of population is Malaysia is 45%.
Estimates for year 2000 reported the following race distribution in Malaysia are: Malays (Bumiputra) is 58%,
Chinese 24%, Indians 8% and other groups 10%. The proportion of races surveyed in Kampung Baru Thye Eng
consists of Indian 56.3%, Malays 40.0%, Chinese 3.64%
For the marital status in Kampung Baru Thye Eng, the target population is those who are 18 years old and
above. The total population of the age considering 18 years and above is 95 and 50.3% are married which has
the highest percentage in that population. This is because the village is a rural area. And, the education level
among the villagers is not very good, with around 75% completing either primary or secondary education.
Hence, they choose to get married. Meanwhile, the second highest percentage is the single status in that
population. This could be due to their priorities in life where career comes first. In Malaysia, most of the women
who are married become housewives and it accounts for high percentage of unemployed villagers.
Based on the graph 1.5, about 11.1% villagers have a low income (<RM 500). The poverty line in Malaysia is
RM830 per month for a family. From the survey, most of the families are above the poverty line. A healthy
percentage of the families are earning more than the minimum wage of RM 900 stipulated by the government.
Based on the pie chart (Figure 7), there is around 39.39% accounting for secondary education. There is only
4.24% pursued their studies until tertiary level.
The main type of family in Kampung Baru Thye Eng is nuclear family which constitutes 72.22%. Children
under age of 18 are more likely to live in two parent families than in other family forms in Asian countries. In
2014, there were 7 million household in Malaysia and the percentage of nuclear family is 70.3% (resource from
Malaysia Population and Family Survey 2014,LPPKN Economic Planning unit). Malaysians prefer nuclear
family because it is an autonomous unit free from control of elders. Children are more close to parents and there
are less chances of in-laws conflict. Extended family is also common in Kampung Baru Thye Eng, which
constitutes 25.0%.They share the household responsibilities such as cooking, cleaning and organizing the entire
family.

Environmental Sanitation and Housing Variable

Based on Figure 11, the pie chart reveals that most of the houses in Kampung Baru Thye Eng is made up of
mixed material; that is bricks and wood. Majority of these houses have 3 rooms in it, and some even have up to
7 rooms in the house. 88.89% of the villagers usually clean their house every day, based on Figure 13.
Based on Figure 22, data collected shows that most of the houses in there are equipped with continuous
electricity supply (91.6%). 2.87% of the houses survive without electricity supply and 5.56% houses deal with
non-continuous electricity supply.
Most of the villagers are having a continuous electricity supply since Kampung Baru Thye Eng area is
developing. Moreover, the current governments project to develop rural areas via the project Rural
Transformation Project, and one of the projects target is to provide a continuous electricity supply to rural areas
is also contributes to this factor. The houses with no electrical supply are due to poverty and being unable to pay
the electrical bill.
Most of the villagers are having electricity bill between RM20-RM 60 (58.82%).
All the houses are equipped with constant pipe water supply. 91.43% of them usually boil their water before
drinking.
The villagers in Kampung Baru Thye Eng mostly use the septic tank type latrine. A few of the houses (around
10%) still use burial methods
The most frequented method to dispose the garbage was via garbage dumping which accounted for about
77.8%. This is because it was the most convenient, easy, and cheapest method for the villagers to dispose the
garbage.
Maternal and Child Care
All women are given complete immunization during their pregnancy. The pregnant mothers understand the
importance of being vaccinated and take their effort to get themselves vaccinated and also for their children.
They understand that being vaccinated improves the child`s health and evades any health problems.
Based on Figure 31, all of the pregnant mothers do go for their antenatal check-ups. 80.0% of them did not
suffer from any complications during their last pregnancy. However, 26.67% of the pregnant mothers had not
taken any sort of immunization during their pregnancy.
Table 4 shows the completion of vaccination among the children in Kampung Baru Thye Eng.All the four
children have been vaccinated according to schedule. One child hasnt received his vaccination yet because he
is still not up to the required age to receive the vaccination dose. Overall shows that most of the children were
vaccinated and they have a satisfying immunization.

Nutritional Assessment

Based on Table 6, most of the respondents take at least 3 meals per day, while some of them (9 of them/25.0%)
take more than 3 meals per day. 22 out of the 36 respondents usually dont skip any meals, while 9 of them
usually skip breakfast, and the remaining, lunch. Majority of the respondents do eat fish or poultry every day.
Vegetable consumption is also high among the respondents, with many of them eating vegetables every day in
the week.
32 out of the 36 respondents use vegetable oil for their cooking purposes. A vast majority of them do not
consume any type of nutritional supplements. Most of the respondents also do not consume much salty or oily
food.
Morbidity and Health Behaviours
Based on Table (15), 21.1% or 8 of the respondents had suffered from an acute disease in the last 3 months. Out
of these 8 people, only 6 of them did seek medical care for their disease.
Based on Figure (54), the most common type of disease that affects the residents of Kampung Baru Thye Eng is
respiratory tract infections. This accounts for 42.86% of the total type of illness that befalls these villagers.
Based on Table (18), 14 of the residents have suffered from disease that lasted for 6 weeks consecutively, which
is 37% of the total population of respondents.
The pie chart in Figure (65) shows that the most common cause of death in Kampung Baru Thye Eng in the past
1 year was due to old age. 2 villagers had passed away due to this, accounting for 1.21% of the total population
of Kampung Baru Thye Eng.
The pie chart in Figure (66) shows the Body Mass Index of the residents of Kampung Baru Thye Eng. Although
it clearly depicts half of the population in that are of normal body weight, it is important to note than almost the
other half of the population are overweight which is approximately 47.44%. This can easily relate to the
incidence of cardiovascular related diseases among the population. Among the population also lies 2.56% which
is equivalent to 2 members of the population who are under the category of underweight.
As for the blood pressure category, the amount of residents suffering from hypertension is 30.53% of the whole
population. This means that the majority of the population which is about 69.47% are of within the normal
blood pressure level. Though it may seem like a small percentage of them suffering with hypertension, it is
important to know that the risk factors to increase this percentage is abundant in the area especially since half of
the population are overweight. Thus this condition can easily be the catalyst for more cardiovascular related
problem that this village already suffers from.
Based on the cross tabulations, there were no correlations between sex of respondents and BP level. However,
there is a relationship between the occupation and BP level, showing that employed people had higher BP levels
than unemployed people, relating to possible stress at work.
Conclusion

In Kampung Baru Thye Eng, the highest proportion of race is Indian followed by Muslim and Chinese. The
dependency ratio is an indicator that can be used to estimate the economic burden of a family. The average
dependency ratio of household in Kampung Baru Thye Eng is in an unhealthy state because the number of
individuals who are economically inactive outnumbers the active ones. The education level of the residents is in
the borderline (secondary level) and this corresponds to the occupation and the income status. Those with the
higher educational level have the chances to have a better job with high income. The residents should have
awareness towards importance of education. This accounts for the income status of residents at the poverty line.
Most of the households do not face any problems with electricity supply, water supply, wastage disposal and
sanitary latrine. The cleanliness level is at the satisfactory level. Maternal and child healthcare is at the
satisfactory level in Kampung Baru Thye Eng. Most of the children are vaccinated. In conclusion, the health
status in this community is satisfying.

Recommendation
In order to improve the education level of the individual and family, parents should take their
responsibilities in their childrens education and to ensure that they have proper education including primary,
secondary and tertiary too. The residents should be educated about the method of proper waste disposal. The
residents still practice garbage burning and this should be taken seriously because it can cause pollution to the
land and air. MPSPK should provide garbage bin in each and every house in Kampung Baru Thye Eng, to
reduce the burden of residents to dispose their garbage. All the septic tanks must be improved to prevent
insanitation. For example, the size of the faeces drop hole in the floor or slab should not be larger than 25 cm to
prevent children falling in. Light should be prevented from entering the pit to reduce access by flies. This
requires the use of a lid to cover the hole in the floor when not in use. There is a need to create awareness
regarding the significance of family planning. This is to prevent unwanted pregnancies or increase burden to the
family. Programs should be done to create awareness among the pregnant women about how to take care of
themselves, foods to consume during pregnancy and exercises that can be done during pregnancy. Communitybased antenatal care services should be introduced in this village so that it is more convenient for the women to
receive antenatal care. Health campaigns should be organized to ensure that the residents receive proper health
education and regular medical check-ups. Residents should be made aware regarding importance of healthy diet
and sufficient physical activity. Mobile health care services should be provided for the convenience of the
residents.

REPORT ON HEALTH CAMP AT KAMPUNG BARU THYE ENG, BEDONG KEDAH 2016

Community Medicine posting in MBBS Year 3, AIMST University, requires the students to conduct a survey
in a community and to derive a community diagnosis based on the community survey conducted. At the end of
the survey, a health camp is to be conducted by the students to educate awareness among the residents of the
community. Both the survey and health campaign was conducted by members of Group D, Batch 19, MBBS
Year 3, AIMST University. This group consists of 25 medical students, supervised by course coordinator Dr. Inn
Kynn Khaing and advised by Head of Community Medicine Unit, Associate Professor Dr. Kyi Kyi Sein,
Associate Professor Dr. Leela Anthony Joe, and Associate Professor Dr. Tracy Sein.

The area that was assigned to us was Kampung Baru Thye Eng, Bedong, Sungai Petani, a moderate
socioeconomic village mainly accommodated by Indian ethnicity. At the end of the survey, we decided to
conduct the medical camp on the 13th May 2016. Planning and election of organizing committee was done 2
weeks prior to that date. The expected crowd for the health campaign was around 50 people, comprising mainly
of old folks, middle age adults, school-going children and pre-school children. On that very same day, the
Community Medicine Unit, Faculty of Medicine, Aimst University, together with the Rotary Club of Bandar
Sungai Petani, organized a Health Campaign in Kampung Baru Thye Eng, Sungai Petani. This event was
financially assisted by the Rotary Club of Bandar Sungai Petani.

The main objective of this health campaign was to instil basic health knowledge on the various communicable
and non-communicable diseases around us. This campaign was designed to educate the residents on the
preventive measures of various diseases and to promote a healthy lifestyle among the residents in Kampung
Baru Thye Eng. Through this campaign also, we would be able to highlight the medical problems faced by the
residents, and offer necessary help to improve their quality of life. Last but not least, it also provided an
opportunity for the medical students to expose themselves to various essential skills including history taking,
BMI measurement, blood pressure measurement and blood glucose assessment.

The event begun at 3.30pm. The first booth that greeted the public was the registration booth. Here, the
residents of Kampung Baru Thye Eng had to register themselves using their MyKad. Next, their height and
weight were measured, which was done by the medical students from Group D. This was essential in calculating
their BMI levels. Later, their blood pressure level was assessed using sphygmomanometers. Following that, the
residents were tested for their blood glucose level. The people were not informed that they were supposed to
fast before coming to the medical camp. Hence, the team that was taking the glucose levels compared the levels
with fasting blood glucose levels and post prandial glucose levels, accordingly. The residents were then referred
to the specific stations according to their blood pressure, glucose level and BMI. In the respective stations, a
few students were in charge to assist the consultants.

A total of four doctors were brought in for medical consultation namely Dr. Tin Soe (Medicine), Dr. Christina
Gellknight (Opthalmologist), Dr. Narayanan (Opthalmologist), Dr. Kanchan Ali (Paediatrician) and Professor
T.Pandurangan (Surgery), and who also the Dean of Faculty of Medicine, AIMST University. They contributed
to this health campaign by examining the patients, offering necessary counselling and prescribing medication to
the patients. At the same time, they also taught the medical students on how to perform a physical examination
and elicit the signs and symptoms in the patient. We were also aided by a Year 4 student, Kent Pee, who was
helping out the lecturers in the ophthalmology section, and was also tutoring the students. Dr. Leela Anthony
Joe, from the Community Medicine Unit played an important role in guiding and assisting the medical students
in the proper way of history taking and vital signs assessment such as BMI, blood pressure and blood glucose
level measurements. We were also joined by Professor Dr. PK Rajesh in his capacity as President of Rotary
Club Bandar Sungai Petani. He was accompanied by a few members of the Rotary Club.

Besides the medical check-up, there were several booths set up to educate and create awareness regarding
various lifestyle issues affecting the health. These include posters and brochure distribution about healthy diet,
effects of smoking, obesity and diabetes. Dr. Leela was at hand to demonstrate proper breast self-examination
to the women present there. Besides that, the Rotarians gave a talk on the vision and mission of the Rotary
Club. Professor Dr. P.K. Rajesh, Head of Department of Microbiology unit of AIMST University and also the
current President of Rotary Club Sungai Petani, gave a talk regarding the current emerging diseases including
typhoid and polio. This talk was very beneficial not only for the medical students but also the residents present
at the event. During the closing ceremony, souvenirs were distributed to the lecturers, medical consultants,
members of Rotary Club Sungai Petani and the Head of the village.

A part of this health camp also includes interactive activities and health education for children. This activity
was done on the same day at the Perpustakaan Kampung Baru Thye Eng, around 100 meters from the
Community Hall. It was conducted by 5 medical students from the same group. The activity was held from 3.30
pm to 5.00 pm. There were a total of 30 children who participated in the activities. The first activity that was
carried out was a colouring competition. The paper provided was that of vegetables, so it was also to educate the
children regarding the many different types of vegetables around us and its importance for health. The children
were given 45 minutes to colour the picture. Crayons and colour pencils were provided to them.

After the colouring event, the children were then invited to participate in a tooth-brushing and handwashing
activity. First, the medical students demonstrated the proper methods of hand-washing. After that, all the
children were given the opportunity to perform it step by step. Next, 2 dental students from the dental faculty of
AIMST University were at hand to explain and demonstrate to the children on the proper tooth-brushing
techniques. Toothpaste and toothbrushes were provided for them. Last but not least, we ended the session with
prize giving ceremony for the colouring competition. All the children were given a consolation prize, while the
winners received a stationary set. In total, this one day medical camp saw around 50 participants, excluding
children. We received good response from the residents of Kampung Baru Thye Eng. They looked satisfied with
the way the event was conducted and the medical assistance provided. They also mentioned that this kind of a

beneficial event should be held often in their village. As for the children, they were very excited and buzzing
with happiness throughout the event. The whole event ended at around 5.30 pm, and the medical students got
together to clean up the area before departing. Of course, pictures were taken as memories.

From this medical camp, it is believed that the awareness among the people of Kampung Baru Thye Eng has
improved, especially regarding various chronic diseases, healthy eating habit and importance of a balanced diet.
Although our Health Campaign had come to an end, we believe that we did deliver a sufficient take-home
message to all the villagers and children there. All in all, this Health Campaign was considered a great success,
with the students receiving praises from the lecturers regarding their approach towards the villagers and their
warmth throughout the medical camp duration.

TOPIC: HEALTHY LIFESTYLE AND FOOD HYGIENE

INTRODUCTION
Living a healthy lifestyle is certainly not easy. A healthy lifestyle is defined by three different categories
physical, mental, emotional and spiritual. In order to live a truly healthy lifestyle, you must balance all three
categories and they must all function together simultaneously.

In order to live a physically healthy lifestyle, you must learn how to balance your everyday life. Doing a
minimum of thirty minutes of cardiovascular activity for just three days a week, can do a myriad number of
positive things for your body. Not only can physical activity extend your years of life, but it can also reduce the
likelihood of getting many health related problems. Exercising is not the only important feature of being
physically healthy, though. A healthy diet is the key. The food pyramid is there for a reason Along with exercise
and a healthy diet, sleep is also very important! A healthy range of hours of sleep is between 7-9 hours. Once
youve reached a state of balance, you will already feel that much better physically, and even, mentally.

The term "food hygiene" is used to describe the preservation and preparation of foods in a manner that ensures
the food is safe for human consumption. This term typically refers to these practices at an individual or family
level, whereas the term "food sanitation" usually refers to these types of procedures at the commercial level
within the food industry, such as during production and packaging or at stores or restaurants. Food hygiene in
the home kitchen includes things such as the proper storage of food before use, washing one's hands before
handling food, maintaining a clean environment when preparing food and making sure that all serving dishes
are clean and free of contaminations. Meats must be stored and cooked properly as part of proper food hygiene.
Many people use containers that are especially designed for use in a freezer to preserve raw meats for later use.
Freezing helps slow the process of decay, thus minimizing the chances for food poisoning when the meat is
used later. Unfrozen meats should be stored in a refrigerator at a temperature of 40 Fahrenheit (4.44 Celsius)
or less. Meats also should be cooked thoroughly and to the proper temperature at least 140 to 165 Fahrenheit

(60 to 74 Celsius), depending on the specific type of meat before being eaten. Food hygiene also includes
keeping preparation areas clean and germ-free. Mixing bowls, spoons, paring knives and any other tools used in
the kitchen should be washed thoroughly before they are used, as well as after. Kitchen countertops and cutting
boards also should be cleaned and sterilized from time to time. Keeping the workspace is sanitary decreases the
chance that food will be contaminated and make people sick.
Preventing cross-contamination also is an important aspect of food hygiene. this can occur when cooking and
preparation utensils are used with more than one type of food without being washed in between. For example, if
the knife used to cut raw chicken is also used to chop lettuce for a salad, there is a chance that Salmonella
bacteria will be transferred to the lettuce. This bacteria is killed when the chicken is cooked, but can continue to
live on the vegetable, and could make someone who eats it sick with food poisoning. A cook might run a sink
full of hot soapy water as part of the preparation process, then drop each utensil in after using it. This not only
makes it easier to clean up after the food is prepared, it also prevents unwashed utensils from being reused. One
aspect of food hygiene that some people do not address is cleaning dishes before placing them on the table
before a meal. Although dishes that have been in a cupboard are likely to be relatively clean, a quick rinse with
hot water and a small amount of dish soap will prevent stray bacteria from or other contaminants from being on
the dishes. This is especially important for dishes that have not been used for quite a while, such as those
reserved for special occasions.

OBJECTIVES OF SURVEY
1. To assess the ways of healthy life style and food hygiene practised among villagers.

2.
3.
4.
5.

To assess the awareness towards hygiene in the community.


To assess opinion on healthy life style and food hygiene among villager.
To assess opinion on ways to improve the life style and food hygiene among villagers.
To assess the interest of villagers in taking initiative to improve lifestyle and food hygiene.

JUSTIFICATION
The result from focus group discussion is used to help the villagers to improve healthy life style and food
hygiene.

METHODOLOGY:

Focus group discussion is focus group is a data collection procedure in the form of a carefully planned
group discussion among about ten people plus a moderator and observer, in order to obtain diverse ideas
and perceptions on a topic of interest in a relaxed, permissive environment that fosters the expression of

different points of view, with no pressure for consensus


Purposive sampling (Heterogeneity sampling)
We verbally invited 10 different participants from the village on the day FGD was carried out.
On the day of FGD, only 7 out of 10 villagers turned up for the discussion session.
Focus Group Location: A small hall beside the mosque in the village.
Cadre: Avenesh Gopal (moderator), Ravines Selvaraju (note-taker 1), Priyadashini (note-taker 2),

(tape-recorder), Bryan Joseph (photographer 1), Logindrah(photographer 2)


Duration: 30 minutes
Transcriber: Ravines Selvaraju and Priyadashini
Individuals agreed to participate in the research of their own free will.
Written consent is preferred, but verbal consent was done instead.
Researchers agreed to keep personal information that is revealed to them confidential.

Criteria of targeted group:

Working adults aged 18 years and above

Male and female


Adolescents aged 13 and above

FINDINGS
Details of participants:
Participants*
Individual 1
Individual 2
Individual 3
Individual 4
Individual 5
Individual 6
Individual 6

Age
39
18
22
17
45
56
56

Sex
Female
Male
Male
Female
Female
Female
Female

Occupation
Housewife
Student
Student
Student
Housewife
Housewife
Housewife

*not real name if participants


RESULTS:
According to the discussion, the participants are all aware that they are not practicing a healthy lifestyle and
food hygiene. This actually shows that their poor life style and food hygiene that has been practicing by the
villagers actually lead to some health problems and also causes gastrointestinal infection among the villagers.
Some of them are not aware about poor food hygiene and food sanitation .From the discussion we had , they
agreed to change their lifestyle if they have proper guidance or knowledge on that.

CONCLUSION

From the discussions, we can conclude that the villagers are not practicing a healthy lifestyle and food
hygiene .Some of them are aware about these problems and yet no further initiative were taken by them due to
poor knowledge on the healthy lifestyle and also food hygiene .From this we came to a conclusion that only
some uses the correct hand wash steps to wash hands before and after meals and some of them not bother to
wash hands also .Besides that , poor food hygiene Some of them fail to prepare , store and reheat the food
well .Many of them dont clean their kitchens . Only of the house kitchen is nearby the garbage areas which
allows more flies to enter in the kitchen and yet the villagers didnt show any initiative to store the food
properly However, they have agreed to improve their lifestyle and also food hygiene if there is a guidance on
how to ways to improve.

RECOMMENDATIONS
The villagers need to be educated further regarding healthy lifestyle and food hygiene. Health educations and
health programmes are very much important to create awareness among For example health ministry can send
some volunteers to the village to teach them on steps to wash hands ,effective ways to store food and many
more .the villagers on how to practice good lifestyle and also food hygiene. Other than that, the government
must take action on the number of street dogs and cats in the village which actually disturbs the villagers
daily life and also hygiene. A petition can be signed by all the villagers and submitted to the government so
that they can do their part. The villagers need to be more cooperative and get involved in activities like
gotong royong more often to keep their village clean especially if their houses are nearby the garbage
dumping areas.

Annex 1:
Question Guidelines:1. Do you wash hands regularly before and after meal?
2. Do you soak your utensils in hot water before using them?
3. How far your kitchen from toilet or garbage dumping area?
4. Do you place the cooked food on the same area where there is raw meat, poultry or seafood?
5. Is your kitchen ventilated properly for cooking?
6. Do you have pets at home? If yes how often it comes to kitchen?
7. How often you reheat your food?
8. Do you cover your food on table after eat?
9. Do you boil your water before drink?
10. How often do you eat fruits in a week?
11. How often do you exercise or go for a walk in a week?
12. How often you eat oily, salty, sugary or fast foods per week ?
13. How many of you have diabetes mellitus and hypertension?
14. Do you wash the vegetables and meat properly before you cook?
15. How often you clean your kitchen?
Annex 2:

Moderator:
1. Do you wash hands regularly before and after meal?
INDIVIDUAL 1: I will wash my hands regularly before and after meal.
INDIVIDUAL 2: I will wash my hands regularly before and after meal.
INDIVIDUAL 3: I will wash my hands regularly before and after meal.
INDIVIDUAL 4: I will not my wash hands regularly before meal.
INDIVIDUAL 5: I will not my wash hands regularly before meal.
INDIVIDUAL 6: I will wash my hands regularly after meal.
INDIVIDUAL 7: I will wash my hands regularly before and after meal.
2. Do you soak your utensils in hot water before using them?
INDIVIDUAL 1: I will soak my utensils in hot water before using them.
INDIVIDUAL 2: I will not soak my utensils in hot water before using them.
INDIVIDUAL 3: I will wash soak my utensils in cold water before usingthem.
INDIVIDUAL 4: I will soak my utensils in cold water before using them.
INDIVIDUAL 5: I will not soak my utensils in hot water before using them.
INDIVIDUAL 6: I will soak my utensils in hot water before using them.
INDIVIDUAL 7: I will not soak my utensils in hot water before using them.
3. How far your kitchen from toilet or garbage dumping area?

INDIVIDUAL 1: Very near


INDIVIDUAL 2: Very far
INDIVIDUAL 3: Quiet near
INDIVIDUAL 4: Very far
INDIVIDUAL 5: Very far
INDIVIDUAL 6: Very near
INDIVIDUAL 7: Very near
4. Do you place the cooked food on the same area where there is raw meat, poultry or
seafood?
INDIVIDUAL 1: No
INDIVIDUAL 2: No
INDIVIDUAL 3: No
INDIVIDUAL 4: No
INDIVIDUAL 5: No
INDIVIDUAL 6: No
INDIVIDUAL 7: No
5. Is your kitchen ventilated properly for cooking?
INDIVIDUAL 1: No
INDIVIDUAL 2: Yes

INDIVIDUAL 3: Yes
INDIVIDUAL 4: Yes
INDIVIDUAL 5: No
INDIVIDUAL 6: No
INDIVIDUAL 7: No
6. Do you have pets at home? If yes how often it comes to kitchen?
INDIVIDUAL 1: No
INDIVIDUAL 2: Yes, I have a cat and it will be in kitchen most of the time
INDIVIDUAL 3: Yes but it wont enter the kitchen
INDIVIDUAL 4: Yes i have a dog and it will be kitchen whenever Im in kitchen.
INDIVIDUAL 5: No
INDIVIDUAL 6: No
INDIVIDUAL 7: No
7. How often you reheat your food?
INDIVIDUAL 1: Before the meal
INDIVIDUAL 2: Before the meal
INDIVIDUAL 3: Once in awhile
INDIVIDUAL 4: Before the meal

INDIVIDUAL 5: Before the meal


INDIVIDUAL 6: Before the meal
INDIVIDUAL 7: Before the meal
8. Do you cover your food on table after eat?
INDIVIDUAL 1: No
INDIVIDUAL 2: Yes
INDIVIDUAL 3: Yes
INDIVIDUAL 4: Yes
INDIVIDUAL 5: No
INDIVIDUAL 6: Yes
INDIVIDUAL 7: Yes
9. Do you boil your water before drink?
INDIVIDUAL 1: No
INDIVIDUAL 2: Yes
INDIVIDUAL 3: Yes
INDIVIDUAL 4: Yes
INDIVIDUAL 5: No
INDIVIDUAL 6: No
INDIVIDUAL 7: Yes

10. How often do you eat fruits in a week?


INDIVIDUAL 1: Everyday
INDIVIDUAL 2: 2 times in a week
INDIVIDUAL 3: Everyday
INDIVIDUAL 4: Everyday
INDIVIDUAL 5: I dont eat fruits.
INDIVIDUAL 6: I dont eat fruits.
INDIVIDUAL 7: I dont eat fruits.
11. How often do you exercise or go for a walk in a week?
INDIVIDUAL 1: Everyday
INDIVIDUAL 2: 3 times in a week
INDIVIDUAL 3: I dont have time to exercise or walk
INDIVIDUAL 4: Everyday
INDIVIDUAL 5: Once in a month
INDIVIDUAL 6: Once in a month
INDIVIDUAL 7: Every weekend
12. How often you eat oily, salty, sugary or fast foods per week?
INDIVIDUAL 1: Everyday

INDIVIDUAL 2: Everyday
INDIVIDUAL 3: I dont eat fast foods
INDIVIDUAL 4: Everyday
INDIVIDUAL 5: Once in a month
INDIVIDUAL 6: Every weekend
INDIVIDUAL 7: Every weekend
13. How many of you have diabetes mellitus and hypertension?
INDIVIDUAL 1: No
INDIVIDUAL 2: Yes
INDIVIDUAL 3: Yes
INDIVIDUAL 4: Yes
INDIVIDUAL 5: Yes
INDIVIDUAL 6: No
INDIVIDUAL 7: Yes
14. Do you wash the vegetables and meat properly before you cook?
INDIVIDUAL 1: Yes
INDIVIDUAL 2: Yes
INDIVIDUAL 3: Yes

INDIVIDUAL 4: Yes
INDIVIDUAL 5: Yes
INDIVIDUAL 6: Yes
INDIVIDUAL 7: Yes
15. How often you clean your kitchen?
INDIVIDUAL 1: Yes (Every weekend)
INDIVIDUAL 2: Yes (3 times in a week)
INDIVIDUAL 3: Yes (2 weeks once)
INDIVIDUAL 4: Yes (Every weekend)
INDIVIDUAL 5: Yes (3 times a week)
INDIVIDUAL 6: Yes (2 weeks once)
INDIVIDUAL 7: Yes (2 weeks once)

III. CLINICO-SOCIAL CASE STUDY


CASE NO. 1

COMMUNITY MEDICINE
PROFORMA FOR INTERGRATED APPROACH TO A CLINICAL CASE

NAME OF THE PATIENT :- Arumugam A/L Narayanasamy


AGE :- 38 years old

SEX :- Male

ADDRESS :- Kampung Thye Eng, 08100 Bedong, Kedah, Malaysia

PRESENTING COMPLAINTS :The patient is a known hypertension and DM patient since 10 years ago.
PRESENT HISTORY :In 2006, patient suddenly developed 2 swellings on left shin and 1 swelling on the back of neck with presence
of discharge. He denied any trauma history. At first week, he applied traditional remedy but the swelling didnt
resolve. Then, he seek medical treatment in KK Bedong and daily wound cleaning and ointment were
prescribed. He was diagnosed with HTN, DM and hypercholesterolemia at that time. 3months later, he did a full
body check up and the diagnosis was confirmed. Patient claimed to compliance to medications and follow up at

KK Bedong.
PAST HISTORY :No history of hospitalization before.
PERSONAL HISTORY :(1)PERSONAL HABITS - Patient is an active chronic smoker with 20 pack-year history. He also started
drinking alcohol since 18 years old with average one bottle per day. Currently, he has no intention to cut down
the cigarette and alcohol. He claimed that he is not dependent on alcohol.
(2) EDUCATION - He studied until primary school (Standard 2)
(3) OCCUPATION- He worked as a junk collector from age of 13 year old. Once he was diagnosed with HTN
and DM, he changed his work to contract worker and he claims that he becomes tired very easily and unable to
carry heavy weights.
FAMILY HISTORY:Strong family disposition of HTN and DM. His grandparents, parents and all sibling suffered from the same
illness. No history of asthma, CVD and stroke running in the family.
CONTACT / TREATMENT / INVESTIGATION HISTORY:Patient claimed to compliance to medications and follow up at KK Bedong.
IMMUNISATION HISTORY:Unknown.
FAMILY PROFILE:No
.

Name

Ag
e

Sex

Relatio
n

Education

Occupation

Marital
Status

Remarks

1.

Mariamm
ah

38

Femal
e

Wife

Primary

Selfemployed

Marrie
d

Yogenesh

16

Male

Son

Secondar
y

Student

Single

Yashini
Devi

13

Femal
e

Daught
er

Secondar
y

Student

Single

Premy

10

Femal
e

Daught
er

Primary

Student

Single

Devendir
an

Male

Son

Primary

Student

Single

Dhivyan

Male

Son

Kindergart

Student

Single

Raj

en

INCOME: Family income is fluctuating with average RM700 per month. The family income is barely sustainable with the
expenditure. He is currently applying for financial aid from Government.
ENVIRONMENTAL HISTORY:1. Type of House: The house is a wood house with adequate lighting and ventilation.
2. Type of Family: Nuclear
3. Garbage Disposal: Open burning
4. Source of Water: Treated pipe water
5. Latrine: 1 latrine located inside the house.
General Examination
:
-Overweight
-Patient is conscious and alert.
-No signs of respiratory distress or dehydration .
-Warm, pinkish and moist palm, no palmar erythema, no tendon xanthoma
-Nail colour pinkish, no digital clubbing .
-No flaming tremor
-No needle puncture marks on forearm
-His pulse rate is 76 bpm with normal volume, tone and rhythm.
-His blood pressure is 150/80 mmHg.
- No xanthelesma on the eyelids
- Sclera is white, no sign of jaundice
- Both pupils are round, regular and reactive
-Oral hygiene is average, no dehydration, no anemia and no central cyanosis.
- No cervical lymphadenopathy
- No bilateral pitting edema
Mental state examination:
-Good rapport
-Good eye contact
-His speech was coherent and relevant with normal tone, amount, speed and volume.
-Appropriate affect
Systemic Examination[ RS/ CVS ]
Inspection

: Chest wall has no gross deformities


There is no scar or masses can be seen.
There is no sign of respiratory distress.

Palpation
Percussion
Auscultation

: No tracheal deviation
Apex beat can be felt at left 5th ICS at midclavicular line.
: Lung percussion normal
: Normal breath sound.
S1 and S2 heard with no murmurs at 4 areas.

OTHER SYSTEM EXAMINATION :Abdomen examination :


- Inspection : abdomen is round but not distended ; umbilicus is inverted ; all quadrants move
synchronously with respiration; no visible peristalsis ; no other skin lesions on the abdominal wall
- Palpation : soft and non-tender; no mass can be felt. Liver and spleen is not palpable.
- Percussion : Liver span is normal (7cm)
- Auscultation : presence of normal bowel sounds.

PROVISIONAL DIAGNOSIS / DIFFERENTIAL DIAGNOSIS


Provisional diagnosis: HTN, DM , Hypercholesterolemia
Differential diagnosis: INVESTIGATIONS: Blood/ Urine/ Fundoscopy
Others
1) Blood pressure level
Lab investigation:
1) Routine test (check blood glucose level, check cholesterol level)
2) Biochemical screen such as renal profile test and lipid profile test (check for the association with metabolic
syndrome)
MANAGEMENT OF THIS PATIENT:Pharmacological management:
1) Simvastatin 20mg ON
2) Amlodipine 10 mg ON
3) Glibendazamide 25mg BD
4) Metformin 500mg BD
5) Invoril 20mg BD
Correct predisposing factors:
1) Advise patient to stop smoking and alcohol as they are most important risk factor of stroke and CVDs.
2) Advise patient to take adequate nutritional supplements and eat balanced diet to improve the recovery from
stroke).
3) Recommend to patient to receive treatment in a rehabilitation program. (This can help him regain his
strength, recover as much function as possible and return to independent living.

PREVENTIVE MEASURES INSTITUTED:


1) Diet modification
2) Regular exercise
2) General knowledge on complications that might develop from DM and HTN
DISCUSSION- 1
Aging process.
DISCUSSION- II
Medical Problems in the Family : Family history of Diabetes mellitus and hypertension
Economic Problems
: Low household income
Social Problems
: Not significant
DISCUSSION- III
What are the levels of prevention that have failed and why?
Primary prevention- Lack of health promotion during health campaign leads to lack of awareness of public
towards health issues
Secondary prevention- Patient lack of attention towards her condition
Tertiary prevention: Lack of awareness of healthy diet

CASE NO. 2

COMMUNITY MEDICINE
PROFORMA FOR INTERGRATED APPROACH TO A CLINICAL CASE

NAME OF THE PATIENT: Salmah binti Ayub


AGE: 50 years old

OCCUPATION: Housewife

SEX: Female

ADDRESS: Kampung Baru Thye Eng


COMPLAINTS: Difficulty in breathing
PRESENT HISTORY: Patient experienced sudden onset of breathlessness and difficulty in breathing during
hazy days. Patient claims that she will experience similar symptoms every time during rainy days. She also
claims that she can exercise well and doesnt experience any shortness of breath during exercise. Once she feels
breathlessness, she uses inhaler (Budesonide) first to stabilize her condition. If shortness of breath doesnt
subside, then she will use another inhaler (Ventolin). Patient refuses to take both inhalers at the same time as it
will make her feel tired. All the medicine that she takes currently is prescribed by the doctor in Klinik

Kesihatan. Patient also has seretide accuhaler which is prescribed by specialist. Patient claims that accuhaler is
her last option to relieve her breathlessness.
PAST HISTORY: Patient is a known asthma patient for 36 years. She started to have asthma when she was 14
years old. She has a family history of asthma (her mother). There is no other known medical illness. No
significant past surgical history.
PERSONAL HISTORY: Patient studied until SPM and is married and currently staying with her husband,
children, in a single storey village house. She does not smoke, consume alcohol or drug. She is a non-vegetarian
and has a balanced diet. Currently, she is a housewife.
CONTACT / TREATMENT HISTORY: Patient takes budenoside and ventolin when she feels difficulty in
breathing. Patient claims that she will stop the medication once her condition is stable. She has hospital
appointment (once five months) for check up and takes medicine. Previously, she had appointment once three
months.
IMMUNISATION HISTORY: BCG, ATT, VDRL, Hep B, Rubella
FAMILY PROFILE
No.

Name

Age

Sex

1
2

Rosli bin Ashak


Muhd Sukri bin Rosli

54
23

Male
Male

Siti Qhagahliza

18

Femal
e

Educatio
n
SPM
SPM
SPM

Occupation
Unemployed
Non
government
Non
government

PERCAPITA INCOME: RM 800


ENVIRINMENTAL HISTORY
1. Type of House
: Wooden and brick
2. Type of Family
: Nuclear family
3. Disposal of Waste
: Garbage dump
4. Drainage Waste
: Drain
5. Sanitary Latrine
: Septic Tank
GENERAL EXAMINATION
Average height and weight, normal BMI (45kg, 157cm, BMI=18.26)
Conscious, well orientated to time, place and person
No deformities and no swellings
No signs of respiratory distress
No signs of dehydration
Palms are pink and dry
No clubbing
No palmar erythema
Pulse- 76bpm, normal volume, rhythm, character
No signs of needle prick

Income
RM2000
RM1200

No sunken eyes orbit


No anemia and jaundice
No pallor
No central cyanosis, oral hygiene is good
No raised JVP
Breathing pattern and the rate was normal

SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
Inspection: No scar or masses seen on chest wall. There were no visible pulsations or prominent veins.
Chest is normal and symmetrical. Chest moves symmetrically with respiration.
Palpation: Trachea is centrally placed, chest expansion is normal, vocal and tactile fremitus is normal.
Percussion: No dullness or hyper resonance.
Auscultation: Vesicular breath sound and wheezing can be heard on both sides. No crackle is heard.
CARDIOVASCULAR SYSTEM
Inspection: No scar, masses, visible pulsation or prominent veins. No deformities of sternum or spine. Chest
is normal and symmetrical.
Palpation: Apex beat can be felt and not displaced, no thrills and heaves felt.
Percussion: Not done routinely.
Auscultation: 1st and 2nd heart sounds was heard. No additional heart sounds or murmurs were heard.
DIFFERENTIAL DIAGNOSIS: Emphysema, COPD
PROVISIONAL DIAGNOSIS: Bronchial Asthma
INVESTIGATIONS: Chest x-ray, Oxygen saturation monitoring, Pulmonary function test, Allergy testing
MANAGEMENT OF THIS PATIENT: Medication- MDI budesonide 4 dose 2x daily and MDI ventolin 2
dose when needed. Reduce exposure to dust and wear mask.
PREVENTIVE MEASURES INSTITUTED: Avoid inhalation of dust, use face mask
DISCUSSION- 1
Probable Source of infection- Environmental factors such as smoke from vehicles, dust mites, smoke from
burning rubbish, tobacco smoke
Measure to protect the other members in the family: Use face mask, avoid open burning
Measure to protect the community: Avoid open burning, use face mask, reduce air pollution, mass education
on risk factors of bronchial asthma
DISCUSSION- II
Medical Problems in the Family : Family history of asthma (mother)
Economic Problems
: Low household income
Social Problems
: Not significant
DISCUSSION- III

What are the levels of prevention that have failed and why?
Primary prevention- Lack of health promotion during health campaign leads to lack of awareness of public
towards health issues
Secondary prevention- Patient lack of attention towards her condition
Tertiary prevention: Lack of awareness about importance of avoidance of allergens in preventing disability,
lack of cost-effective treatment, lack of breathing exercise to prevent the development of severe COPD

CASE NO. 3

COMMUNITY MEDICINE
PROFORMA FOR INTERGRATED APPROACH TO A CLINICAL CASE
NAME OF THE PATIENT: Thilaiammal Ponnusamy
AGE: 84 years old

OCCUPATION: Unemployed

SEX: Female

ADDRESS: No. 7, Kampung Baru Thye Eng, 08100 Bedong Kedah Darul Aman
COMPLAINTS: Pain at left arm with underlying Hypertension and Diabetes mellitus
PRESENT HISTORY: Patient claims to have sharp pain at her left arm radiating from her chest. She says that
the pain is intermittent. She has no difficulties breathing. She constantly feels lethargic and has severe backache.
She claims to sometimes have palpitations especially in stressful situations where she thinks a lot. All the
medicines that she takes currently is prescribed by the doctor in Klinik Kesihatan.

PAST HISTORY: Patient is a known hypertension and diabetes mellitus patient for over 70 years. She claimed
to have been diagnosed with both illnesses at the age of 10 through random screening. She is unsure of her
family history. There is no other known medical illness. She had a cataract surgery done on her left eye 10 years
ago.
PERSONAL HISTORY: Patient did not go to school and is widowed. She currently lives with her daughter and
her family in a village house. She does not smoke, consume alcohol or drugs. She is a non-vegetarian. Her diet
since childhood has not been in control and she often eats sweets.
CONTACT / TREATMENT HISTORY:
Patient currently takes:
- Hydrochlorothiazide 50mg OD
- Acetylsalicyclic Acid 100mg Glycerin 45mg OD
- Perindopril 8mg OD
She has hospital appointment on a monthly basis for check up and takes medicine.
IMMUNISATION HISTORY: Unsure
FAMILY PROFILE
No.

Name

Age

Sex

Educatio
n

Occupation

Income

Gopalan Ramayanan

60

Male

Primary
School

Nongovernment
(Labourer)

RM 500

Santha Muniandy

59

Femal
e

Cleaner

RM 600

Menon Nair

29

Male

Unemployed
(Disabled)

Sangkaran Nair

20

Male

Tertiary
Educatio
n

Student

Previn Nair

16

Male

Secondar
y School

Student

PERCAPITA INCOME: RM 1100


ENVIRINMENTAL HISTORY
6. Type of House
: Brick
7. Type of Family
: Extended family
8. Disposal of Waste
: Garbage dump
9. Drainage Waste
: Drain
10. Sanitary Latrine
: Septic Tank

GENERAL EXAMINATION
Average height and weight, normal BMI (46kg, 144cm, BMI=23.5)
Conscious, well orientated to time, place and person
Mild kyphosis
No signs of respiratory distress
No signs of dehydration
Palms are pink and dry
No clubbing
No palmar erythema
Pulse- 96bpm, normal volume, rhythm, character
No signs of needle prick
No sunken eyes orbit
No anemia and jaundice
No pallor
No central cyanosis, oral hygiene is good
No raised JVP
Breathing pattern and the rate was normal
Fine tremors seen on limbs and head nodding
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
Inspection: No scar or masses seen on chest wall. There were no visible pulsations or prominent veins.
Chest is normal and symmetrical. Chest moves symmetrically with respiration.
Palpation: Trachea is centrally placed, chest expansion is normal, vocal and tactile fremitus is normal.
Percussion: No dullness or hyper resonance.
Auscultation: Normal breath sound heard on both sides with no added sounds.
CARDIOVASCULAR SYSTEM
Inspection: No scar, masses, visible pulsation or prominent veins. No deformities of sternum or spine. Chest
is normal and symmetrical.
Palpation: Apex beat can be felt and not displaced, no thrills and heaves felt.
Percussion: Not done routinely.
Auscultation: 1st and 2nd heart sounds was heard. No additional heart sounds or murmurs were heard.
DIFFERENTIAL DIAGNOSIS: Aortic aneurysm
PROVISISONAL DIAGNOSIS: Hypertension and Diabetes mellitus associated with aging
INVESTIGATIONS: Blood screening, Chest Xray
MANAGEMENT OF THIS PATIENT:

Medication:

Hydrochlorothiazide 50mg OD
Acetylsalicyclic Acid 100mg Glycerin 45mg OD
Perindopril 8mg OD

PREVENTIVE MEASURES INSTITUTED: Diet control


DISCUSSION- 1
Aging process.
DISCUSSION- II
Medical Problems in the Family : Family history of Diabetes mellitus and hypertension
Economic Problems
: Low household income
Social Problems
: Not significant
DISCUSSION- III
What are the levels of prevention that have failed and why?
Primary prevention- Lack of health promotion during health campaign leads to lack of awareness of public
towards health issues
Secondary prevention- Patient lack of attention towards her condition
Tertiary prevention: Lack of awareness of healthy diet

CASE NO. 4

COMMUNITY MEDICINE
PROFORMA FOR INTERGRATED APPROACH TO A CLINICAL CASE

NAME OF THE PATIENT : Ganasan A/L Rengasamy


AGE : 69 years old

Occupation: Tourist bus driver

SEX :MALE

ADDRESS : No. 14, Kampung Baru Thye Eng, 08100,


Sungai Petani, Kedah Darul Aman
PRESENTING COMPLAINTS : Patient complained of weakness on right side of the body.
PRESENT HISTORY :

Patient complained of weakness in right side of the body 7 years ago. Patient faces trouble in seeing on
the right side. Patient also suffers from loss of balance and needs to be supported at times. Able to walk but very
slowly and supported by the walls. His symptoms started year 2009 when he was praying. While trying to get
up from a kneeling position he suddenly fell on to the floor and was unable to get up and was confirmed
suffering from stroke in HSAH. Patient has no problems in swallowing. Patient did not suffer any head trauma
prior to his condition.
Patients hypertension and cholesterol level is now under control as he is compliant to the medication.
Patient has no sleep or appetite problems. He was in a semiconscious state during admission. Upon
examination, Patient was not able to move the right side of the body. Patient suffered from right side face
drooping. Patients speech was severely slurred. His blood pressure recorded was 220/110 mmHg. Patients
blood test result showed high cholesterol level. CT scan was done. ECG result recorded was normal. Patient
was admitted for a week.
Soon he was discharged with some medication. Last year around September, patient complained of
dizziness. He also complained of weakness and numbness on the right side of the body in the night after eating
beef soup. So he took 2 Panadol and went to sleep. He woke up in early morning next day to use washroom and
he fell on the way. He was unable to stand on his feet and called out to his family members for help. His wife
helped him and immediately brought him to the nearest private clinic. The doctor then referred him to Hospital
Sultan Abdul Halim.

PAST HISTORY : Medical History: Did not undergo any surgery/ previous hospitalization. No major injuries to any part of
body. No similar episode in infancy or childhood. No episode of head trauma.

Drug history: Nil

PERSONAL HISTORY:

Education level: Secondary school


Marital status: He got married at the age of 28 and was blessed with three children.
Occupation: Unemployed. Patient stopped working after suffering from stroke.
Habits: Patient smokes cigarettes daily since the age of 17. Patient attempted to quit once after suffering
from stroke but failed to stop.

FAMILY HISTORY:

There is no significant family history of stroke.


His father passed away when age 72 years old and was having Diabetes Mellitus, while his mother was died
due to old age when age 89years old.

CONTACT / TREATMENT / INVESTIGATION HISTORY:

Patient had a CT scan done during his hospitalization.


Patient has been on the following medications:
a Amlodipine 10mg OD
b Simvastatin 20mg OD

c
d
e

Glyprin 100g OD
Ramitidine 150mg BD
Acetylsacylic acid 150mg OD

IMMUNISATION HISTORY
Unable to retrieve information
FAMILY PROFILE:
No.

Name

Age

Sex

Education

Occupation

Income

GANESAN A/L
PUMUSAMY
NAGANEL A/P
ARUMUGAM
THIGARAJAN

68

Male

Secondary

Unemployed

64

Female

Secondary

Unemployed

33

Male

Secondary

RM500

4.

THAMIYANTHI

10

Female

Secondary

Works in
private sector
Student

5.

THIRUVARASAN

Male

Primary

Student

1.
2.
3.

PERCAPITA INCOME: RM 500

ENVIRONMENTAL HISTORY
1

Type of House

: Brick house

Type of Family

: Nuclear

Garbage Disposal: Open burning

Waste Water/Sullage disposal: Pipe Water

Latrine

: flush

General Examination :
General appearance patient appears well built and tall.

Pulse rate= 70/min


Respiratory rate = 14 breaths per min
Mental status: alert, good memory, orientated to time, place and person.

Head
Eyes: no jaundice
Oral cavity: good hygiene, presence of nicotine stain, no cyanosis
No enlargement of cervical lymph nodes
Hands
Dry and warm(normal) and pink in colour (normal)
No clubbing, Oslers node, Janeway lesion and splinter haemorrhage and capillary refill time is
normal
Nail colour (normal)

Systemic Examination

[CVS]

Inspection

: No visible scars, masses or pulsations, No skeletal deformities

Palpation

: No abnormal findings

Percussion

: No abnormal findings

Auscultation

: Absence of murmur

OTHER SYSTEM EXAMINATION

CNS:
Examination of Sensory System: Intact
Examination of motor system:
o Bulk of muscle No reduction in muscle bulk.
o Tone of muscle: Decreased tone in right side limbs.
o Power of muscles: right side limbs relatively weaker than left side limbs
o Reflexes: normal on both sides.

PROVISIONAL DIAGNOSIS / DIFFERENTIAL DIAGNOSIS


Stroke
Deep vein thrombosis
Systemic infection

INVESTIGATIONS:
CT scan should be done.
MRI scan
EEG

MANAGEMENT OF THIS PATIENT


f
g
h
i
j

Amlodipine 10mg OD
Simvastatin 20mg OD
Glyprin 100g OD
Ramitidine 150mg BD
Acetylsacylic acid 150mg OD

PREVENTIVE MEASURES INSTITUTED:


Patient should stop smoking.

DISCUSSION I
Probable Source of infection: nothing significant
Measure to protect the other Members in the Family
Dietary changes: Reduce salt intake and fatty food to prevent increase in blood pressure, and thus
reduce the risk of having stroke.
Physical activity: Exercise at least 3 times per week, with each session lasting about 20-30 minutes
to ensure a healthy lifestyle.
Each family member is advised to go for regular health screening, especially those above the age of
40 to help identify the risk factors of having a stroke (eg. hypertension, hypercholesterolemia,
obesity)
Measure to protect THE COMMUNITY

Dietary changes: Reduce salt intake and fatty food to prevent increase in blood pressure, and thus
reduce the risk of having stroke.

Physical activity: Exercise at least 3 times per week, with each session lasting about 20-30 minutes
to ensure a healthy lifestyle.
Each person is advised to go for regular health screening, especially those above the age of 40 to
help identify the risk factors of having a stroke (eg. hypertension, hypercholesterolemia, obesity)

DISCUSSION II
Medical Problems in the Family / Family History: Patient suffers from hypertension, hypercholesterolemia and
stroke. Family history of diabetes mellitus.
Economic Problems: Low household income
Social Problems: Not significant
DISCUSSION III
What are the levels of prevention that have failed and why?

Primordial prevention failed. This is because patient did not practice proper balanced diet inadequate
exercises.

CASE NO. 5

COMMUNITY MEDICINE
PROFORMA FOR INTERGRATED APPROACH TO A CLINICAL CASE
NAME OF THE PATIENT :- Janaki
AGE :- 65 years old

SEX :- Female

ADDRESS :- Kampung Baru Thye Eng, 08100 Bedong, Kedah


PRESENTING COMPLAINT: The patient complained of excessive thirst and increased urine frequency since 2 years ago.

PRESENT HISTORY :The patient is a known case of diabetes mellitus since May 2014. She experienced polyuria and
polydipsia for about 3 months before she was diagnosed. She also complained of increased
urine frequency at night. The patient is also a known case of asthma since she was 10 years
old. She goes for regular check-up for her asthma and during such routine check-up, she was
diagnosed with diabetes mellitus. She has been on antidiabetic drugs such metformin for the
past 2 years. She claims to be compliant to the drug and that her diabetes mellitus is well
controlled. She is under routine check-up every 3 months at Hospital Abdul Halim, Sungai
Petani and during her last check-up 2 months ago, her blood glucose level was normal.
Recently, she claims that she has been feeling dizzy when she walks and has fainted on 2
occasions in the past 1 month. According to the patient, her blood glucose level has
suddenly gone down and it may be due to her habit of skipping her meals especially
breakfast. She did not seek medical care for the hypoglycaemia as she felt fine after eating
and resting for a while.
PAST HISTORY :Medical history:
Patient is a known case of asthma since the age of 10 years old with poor-control. She last attack was 1 month
ago in which she had to go to hospital and given gas.
In 2014, patient was diagnosed with Diabetes Mellitus.
Surgical History:
No surgical history.
PERSONAL HISTORY :The patient is a non-smoker, non-alcoholic but she chews bettle nuts since teenage.
She is uneducated.
The patient was a rubber tapper for more than 30 years and stopped 20 years ago to take
care of her grandchildren.
Currently, her family owns a farm right near their house where they rear goats. The patient
takes care of the goats everyday.
FAMILY HISTORY:
Strong family history of diabetes mellitus and asthma. Her son has diabetes mellitus while
her mother and younger brother had asthma.
CONTACT / TREATMENT / INVESTIGATION HISTORY
Currently the patient is under medication for asthma and diabetes mellitus. She is also
taking antihypercholesterolemia drugs. She is compliant to the medications and goes for
follow-up to Hospital Sultan Abdul Halim, Sungai Petani.
IMMUNISATION HISTORY
Unknown.

FAMILY PROFILE:
No
Name
.
KRISHNAN
1.
2.

Ag
e
75

MALE

UNEDUCATED

UNEMPLOYED

JANAKU

65

FEMALE

UNEDUCATED

UNEMPLOYED

JALANDREAN

49

MALE

UNEDUCATED

UNEMPLOYED

KULAMAGAL

41

FEMALE

UNEMPLOYED

PRASAD

18

MALE

STUDENT

SANTHOSH

13

MALE

STUDENT

SARAVANAN

36

MALE

SECONDARY
EDUCATION
SECONDARY
EDUCATION
PRIMARY
EDUCATION
UNEDUCATED

VINOTHINI

31

FEMALE

UNEDUCATED

SARISH

MALE

UNEDUCATED

UGGASHINI

FEMALE

NATISH

19

MALE

PRIMARY
EDUCATION
SECONDARY
EDUCATION

Sex

Education

Occupation

SELFEMPLOYED
GOVERNMENT
EMPLOYMENT
OTHERS

RM700
RM800
-

STUDENT

STUDENT

PERCAPITA INCOME: Total income (RM1500.00) divided by 11=RM 136.67

ENVIRONMENTAL HISTORY:1. Type of House: Single-storey brick house.


2. Type of Family: Extended family
3. Garbage Disposal: Dumping
4. Source of Water: Treated pipe water
5. Latrine: 1 latrine located inside the house.

General Examination

Income

Well built
No signs of respiratory distress or dehydration
Radial pulse 68bpm, no radio-radial delay, present collapsing radial pulse

Warm, pinkish and moist palm, no palmar erythema


Nail colour pinkish, no digital clubbing (Lovibond angle less than 180 degree), Schamroths
window test shows intact diamond shape, nail capillary refill time normal, no splinter
hemorrhage
No flapping tremor
No needle puncture marks on forearms
No pallor of palpebral conjunctiva
Slightly yellowish sclera, probably due to old age. No early sign of jaundice
Good oral hygiene, no high arched palate
No enlarge occipital and clavicular lymph nodes
No pitting edema
No tracheal deviation
Mental state examination:
Well grooming
Good rapport
Appropriate eye contact
Coherent and relevant speech
Appropriate affect

Systemic Examination[ RS/ CVS ]


Inspection
Palpation
Percussion
Auscultation

: Chest wall has no gross deformities


There is no scar or masses can be seen.
There is no sign of respiratory distress.
: No tracheal deviation
Apex beat can be felt at left 5th ICS at midclavicular line.
: Lung percussion normal
: Normal breath sound.
S1 and S2 heard with no murmurs at 4 areas.

PROVISIONAL DIAGNOSIS / DIFFERENTIAL DIAGNOSIS


Provisional diagnosis: Diabetes mellitus and asthma
Differential diagnosis: None

INVESTIGATIONS: Blood/ Urine/ Fundoscopy


Others
1) Blood pressure level
Lab investigation:
1) Routine test (check blood glucose level, check cholesterol level)
2) Biochemical screen such as renal profile test and lipid profile test (check for the association with metabolic
syndrome)
MANAGEMENT OF THIS PATIENT:Pharmacological management:
1) Simvastatin 20mg ON
2) Metformin 500mg BD
3) MDI Budesonide use when needed
PREVENTIVE MEASURES INSTITUTED:
1)
2)
3)
4)

Diet modification
General knowledge on complications of diabetes mellitus and asthma
Drug compliances
Prevent inhalation of dust

DISCUSSION 1

Probable Source of infection: Not significant.


Measure to protect the other Members in the Family
Dietary changes : Reduce sugar intake and fatty food to prevent increase in blood glucose level and
thus reduce the risk of having diabetes mellitus.
Physical activity : Exercise at least 3 times per week, with each session lasting about 20-30 minutes
to ensure a healthy lifestyle.
Each family member is advised to go for regular health screening, especially those above the age of
40 to help identify the risk factors of having diabetes mellitus
Measure to protect THE COMMUNITY

Dietary changes : Reduce sugar intake and fatty food to prevent increase in blood glucose level and
thus reduce the risk of having diabetes mellitus.
Physical activity : Exercise at least 3 times per week, with each session lasting about 20-30 minutes
to ensure a healthy lifestyle.
Each person is advised to go for regular health screening, especially those above the age of 40 to
help identify the risk factors of having diabetes mellitus.

DISCUSSION II
Medical Problems in the Family / Family History

Strong family history of diabetes mellitus and asthma. Her son has diabetes mellitus while
her mother and younger brother had asthma.
Social Problems:
None.
Economical problem:
They have low family income.
DISCUSSION III
What are the levels of prevention that have failed and why?
Failed at the level of primordial prevention:
This is due to his unhealthy diet such as increased intake of sugar.
Failed at the level of primary prevention:
This is due to lack of awareness on health issues such as diabetes mellitus due to lesser health promotions.

IV. APPENDIX
APPENDIX 1
DEMOGRAPHIC DATA AND COMMUNITY POSTING QUESTIONNAIRE

HEALTH ASSESSMENT OF KAMPUNG BARU THYE ENG, BEDONG, KEDAH


(A) Demography and Family Characteristics
HN.

Household Number

: |_||_||_]

D1.

No. of Family Members

: ________

Interviewer Name:

Occupants of the house :

D2

D3

D4

D5

D6

D7

D8

D9

D10

D11

No

Name

Age
(yrs)

Sex

Race

Religion

Marital status

Occupation

Education

Relationship

Remark

1. Male
2.
Female

1. Primary

1. Wife /
Husband

3. Self-employed

2. Secondary
3. Tertiary and
above

2. Son / daughter
3. Father /
Mother

4. Widowed

4. Unemployed

99. Others

4. F/M in law

99. Others

5. Retired

5. S/D in law

6. Student

6. Grandchildren

99. Others

7. Uncle / Aunty

1. Malay

1. Islam

1. Single

2. Chinese

2. Buddha

2. Married

1. Government
2. Nongovernment

3. India

3. Christian

3. Divorced

99. Others

4. Hindu
99. Others

99. Others
1

Respond

HOF

D12. Type of Family


1. Nuclear
2. Extended

3. Blended
99. Others(specify) : _____________

D13.
Family Income (Monthly)
1. RM500 (Low Income)
2. RM501-1000 (Lower Middle Income)
3. RM 1001 1500 (Middle Income)

:
4. RM 1501 2000 (Higher Middle Income)
5. > RM2500 (High Income)

(A) Housing And Environmental Sanitation


House
DH1

Type Of House

1. Village House
2. Single-Storey
1.

DH2

Material Made

3. Multi-Storey
99. Others(specify)
:

1. Wood

2. Brick

2.

DH3

No. of Rooms

__________ Rooms

3.

DH4

Kitchen

1. Yes

4.

DH5

How often do you clean your house?


1. Daily
2. Weekly
3. Fortnightly
Latrines

3. Mixed

2. No

4. Monthly
5. Never

DL1 Number of Latrines in the house:


1. None
2. One
DL2

3. Two
4. More than 3
Types of Latrine:

1. Cartage/Buckets
2. Pit Latrine
DL3

3. Septic Tank
99. Others (Specify)_________

Frequency of cleaning the latrine (per week) : ________________

Solid Waste Disposal


DS1

How do you dispose your garbage?

1. Open burning
2. Dumping (River, etc)
3. Bury in the soil

4. Burn
99. Others (specify) ___________

Water Supply
DW1

Water source came from?

1. Rain water
2. Ground water

DW2

3. Pipe water
99. Others (Specify) ________________

How do you treat/purify the water in your household for drinking purpose?

1. Chemical agent
2. Boiling
DW3

3. Filtration
99. Others, (specify)_________

Quality of drinking water (observed by students)


1.Yes

2. No

DW3A Colour
DW3B Clear
DW3C Smell
DW3D Taste
DW4

Interruption of Water Supply:

1. YES

2. NO

DW5

If Yes. How often does it occur:

DW6

Water Bill Monthly:

1. Rarely

2.Frequent

1. < RM10
2. RM 11 - 20
Electrical Supply
DE1
How is the electricity supply to your house?
1. Continuous Supply
2. Cut off. If yes, please state how frequent it is? ______________
3. None
DE2
1.
2.
3.
4.
5.
6.
7.

Electrical Bill (monthly)

None
< RM 20
RM 21 40
RM 41 60
RM61 80
RM 81 100
> RM 100

MATERNAL CARE
(Woman 15 yrs-49 yrs old)

MCA 1) What was your age during first pregnancy ( if any)?

3. RM 21 30
4. >RM 30

MCA 2) Number of pregnancies you had? _____


Currently pregnant?
MCA 3) When was your last pregnancy?
1.

Less than a year

4.

MCA 4) Number of children. ______

5.

MCA 5) Did you have any miscarriage during any of your pregnancies?
6.
1.Yes ( ) 2.No ( )

7.

2.

1-3 years

3.

More than 3 years

MCA5a) If yes, was it

1.

1.

Natural

3.

MCA 6) Do you practice any family planning?

Yes ( )
4.

2.

Induced (Why..)

2. No ( )
MCA6a) If yes, how?

1.
2.
3.
4.
5.
6.
7.
99.

Oral contraceptives (Pil Perancangan Keluarga)


IUCD
Injection (Suntikan Hormon)
Physical barriers (e.g. condom or diaphragm)
Abstinence (Mengelakkan Persetubuhan)
Withdrawal method (Tarik Keluar?)
Calendar method (Cara Kalendar)
Others _________
8.

9.

MCA7) Did you take any of these medications during recent pregnancy?
1.
2.
3.
99.

Allopathic (Prescribed) Medicine


Traditional Medicine (specify)___________________
Both
Any other medication (specify)__________________

4.

MCA8) Where did you go for your antenatal care during your recent pregnancy?

1.
2.
3.

Government Hospital
Government Health clinic
Private Hospital

5.
6.

MCA9) Do you go to regular antenatal follow-up?


1.
7.

4. Traditional Birth Attendant


99. Others (specify)
_________________________

Yes ( ) 2. No ( )

MCA9b) If no or not all, what was the reason?

1. The nearest health care center is too far away or no transport


2. Lack of time
3. No Companion
99. Others: _____________
8. MCA10) Did you face any complications during your last pregnancy?
1. Yes,
9. MCA10a) If Yes,what was the problem?
1. Diabetes mellitus
4. Anaemia
2. Hypertension/ pre-eclampsia
5. Eclampsia
3. Obesity
6. 99. Others (specify)________
7.
2. No

8.
9.

MCA11) Any immunization taken during last pregnancy?

1.
4.

Yes

2.

5.

DELIVERY/ POST NATAL

No

6. DPN1) Where did you deliver your last child?


1. Government Hospital
2. Alternate birth centre
3. Private Hospital
5.
6. DPN2) Was your child
1. Preterm
3.
4.

3.

Not sure

4. Traditional Birth Attendant


99. Others (specify)

2.

DPN3) What was the method of delivery of your children?


1 Spontaneous vaginal delivery
2 Cesarean section

Full term

Assisted delivery

4
1.
2.
3.
5.
6.

5 DPN4) What are the complications you faced during/after delivery?


Prolonged labour
4. Post-partum haemorrhage
Convulsions
99. Others(specify).....................
Prolapse of the cord
DPN5) How many times did the staff nurse provide in-house care?

7.
8.
9.

BREAST-FEEDING

10. DPN6) Did you breastfeed your child?


1.
3.

Yes ( )
DPN7) Is there any problems during breastfeeding?

2.

No ( )

1.

Yes ( )DPN7a) State______

2.

No ( )

3.

DPN8) How long did you breastfeed (exclusive) your child?

1.

Less than 6 months

2.

6 months or more

4.
5.
6.

CHILD IMMUNIZATION VARIABLES

7.

CM1) Is the immunization complete according to the schedule?

1.

Yes

2.

No

2.

CM2) Child

3.

Child

4.

CM3) Age

5.

Age

6.

CM4) Sex

7.

Sex

8.

CM5) Immunization card (1.yes/2.no)

9.

Immunization card (1.yes/2.no)

10. CM6) At birth

11. BCG
(1.yes/2.no)

12. At birth

13. BCG
(1.yes/2.no)

14.

15. Hep
B(1.yes/2.n
o)

16.

17. Hep
B(1.yes/2.no)

18. CM7) 1
month/bulan

19. Hep
B(1.yes/2.n
o)

20. 1 month/bulan

21. Hep
B(1.yes/2.no))

22. CM8) 2
month/bulan

23. DPT(1.yes/
2.no)

24. 2 month/bulan

25. DPT(1.yes/2.n
o)

26.

27. IPV(1.yes/2
.no)

28.

29. IPV(1.yes/2.no
)

30.

31. HIB(1.yes/2
.no)

32.

33. HIB(1.yes/2.no
)

34. CM9) 3
month/bulan

35. DPT(1.yes/
2.no)

36. 3 month/bulan

37. DPT(1.yes/2.n
o)

38.

39. IPV(1.yes/2
.no)

40.

41. IPV(1.yes/2.no
)

42.

43. HIB(1.yes/2
.no)

44.

45. HIB(1.yes/2.no
)

46. CM10) 5
month/bulan

47. DPT(1.yes/
2.no)

48. 5 month/bulan

49. DPT(1.yes/2.n
o)

50.

51. IPV(1.yes/2
.no)

52.

53. IPV(1.yes/2.no
)

54.

55. HIB(1.yes/2
.no)

56.

57. HIB(1.yes/2.no
)

58. CM11)6
month/bulan

59. Hep
B(1.yes/2.n
o)

60. 6 month/bulan

61. Hep
B(1.yes/2.no)

62. CM12) 12
month/bulan

63. MMR(1.yes
/2.no)

64. 12
month/bulan

65. MMR(1.yes/2.
no)

66. CM13) 18
month/bulan

67. DPT(1.yes/
2.no)

68. 18
month/bulan

69. DPT(1.yes/2.n
o)

70.

71. IPV(1.yes/2
.no)

72.

73. IPV(1.yes/2.no
)

74.

75. HIB(1.yes/2
.no)

76.

77. HIB(1.yes/2.no
)

78. CM14) Completed before 2 years old

80. Completed before 2 years old

79. (1.yes/2.no)
82.
83.
84.
85.
90.

81. (1.yes/2.no)

CM15) Immunization Status


1.Complete / adequate
2.Partially. *Uncompleted
3.Non-immunized*

91.

94.
1.
2.
3.
4.

86.
87.
88.
89.
92.

Immunization Status
1.Complete / adequate
2.Partially. *Uncompleted
3.Non-immunized)

93.

CM15.2) If it is not complete/partially complete, why?


Inconvenience (No transport, no time, no family support etc)
Lack of Motivation (cultural conflict, postponed, rumors)
Lack of Information (Unaware of schedule, fear of side effect etc)
Others.

95.
96. NUTRITIONAL ASSESSMENT
NU1. Do you have any food allergy?
1 Yes;
NU1a. State
2 No
97.
NU2. How many meals do you have daily?
1 Less than three
2 Three
3 More than three
98.
NU3. Which meals do you often skip? You can choose more than one option
1 Breakfast
2 Lunch
3 Dinner
4 None
99.
NU4. How many times do you eat poultry/fish in a week?
100.
..
101.
NU5. How many times do you eat vegetable in a week?
102.

103.
NU6. How many times do you eat dessert/snacks/fast food in a week?
104.
..
105.
NU7. What did you and your family eat yesterday?
106.Meals
108.NU7a. Breakfast

107.Food taken
109.
110.
112.

111. NU7b. Lunch

119.

113.

114. NU7c. Dinner

115.

116. NU7d. Others

117.
118.

120.
NU8. What type of oil do you use in your daily cooking?
1 Vegetable-based oil, eg canola,olive
2 Animal-based oil
121.
NU9. Do you take any nutritional supplements?
1 Yes;
NU9a. State
2 No
122.
NU10. How many teaspoons of sugar do you use in your beverages/food in a day?
123.
1 Less than four teaspoons
2 Four teaspoons
3 More than four teaspoons
124.
NU11. Do you like to eat salty foods? (Ex. Dried fish, anchovies)
1 Yes;
NU11a. State how many times per week
..
2 No
125.
NU12. Do you like to eat oily foods? (Ex: Fried chicken and chips)
1 Yes;
NU12a. State how many times per week
...
2 No
126.
127. C.MORBIDITY AND HEALTH SEEKING BEHAVIOURS.
128.Inquire about acute morbidity condition
129.
130.MB1. Have you suffered from any disease (morbidity/illness) in last 3 months?
131.

1. Yes

2. No (skip to next section)

132.
133.MB2. Which kind of illness did you suffer?
134. 1. Communicable disease 2. Non-communicable disease

99. Others

135.
136.MB3. Did you seek health care for this illness?
137. 1. Yes

2. No

138.
139.MB4. If no, state the reason for not seeking health care?
140. 1. lack of money 2. No transport facilities

3. Lack of time

141.
142. 99. others
143.
144.
145.
146.MB5. Where did you seek health care for this illness?
147.

1. Government hospital

2. Private Hospital/Clinic

3. Klinik Kesihatan

148.

4.Bomoh

5. Pharmacy

149.

99. Others .

150.
151.MB7. What was the diagnosis of your illness?
152..
153.
154.MB8. Do you take regular treatment for this illness?
155.

1. Yes

2. No

156.
157.MB9. If no, state the reasons for not taking treatment regularly for this
illness?..................................................................................................
158.
159.Inquire about Chronic morbidity condition
160.
161.MB10. Have you suffered from any disease (morbidity/illness) consecutively for 6 weeks or
162.
163.

more?
1. Yes

2. No (skip to next section)

164.
165.MB11. Which kind of illness did you suffer?
166. 1. Communicable disease 2. Non-communicable disease

9. Others

167.
168.MB12. Did you seek health care for this illness?
169. 1. Yes

2. No

170.
171.MB13. If no, state the reason for not seeking health care?
172. 1. lack of money 2. No transport facilities

3. Lack of time

173. 9. others
174.
175.MB14. Where did you seek health care for this illness?
176. 1. Government hospital

2. Private Hospital/Clinic

3. Klinik Kesihatan

177.

4.Bomoh

5. Pharmacy

178.

99. Others .

179.
180.MB15. What was the diagnosis of your illness?
181...
182.
183.MB16. Did you take regular treatment for this illness?
184.
185.

1. Yes

2. No

186.MB17. If no, state the reasons for not taking treatment regularly for this
illness?...................................................................................................
187.
188.MB18. Did you take medical-check up for this illness?
189.

1. Yes

2. No

190.
191.Inquire about acute morbidity condition among family members
192.
193.MB19. Have any one of your family members suffered from any disease (morbidity/illness) in last 3 months?
194.

1. Yes

2. No (skip to next section)

3.Unsure

195.
196.MB20. Which kind of illness did he/she suffer?
197. 1. Communicable disease 2. Non-communicable disease

9. Others

198.
199.MB21. Did he/she seek health care for this illness?
200. 1. Yes

2. No

3. unsure

201.
202.MB22. If no, state the reason for not seeking health care?
203. 1. lack of money 2. No transport facilities

3. Lack of time

204. 9. others
205.
206.MB23. Where did he/she seek health care for this illness?
207. 1. Government hospital

2. Private Hospital/Clinic

3. Klinik Kesihatan

208.

4.Bomoh

5. Pharmacy

209.

99. Others .

210.
211. MB24. What was the diagnosis of his/her illness?
212..
213.
214.MB25. Did he/she take regular treatment for this illness?
215.

1. Yes

2. No

3.Unsure

216.
217.MB26. If no, state the reasons for not taking treatment regularly for this illness?
218...................................
219.
220.Inquire about mortality condition among family members
221.
222.MB27. Have any one of your family members passed away last year?
223.

1. Yes

2. No

224.
225.MB28. If yes, how many?
226..
227.MB29.Age of death
228.1.Infant(0-6yrs)

2.Children(7-12yrs)

229.4.Young Adult(19-24yrs)

3.Adolescence(13-18)

5.Adults(25-60)

6.Geriatric(>60)

230.
231.MB30. What is cause of death?
232..
233.
234.
235.(Based on the respondents id)
1.
2. W
3.
N
e
i
g
h
t
(
k
g
)

H
e
i
g
h
t

4.

5. S

6. D

B
P(
m
m
H
g)

B
P(
m
m
H
g)

236.
237.
238.
239.
240.
241.
242.
243.
244.
245.
246.
247.
248.
249.
250.
251.
252.
253.

(
m
)

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

255.

37.

38.

39.

40.

41.

42.

256.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

59.

60.

61.

62.

63.

64.

65.

66.

254.

257. APPE
NDIX 2

258. CLIN
ICAL
CASE

STUDY PROFORMA
259.
260.
261.

I. IDENTIFICATION DATA
262.
263.
264.
265.

1. Name of the patient


2. Age

266.
267.
268.
269.
270.
271.
272.
273.
274.
275.
276.
277.
278.
279.
No

280. Nam
e

3. Sex
4. Occupation
5. Income
6. Religion & Caste
7. Address

281.
Sex

282.
Ag

283.
R

284.
E

II. FAMILY COMPOSITION


286.
288.
289.291. Rema
O
M
I rks

285.
t

287.
p

290.
z

292.

293.

294.

295.

296.

297.

298.

299.

300.

301.

302.

303.

304.

305.

306.

307.

308.

309.

310.

311.

312.

313.

314.

315.

316.

317.

318.

319.

320.

321.

322.

323.

324.

325.

326.

327.

328.

329.

330.

331.

332.

333.

334.

335.

336.

337.

338.

339.

340.

341.

342.

343.

344.

345.

346.

347.

348.

349.

350.

351.

352.
353.
354.
355.
III. SOCIO ECONOMIC HISTORY
356.
357. Education: Level, Abilities, Potential etc.
358.
359.
Occupation: Nature of Work, Hours of Work, Hazards if any,
360.
Distance of workplace etc
361.
362. Income:
Total family income (from all sources)
363.
364.
.................................................................. Per capita Income. (Rm per month)
365.
366.
Expenditure (Rm -------------- per
month)
367.

368.
369.
370.
1. Housing:

IV. ENVIRONMENT
Type of wall, roof, area, floor space,

371.
372.
2. Kitchen inspection: Type of fuel used
373.
374.
375.
3. Water supply: Source & storage.

Ventilation & Lighting

Storage of food,
protection from dust/smoke

376.
4. Disposal of Wastes
377.
5. Latrines:

(sanitary type / drainage /

open air defecation).

378.
6. Insects, noise, nuisance etc.
379.
380.
381.
382.
383.
384.
385.

V. CLINICAL CASE HISTORY WITH EXAMINATION


1.- Presenting Complaints
386.
387.
388.

389.
390.
391.

"Define the main Complaint and its duration"


(Presenting Complaint is the problem which made the patient come
to a doctor)..,,

2. History of Present Illness


392.
393.

394.
395.
396.

i.e., the story of the illness from the beginning


(Symptom analysis - Pain, Fever, Cough etc).

3. History of Previous Illness


397.

398.
399.

All important illnesses from infancy onwards,

Same illness.
Other illness.

Related illness.

- Treatment taken.

400.
401.
402.
403.
404.

4. Treatment History

405. Details of drugs taken for the present illness & previous illnesses, adverse reaction to
drugs if any, duration of treatment etc.
406.
407.
408.
409.
410.

5. Personal History
(Habits, Belief & Attitude of the Patient).
411.
412.
413.
414.
415.
416.
417.
418.
419.

420.
421.
422.
423.

- Beliefs & Customs (social / religious).


- Diet.
- Attitude towards life, illness etc.
- Use of Alcohol & Tobacco.

6. Menstrual History
(In case of women Patients)
424.
425.
426.
427.
428.

429.
430.
431.

- Domestic & Marital relationship.

- Age of menarche or menopause.


- Duration of cycle & regularity.
- No. of days of flow & quantity.

7. Mothers:
- Detailed history regarding Antenatal period,, Intranatal period &
- Postnatal period, (LMP, EDD, Para, gravida).

432.
433.
434.
435.
436.
437.
438.

Immunization details -verification of immunization cards


- Family Welfare Methods (Contraceptives) use etc.

- Age of marriage, parity, previous history of confinement,


(Consanguinity).

439.
440.

8. Child
- History from Birth, details of breast feeding & weaning,
- History of illness.

441.
442.

448.
449.
450.
451.
452.

443.
- Immunization status Immunization card verification.
444.
- BCG Scar verification
445.
446.
- Other Siblings Utilization of child care services or like benefits
447.
PHYSICAL EXAMINATION
1.General Examinations:
453.
454.
455.
456.
457.
458.
459.
460.

- General appearance: look healthy, unwell or ill.


- Build, state of nutrition, obesity, oedema.
- Intelligence, Mental Status & Expression.
- Skin: colour, cyanosis, anaemia, jaundice, pigmentation.
- Deformities & swellings.
- Temperature, pulse, respiration rate.

471.
472.
473.
474.
475.
476.
477.
478.
479.

461.
462.
- Hair - head & body hair.
463.
464.
- Eyes,face.
465.
466. - Mouth, pharynx, neck.
467.
468. - Thorax, abdomen, limbs.
469.
470.
2. Systemic Examination
1.CVS
- Pulse

regular / irregular, rate.

- Neck veins - visible, distended etc.


- B P.

480.
481.
482.
483.
484.
485.
486.

- Apex beat.
- Heart sounds.
- Murmur

2 Respiratory System:
487. - Rate - (14-18 per minute in adults).
488.
489.
- Inspection - Refer "TB case sheet".
490.
491.
- Palpation - Refer "TB case sheet"
492.
493.
- Percussion - Refer "TB case sheet"
494.
495.
496.
3. Dermatological examination
497.
498.
(HANSONS - Type, with / without complications).
499.
500.
- Patches
501.
502. - Anaesthesia (Sensory loss - touch, pain & temperature).
503.
504. - Peripheral nerve thickening.
505.
506. - Motor weakness.
507.
508.
- Palm, sole, hands, feet, nails, muscle wasting, deformities,
509.
ulcers etc.
510.
511.
Probable Diagnosis [Differential Diagnosis]
512.
513.
- Relevant Laboratory Investigations
514.
515.
- Confirmation of Diagnosis
516.
517.
- Management
518.
519.
DISCUSSIONS
520.
(Presentation of the CASES)
521.
522.
1. Natural history of the disease & levels Of prevention.
523.
524.
2. Factors responsible for the disease in this particular case.
525.
526.
3. Could the disease have been prevented / arrested, if diagnosed and
527.
treated early.
528.

529.
530.
531.
532.
533.
534.
535.
536.
537.
538.
539.
540.
541.
542.
543.
544.
545.
546.
547.
548.
549.
550.
551.
552.
553.
554.
555.
556.
557.
558.
559.
560.
561.
562.
563.
564.
565.
566.
567.
568.
569.
570.
571.
572.
573.
574.
575.
576.
577.

4. What measures are to be taken?


a. To prevent spread to others.
b. To prevent recurrence with same individual.
c. To prevent its occurrence in other members.
d. To prevent the progress if it occurs in others.
e. Diet, rest, follow up, rehabilitation.
5. Services available for the treatment of this condition.
6. Community services available for combating this disease on large scale.
7. Lab investigation

578.
579.

APPENDIX 3: HEALTH CAMP PICTURES

580.

581.

582.
583.
584.
585.
586.

Focus Group Discussion being conducted

Colouring competition for children

587.

588.
589.
590.

Dental hygiene demo for children

Ocular examination for villager.

591.
592.
593.

Group D, Batch 19
594.

595.

596.

REFERENCES
597.
598.
599.

600.

Recommended Books
601.

1. James F. Jekel, David L. Katz, Joann G. Elmore. Epidemiology, biostatistics, and preventive medicine. 2nd
ed. W.B. Saunders, 2001.
602.
2. R. Beaglehole, R. Bonita, T. Kjellstrom. Basic epidemiology. WHO, 1993
603.
3. Sir Austin Bradford Hill . A short textbook of medical statistics. Hodder and Stoughton, 1977.
604.
4. Martin Bland. An introduction to medical statistics. 3rd ed. Oxford University Press, 2000.
605.
5. Alastair Campbell, Grant Gillett, Gareth Jones. Medical ethics. 3rd ed. Oxford University Press,
606.
6. Cecil G. Helman. Culture, health, and illness. 4th ed. Butterworth-Heinemann, 2000.
607.
7. Graham Scambler (ed.) Sociology as applied to medicine. 5th ed. Saunders, 2003.
608.
8. K.Park. Text Book of Preventive and Social Medicine. M/s Banarasidas Bhanot Publishers, Jabalpur,
482001, India
609.
9. Epidemiology. Leon Gordis. III Edition 2004. ELSEVIER SAUNDERS 170 S Independence Mall W.300 E.
Philadelphia. USA
610.
10. World Health Report 2006
611.
612.
613.
614.
615.
616.
617.
618.
619.
620.
621.
622.
623.
624.

Reference Books
625.

1. Robert B. Wallace, John M. Last (eds). Maxcy-Roseneau-Last public health & preventive medicine. -14th ed.
Appleton & Lange, 1998
626.
2. Gary D. Friedman. Primer of epidemiology. 5th ed. McGraw- Hill, 2004

627.
3. Richard Farmer, David Miller, Ross Lawrenson. Lecture notes on epidemiology and public health medicine.
-4th ed. Blackwell Science, 1996.
628.
4. W.O. Phoon and P.C.Y. Chen (eds.) Textbook of community medicine in South-east Asia. Wiley, 1986.
629.
5. R. S. F.Schilling. Occupational health practice. Butterworth, 1973.
630.
6. Ranjit Kumar. Research Methodology. A step by step guide for beginners II nd Edition Sage Publications
New Delhi India
631.
7. C.R Kothari. Research Methodology. Methods and Techniques. II Edition 2004. New Age International
Publishers. New Delhi
632.
633.
634.
635.
636.

WEBSITES
1. www.moh.gov.my
637.
2. www.who.int/en
638.
3. www.cdc.gov
639.
4. www.nationmaster.com.index.phb

640.
641.

642.

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