The document discusses the epidemiology of various diseases in Malaysia, noting that vaccine preventable diseases are on the decline due to immunization programs, while water and food borne illnesses have decreased with improved sanitation but food poisoning is increasing. It also examines the trends and risk factors of HIV/AIDS, vector borne diseases like dengue, and non-communicable diseases such as hypertension, cancer, and diabetes, which are rising issues in Malaysia associated with lifestyle risk factors including smoking, physical inactivity, and diet.

1. EPIDEMIOLOGY
OF DISEASES IN
MALAYSIA

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

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

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

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

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

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

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

20. AIDS/HIV

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

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

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

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

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

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

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

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

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

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

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

43. Non-Communicable Disease

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

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

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

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

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

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

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

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

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

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

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

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

57. Incidence by Type

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

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

63. Diseases Due To Migration

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

67. TERIMA KASIH