The community empowerment program in Kampung Lemoi, Cameron Highlands aimed to improve the health and nutrition of indigenous Semai tribes. Activities included health talks, cooking competitions, and games to promote handwashing and hygiene. Over time, more children attended and fewer cases of malnutrition were reported. While health knowledge improved, ensuring adequate daily nutrition remained a challenge. Continuing supplemental feeding and nutrition education was needed to further support the community's health and well-being.

1. Community Empowerment Program Approach
the Semai tribes, Kampung Lemoi, Cameron Highlands
Suwaibah A.H.1, Nor Zam Azihan M.H.1, Muhammad Naim I.1, Rina A.1, Rafidah Y.2, Zahariah M.N.2
1Pejabat Kesihatan Daerah Cameron Highlands, Tanah Rata, 39000 Cameron Highlands, Pahang
2Jabatan Kesihatan Negeri Pahang, Kementerian Kesihatan Malaysia
ABSTRACT
Problem Awareness on the importance of hygiene and health is often taken for granted by the community. The aborigines are normally difficult to approach which
make it difficult to communicate with them effectively. This situation needs to be nurtured through the community empowerment programme.
Approach Community Empowerment Programme in Kampung Lemoi was held on 18th and 19th November 2016 in collaboration with the Nutrition Unit and the
Mobile Team Unit of Orang Asli (PBOA). This programme is an annual programme that aims to empower aboriginal health volunteers in carrying out health activities
in the community. This is to create awareness and enhance knowledge and health practices including hygiene and nutrition among indigenous people.
Local setting The programme activities conducted were talk on maternal and child health, food pyramid: preparation on safe food, health screening (screening of
cervical and breast examination). The family competition such as food pyramid explorace, eating contest: fruits and vegetables, cooking contests,
cleanliness/tidiness home competition and traditional competitions, “congkak” was also carried out. For kids, the programme is made possible with the activities of
the competition such as proper hand washing, children's look very neat, hygiene match (ticks, nails, feet, teeth and hands) and coloring competition. Aerobic
fitness and hygiene activities were carried out in the Lemoi River by health staffs make them closer to the Orang Asli Semai tribes. A total of 12 children with
increased body weight during the Community Feeding Program (PCF) were emphasized. Children in the PCF were given health education on food hygiene and
healthy food intake to reduce cases of child malnutrition in the village.
Relevant changes Health information is often underestimated by the community so that when the programme is successfully implemented, the Semai tribes’
community would have better understand on balanced diet based on the concept of food pyramid. Competition explorace of food pyramid has attracted the
participants to study the functions of carbohydrates, protein and fat. They have to list foods high in salt and high-sugary foods. Competition match hygiene showed
the children had understood well on the importance of hygiene. Through eating of fruits and vegetables competition, evaluation of the gustatory function among
the Semai tribes can be carried out. Most of them was very good acceptance of the different types of fruits and vegetables (sweet, sour, bitter and umami taste)
which are not available in their rural areas. From cleanliness competition, makes them keep the house and clothes neat and tidy.
Lessons learnt Health education given through Community Empowerment Programme has attracted Semai tribes successfully. The programme should be
continued to give guidance on the importance of hygiene and health care in order to improve the nutritional status and health.
INTRODUCTION
The community empowerment program actively engaging the Aboriginal
community in decisions about their health care was a key element in improving
local health services, increasing Aboriginal people’s trust and access to care
(1). Aboriginal people can face many challenges when accessing mainstream
services. These include unwelcoming hospital settings, lack of transport,
mistrust of mainstream health care, a sense of alienation, and inflexible
treatment options. This has resulted in an overall reluctance to attend services.
Poor communication from health providers and lack of Aboriginal staff at health
services exacerbates the problem(2). To resolve this, health services need to
commit to developing respectful partnerships with local Aboriginal
communities and increase the capacity of services to be more responsive to
Aboriginal people’s requirements (3).
APPROACH
Community Empowerment Programme in Kampung Lemoi was held on 18th and
19th November 2016 in collaboration with the Nutrition Unit and the Mobile Team
Unit of Orang Asli (PBOA). This programme is an annual programme that aims
to empower aboriginal health volunteers in carrying out health activities in the
community.
LOCAL SETTING
LESSONS LEARNT
Health education given through Community Empowerment Programme has
attracted Semai Orang Asli tribes joined to successfully programme. The
programme should be continued to give guidance on the importance of
hygiene and health care in order to improve the nutritional status and health.
RELEVANT CHANGES
Health information is often underestimated by the community so that when the
programme is successfully implemented, the Semai tribes community would
have better understand on balanced diet based on the concept of food
pyramid. Competition explorace of food pyramid has attracted the
participants to study the functions of carbohydrates, protein and fat. They
have to lists the foods high in salt and high-sugary foods. Competition match
hygiene showed the children had understood well on the importance of
hygiene. Through eating of fruits and vegetables competition, evaluation of
the gustatory function among the Semai tribes can be carried out. Most of
them was very good acceptance of the different types of fruits and vegetables
(sweet, sour, bitter and umami taste) which are not available in their rural
areas. From cleanliness competition, makes them keep the house and clothes
neat and tidy.
REFERENCES
1. Improving healthcare for Aboriginal Australians through effective engagement between community and health
services. BMC Health Serv. Res. 2016; 16: 224.
2. Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care:
addressing institutionalised racism and misunderstandings in communication. Intern Med J. 2011;42(1):17–22.
3. Taylor K, Bessarab D, Hunter L, Thompson SC. Aboriginal-mainstream partnerships: exploring the challenges
and enhancers of a collaborative service arrangement for Aboriginal clients with substance use issues. BMC
Health Serv Res. 2013;13:12.
4. Khor Geok Lin, Ph. D. Malnutrition among Semai children. Med. J. Malaysia Vol. 43 No. 4 Dec.1988.
ACKNOWLEDGEMENTS
1. Aboriginal Community of Kampung Lemoi, Cameron Highlands
2. Pejabat Kesihatan Daerah Cameron Highlands
3. Mobile Teams of Orang Asli , Health Clinic of Ringlet
“Gotong Royong” Aerobic Hygiene activity at Lemoi River
Celebrate the happiness with
children‘s favourite foodsChildren increase body weight
Cleanliness home
Colouring
Food Pyramid Explorace
Eating fruits and vegetables
13-14th May 2017
1st National MOH Nutritionist Symposium:
Nutritionist and Well Being of Malaysians
“Congkak”
Cooking contest
There were 230 Aboriginal community of Semai tribes in Kampung Lemoi, with
the total of 49 children (under 6 years). From Pejabat Kesihatan Daerah
Cameron Highlands to this village take up to 2 hours of 75 kms. The programme
activities conducted were talk on maternal and child health, food pyramid:
preparation on safe food, health screening (screening of cervical and breast
examination). The family competition such as food pyramid explorace, eating
contest: fruits and vegetables, cooking contests, cleanliness/tidiness home
competition and traditional competitions, “congkak” was also carried out. For
kids, the programme is made possible with the activities of the competition such
as proper hand washing, children's look very neat, hygiene match (ticks, nails,
feet, teeth and hands) and coloring competition. Aerobic fitness and hygiene
activities were carried out in the Lemoi River by health staffs make them closer
to the Orang Asli Semai tribes. A total of 12 children with increased body weight
during the Community Feeding Program (PCF) were emphasized. Children in the
PCF were given health education on food hygiene
and healthy food intake to reduce cases of child
malnutrition in the village.
Hygiene match
7 Step hand washing
Talk on Maternal and Child Health,
food pyramid & preparation of safe food

2. Community Feeding Program in Kampung Lemoi,
Cameron Highlands Improve the Nutritional Status
of Under 6 Years Children
Suwaibah A.H.1, Nor Zam Azihan M.H.1, Muhammad Naim I.1, Rina A.1, Rafidah Y.2, Zahariah M.N.2
1 Pejabat Kesihatan Daerah Cameron Highlands, Tanah Rata, 39000 Cameron Highlands, Pahang
2 Jabatan Kesihatan Negeri Pahang, Ministry of Health Malaysia
ABSTRACT
The objective of this study was to assess the nutritional status of children aged less than 6 years in the
Community Feeding Programme (PCF). Ready to Use Therapeutic Food (RUTF), a paste containing solid
energy (≥ 500kcal), enriched with micronutrients, made of peanuts, oil, sugar and powdered milk was given
twice a week. Supplementary feeding is given to all children (children with normal weight and malnourished
children. This supplement includes a glass of milk, biscuits/cereals, and multivitamins with iron and fish oil.
Supplements are provided every day except on Saturday and Sunday (5 times a week). Assessment of
nutritional status was carried out periodically since the establishment of the Community Feeding Centre in
2013 to 2016. In year 2013, the number of children at the Center of Community Feeding were 33 children and
increased to 46 children in 2016 (boys =19, girls =27). The increase is due to the family migration of Semai
tribes near the village: Kampung Chenan Cerah and Kampung Terlimau or from others regions/states to
Kampung Lemoi. In 2013, out of 11 cases of malnourished children, 6 had rehabilitated. The total number of
malnourished children had reduced in 2014 (n=6), 2015 (n=7) and 2016 (n=2). In 2016, the number of children
with acute malnutrition were 10.9% (n=5). However, no children had recovered in the Community Feeding
Programme in 2016 (n=0). Nutrition Counseling showed the frequency of daily food intake between 4 to 5
times a day and serving sizes of food due to the availability of resources of balanced and nutritious food
affects the nutritional status of individuals. Daily energy intake did not reach the energy needs due to
inadequate food intake. Supplementary feeding should be continued to improve the nutritional status of
children in the Community Feeding Programme. These programme help reduce morbidity and mortality among
Aboriginal children under the age of 6 years.
Keywords: Community Feeding Programme, Nutritional status, Malnourished children
13-14th May 2017
1st National MOH Nutritionist Symposium:
Nutritionist and Well Being of Malaysians
0
10
20
30
40
50
Normal
weight
Weight
(-2SD)
Weight
(-3SD)
Defaulter Normal
BMI
Total
Boys 15 2 1 1 13 19
Girls 21 2 0 4 18 27
Total 26 4 1 5 31 46
Totalofchildren
CONCLUSIONS
The programme is effective for weight gain in children younger than two
years, with a more pronounced effect on children who start the program
under less favorable weight conditions (2). Supplementary feeding should be
continued to improve the nutritional status of children in the Community
Feeding Programme. These programme help reduce morbidity and mortality
among Aboriginal children under the age of 6 years.
REFERENCES
ACKNOWLEDGEMENT
1. Mobile Team unit of Orang Asli (PBOA)
2. Aboriginal Community Kampung Lemoi Cameron Highlands
3. Pejabat Kesihatan Daerah Cameron Highlands
RESULTS AND DISCUSSION
METHODS &MATERIALS
INTRODUCTION
A study was performed according to secondary data on children aged from six
month to 6 years, from aboriginal families in kampung Lemoi. Ready to Use
Therapeutic Food (RUTF), a paste containing solid energy (>500kcal), enriched
with micronutrients, made of peanuts, oil, sugar and powdered milk was given
twice a week. Supplementary feeding is given to all children (children with
normal weight and malnourished children. This supplement includes a glass of
milk, biscuits/cereals, multivitamins with iron and fish oil. Supplements are
provided every day except on Saturday and Sunday (5 times a week).
Assessment of nutritional status was carried out periodically since the
establishment of the Community Feeding Centre in 2013 to 2016. Weight gain
was measured using weight-for-age z-score values, calculated according to the
World Health Organization standards (2007). These values were obtained in the
program routine, monthly. Children were divided into three z-score groups when
startin g the program: weight gain not compromised (z>-1); risk of low weight
(-2<z<-1); and low weight (z<-2). Percentage of recovered cases was compared
with previous year.
In 2013, the number of children at the Community Feeding Centre were 33
children and increased to 46 children in 2016 (boys =19, girls =27). The increase
is due to the family migration of Semai tribes near the village: Kampung Chenan
Cerah and Kampung Terlimau or from others regions/states to Kampung Lemoi.
(Table 1). In 2013, out of 11 cases of malnourished children, 6 had rehabilitated.
The total number of malnourished children had reduced in 2014 (n=6), 2015
(n=7) and 2016 (n=2). In 2016, the number of children with acute malnutrition
were 10.9% (n=5) (Table 2). However, no children had recovered in the
Community Feeding Programme in 2016 (n=0) (Figure 2).
1. Nutrition Division, Ministry of Health, Malaysia.
2. Elizabeth Kristjansson, Damian Francis, Vivian Welch et al. International Initiative for
Impact Evaluation. Supplementary feeding for improving the health of disadvantaged
infants and children, 2016.
The programme had a positive effect on child weight gain, varying according
to child nutritional status. Daily energy intake did not reach the energy needs
due to inadequate food intake. Nutrition Counseling showed the frequency of
daily food intake between 4 to 5 times a day and serving sizes of food due to
the availability of resources of balanced and nutritious food affects the
nutritional status of individuals (Figure 3). To meet the energy gap between the
child’s needs and current intake, programmes should aim to supply more than
30 per cent of the dietary reference intake for energy. Children are more likely
to consume supplementary food that is palatable, culturally acceptable and
energy and nutrient dense(2).
Table 1 Demographic characteristic of children at Community Feeding Centre in 2016
The objective of this study was to assess the nutritional status of children aged
less than 6 years in the Community Feeding Programme (PCF).
OBJECTIVE
Figure 2 The percentage of recovery at
Community Feeding Centre 2013-2016
Boys Girls
Total (n) 19 (41.3%) 27 (58.9%)
Age <1 year 1 (5.3%) 2 (7.4%)
1-2 year 2 (10.5%) 8 (29.6%)
2-3 year 4 (21.0%) 4 (14.8%)
3-4 year 3 (15.8%) 4 (14.8%)
4-5 year 3 (15.8%) 5 (18.5%)
5-6 year 6 (31.6%) 4 (14.8%)
Exclusive Breastfeeding 19 (41.3%) 27 (58.9%)
0
10
20
30
40
50
2013 2014 2015 2016
PCF's Children 33 34 32 46
Malnourished
Children
11 6 8 5
Recovered cases 6 0 2 0
% Recovered 54.50% 0% 28.60% 0%
Totalofchildren,n
Figure 1 Nutritional status of children
at Community Feeding Centre in 2016
Figure 3 Daily food intake was
taken during nutrition counseling
Case A
Case B
Formula: Percentage of Recovery :
Total of recovery cases X 100
(Current malnourished children + Close cases) – (New cases)
The total of children with normal weight is 26 and normal BMI is 31 (Figure 1).
This anthropometric measurement was taken on November 2016 with 5
defaulter. To get minimum defaulter value, health personnel must plan any
health programme or cooking demonstration activities to encourage the
mother to bring their children to the Community Feeding Centre or clinic.
Community Feeding Programme (PCF) has been implemented since 2013 in the
interior Perak (Hulu Perak), Pahang (Jerantut, Lipis and Cameron Highlands),
Kelantan (Gua Musang) and Sarawak (Long Keluan). Several studies had
revealed that underweight and stunting Orang Asli children were found in one-
third to three quarters of the population groups (Hesham et al, 2005, Shasikala
et al, 2005). Thus, prevalence of child malnutrition was higher among interior
Orang Asli community in Malaysia. The objectives of PCF are to ensure at least
95% of malnourished Orang Asli/ Pribumi children enrolled in the Community
Feeding Programme, to rehabilitate > 25% of malnourished Orang Asli/ Pribumi
children after 6 months in the Community Feeding Programme and to sustain the
normal nutritional status of Orang Asli/ Pribumi children in the Community
Feeding Programme (1).

3. The Rehabilitation Program for Malnutrition Children Improve
Recovery Cases for Malnourished Children Referred to
Health Clinics in Cameron Highlands Year 2012 to 2016
Suwaibah A.H.1, Nor Zam Azihan M.H.1, Muhammad Naim I.1, Janaki M.1, Hoe H.K.1, Khayri Azizi K.1, Yu K.S.1, Jagdev S.1,
Selvi V.1, Siti Rohana M.S.1, Nurul Asiah M.K.1, Rohaida A.2, Mahroni A.2, Rafidah Y. 2, Zahariah M.H.2
1 Pejabat Kesihatan Daerah Cameron Highlands, Tanah Rata, 39000 Cameron Highlands, Pahang
2 Jabatan Kesihatan Negeri Pahang, Kementerian Kesihatan Malaysia
ABSTRACT
The objective of this study was to assess cases of children recovering from malnutrition within 6 to 12 months after receiving the food basket in PPKZM Programme. Malnourished children
are eligible to receive food baskets if their family income is less than RM 2000 per month. Malnourished children are defined as having as a weight for age -2SD to -3SD, height for age -
2SD to -3SD or weight for height -2SD to -3SD. Provision of food baskets from Package 1 to Package 13 based on the guidelines of the management of child malnutrition, the Ministry of
Health. Nutritional status assessment was conducted once a month using weighing scales and Bodymeter (SECA). National Registry System database for PPKZM is used to ensure the
monitoring efficiently. Total attendance of under 6 years old children to health clinics in 2016 were 3156 children as compared with 3664 children in 2015. In 2016, Nutrition Counseling
sessions have shown that less than 6 years children was the highest referred to the Nutritionist (n=122 children.) The total number of cases of underweight children is still active for food
baskets in the year 2016 is a total of 115 cases. This total is significantly reduced when compared to the previous year. In 2016, the case detection underweight children being carried out
by the Mobile Teams of Orang Asli (PBOA) recorded a number of cases of underweight children was the highest in Cameron Highlands, is from Postal Telanok, a total of 39 cases (33.9%)
followed by the Health Clinic of Tanah Rata, a total of 27 cases (23.5%). No cases of underweight children enrolled for food baskets from Health Clinic Kampung Raja since 2013 to 2016.
The percentage of new cases of underweight children had in body increased weight in the food baskets programme in 2016 was 22.2% (n=8). In 2016, the number of cases of
underweight children in the programme recovered were 26.3% (n=35). Coverage and distribution of food baskets and health services need to be with strength. Education on the
modification of food should be strengthened. In addition, an appropriate management of the cases should always be taken seriously to improve the percentage of recovery. Child
Rehabilitation Programme for Malnourished Children (PPKZM) should be continued to improve the health and nutritional status of children aged 6 months to 6 years, to subsequently in
order to achieve optimal physical and mental health.
Keywords: Rehabilitation Program for Malnourished Children (Program Pemulihan Kanak-Kanak Kurang Zat Makanan, PPKZM), Nutritional status, Recovery cases
13-14th May 2017
1st National MOH Nutritionist Symposium:
Nutritionist and Well Being of Malaysians
INTRODUCTION
OBJECTIVE
METHODS & MATERIALS
CONCLUSIONS
Formula: Percentage of Recovery :
Total of recovery cases X 100
(Current malnourished children + Close cases) – (New cases)
0
500
1000
1500
2000
2500
3000
3500
4000
2012 2013 2014 2015 2016
5-6 year 205 225 218 266 281
1-4 year 1154 1691 1787 2089 1925
< 1 year 728 1087 1035 1309 950
Totalofchildren(n)
Figure 1 Total of children referred to health clinic in
Cameron Highlands from 2012 to 2016
N=2087
N=3003 N=3040
N=3664
N=3156
Table 1 Total of children received food basket (active: not recover)
in Cameron Highlands from 2012 to 2016
Table 2 Total of malnourished children in Cameron Highlands from 2012 to 2016
Note: * Food basket 1 AZAM
Percentage,%
Figure 4 The total of recovery cases
from 2012 to 2016
RESULTS AND DISCUSSION
Malnourished children are eligible to receive food baskets if family income less than RM 2000 per month.
Provision of food baskets is in Package 1 to Package 13 based on the guidelines of the management of
child malnutrition, the Ministry of Health. The secondary data was taken for evaluation. Nutritional
assessment conducted once a month using scales and Bodymeter (SECA). Percentage of recovery
calculation using the standard formula as below:
Total attendance of under 6 years old children to health clinics in 2016 was 3156 children compared with
2015, ie a total of 3664 children (Figure 1). In 2016, Nutrition Counseling sessions have shown that less
than 6 years children was the highest referred to the Nutritionist(n=122 children) (Figure 2).
In 2016, the case detection of underweight
children being carried out by the Mobile
Teams of Orang Asli (PBOA) recorded a
number of cases of underweight children
was the highest in Cameron Highlands, is
from Postal Telanok, a total of 39 cases
(33.9%) followed by the Health Clinic of
Tanah Rata, a total of 27 cases (23.5%). No
cases of underweight children enrolled for
food baskets from Health Clinic Kampung
Raja since 2013 to 2016 (Table 1).
The weight gain percentage of children newly enrolled in the food basket within ≤ 6 months in 2016 was
22.2% (n=8)(Figure 3). The trends for weight gain percentage was decreased from 2014 to 2016. Health
personnel should informed the mother to not rely on the food basket package 13, because milk is not
enough for the growth and development. Health personnel should encourage the mother to prepare
variety types of food and increase dietary intake into 5 to 6 times per day to reach the energy
requirements. Food serving size should be given according to group of age.Trends percentage of
recovery cases from 2014 to 2016 was increase from 2014 to 2016. This trends shows the effectiveness
of the rehabilitation programme for malnourished children (Figure 4).
The handling of the cases should always be taken seriously to improve the percentage of recovery. Rehabilitation
Programme for Malnourished Children (PPKZM) should be continued to improve the health and nutritional status of
malnourished children aged 6 months to 6 years. This is because the food basket is dedicated to children who meet
the eligibility criteria to help obtain a balanced and nutritious food, in order to achieve optimal physical and mental
health as well as as well as can reduce the incidence of malnutrition in children at Cameron Highlands.
Figure 3 The gain weight percentage of children
newly enrolled in the food basket (≤ 6 month)
0
20
40
60
80
100
120
Baby
(0-6 m)
Children
(6-12 m)
Children
(1-6 y)
Children
(7-9 y)
Adolescent
(10-12 y)
Adolescent
(13-17 y)
Adolescent
(18-19 y)
Adults
(20-59y)
Adults
(≥60y)
2015 7 32 117 1 0 1 0 37 7
2016 15 16 91 0 0 9 2 86 9
Totalofclients,(n)
Figure 2 The total of children under 6 years (n=122) referred to Nutritionist
at health clinic, Cameron Highlands from 2012 to 2016
The total number of cases of underweight children is still active (received food basket) in 2016 is 115
cases. The underweight children that received food basket is significantly reduced when compared to the
previous year. However, in 2016 the total of malnourished children was increased (n=180)(Table 2). The
main increasing factor was because of the detection of the new cases by the health personnel was
enhanced and quality management of the children was improve.
Health Clinic
2013 2014 2015 2016
Total of
cases (n)
%
Total of
cases (n)
%
Total of
cases (n)
%
Total of
cases (n)
%
KK Tanah Rata 5 7.9% 30 26.1% 40 28.9% 27 23.5%
KK Ringlet 2 3.2% 9 7.8% 11 8.0% 5 4.3%
KK Kg. Raja 0 0 0 0.0% 0 0 0 0
KS Leryar 18 28.6% 27 23.5% 24 17.4% 18 15.7%
KD Lembah Bertam 9 14.3 11 9.6 16 11.6 4 3.5%
KD Tringkap 0 0 0 0 0 0 1 0.9%
KD Kuala Terla 0 0 0 0 0 0 1 0.9%
KD Terisu 3 4.8% 2 1.7% 6 4.3% 9 7.8
Postal Lemoi 9 14.3% 10 8.7% 11 8.0% 11 9.6%
Postal Telanok 17 26.9% 26 22.6% 30 21.7% 39 33.9%
TOTAL (N) 63 100% 115 100% 138 100% 115 100%
Year
Malnourished
children (N)
Malnourished children
(with food basket) (n)
Malnourished
children (without
food basket) (n)
Recovery
cases
(n)
Schooling
(n)
Others
(n)
Malnourished
children
(not recovered) (n)
2012 178 40 98 34 27 6 111
2013 123 18 49 49 3 8 63
2014 287 170 117 4 6 10 123
(49+121*) (115+8*)
2015 156 39 117 12 10 3 131
2016 180 34 149 35 7 10 115
0
20
40
60
80
100
2013 2014 2015 2016
Percentage (%) 4.35 82.61 60.7 22.2
Gain Weight (n) 1 19 34 8
Total, N 23 23 56 36
Percetange,%
To assess cases of children recovering from malnutrition within 6 to 12 months after receiving the food
basket in Rehabilitation Programme for Malnourished Children (Program Pemulihan Kanak-kanak Kurang
Zat Makanan (PPKZM).
Malaysia is one of several ASEAN countries facing simultaneous crises of over and under-nutrition, with
some children overweight while their peers suffer from stunting and wasting. This ‘double burden of
malnutrition’, identified in a recent report from UNICEF, WHO and ASEAN, is also happening in other
middle income countries such as Indonesia, the Philippines and Thailand. According to the latest statistics
from the National Health Morbidity Survey (NHMS 2015) as quoted in the report, 8% of children under 5
suffered acute malnutrition, or wasting (1). Children in rural areas were more likely to be underweight and
less likely to be overweight than urban children. Long-term national monitoring and longitudinal cohort
studies will be critical for under-standing, preventing, and managing the double burden of malnutrition
among children in Malaysia. (2). The majority of the underlying contributing factors to malnutrition in
children were manifested at an individual level – low birth weight, frequency of clinic visit, age on
complementary feeding, and protein intake below recommended nutrient intakes. There is a need for
appropriate public health promotion and socio-economic improvement interventions towards improving the
nutritional status and health of children (3).
REFERENCES
1. National Health Morbidity Survey (NHMS 2015). Overcoming childhood obesity and malnutrition in Malaysia.
2. Amina Z. Khambalia, Siew S. Lim, Tim Gill, and Awang M. Bulgiba. Prevalence and sociodemographic
factors of malnutrition among children in Malaysia. Food and Nutrition Bulletin, vol. 33, no. 1 © 2012,
The United Nations University.
3. Eunice MJ, Cheah WL & Lee PY. Factors Influencing Malnutrition among Young Children in a Rural
Community of Sarawak. Mal J Nutr 20(2): 145 - 164, 2014.
ACKNOWLEDGEMENT
1.Pejabat Kesihatan
Daerah Cameron Highlands, Pahang

4. Prevalence of Malnutrition among Children Referred to
Health Clinics in Cameron Highlands Year 2012 to 2016
Suwaibah A.H.1, Nor Zam Azihan M.H. 1, Muhammad Naim I.1, Janaki M.1, Hoe H.K.1, Khayri Azizi K.1, Yu K.S.1, Jagdev S.1,
Selvi V. 1, Siti Rohana M.S.1, Nurul Asiah M.K.1, Rohaida A.2, Mahroni A.2, Rafidah Y.2, Zahariah M.N.2
1 Pejabat Kesihatan Daerah Cameron Highlands, Tanah Rata, 39000 Cameron Highlands, Pahang
2 Jabatan Kesihatan Negeri Pahang, Kementerian Kesihatan Malaysia
ABSTRACT
The objective of this study was to evaluate the prevalence of malnutrition among children aged between 6 months to 6 years referred to health clinic and to assess cases of children
recovering in Rehabilitation Program for Malnourished Children (PPKZM). Children suffering from underweight within 6 to 24 months after receiving the food baskets were selected.
National Registry System as database PPKZM case for underweight children monitor the program to ensure run more effectively, orderly, rapid and accurate. The total of children aged
less than 6 years referred to the health clinic in Cameron Highlands for year 2016 was 3156. In year 2016, Nutrition counseling sessions have shown that children under 6 years were
highest referred to the Nutritionist as many as 122 children. The total number of cases of malnourished children which is still active for the year 2016 was 115 cases. This total is
reduced as compared with the previous year. In 2016, the detection of cases of underweight children actively carried out by the Mobile Teams Aboriginal which highest report cases of
underweight children in Cameron Highlands, from Postal Telanok, a total of 39 cases (33.9%), followed by Health Clinic of Tanah Rata, a total 27 cases (23.5%). No cases of
underweight children reported to Health Clinic of Kampung Raja since 2013 to 2016. The percentage of new cases of underweight children increased weight in PPKZM program in 2016
was 22.2% (n=8). In year 2016, the number of cases of underweight children in the program PPKZM recovered was 26.3% (n=35). Through Government Transformation Program, the
Ministry of Health improves the nutritional status of underweight children. Targets, covering the case, the distribution of food and service, the use of food ingredients and handling cases
have been updated provide more benefits to the target groups. By continued this program, children who meet the eligibility criteria given food basket help them obtain a balanced and
nutritious food, in order to achieve optimal physical and mental development.
Keywords: Rehabilitation Program for Malnourished Children (PPKZM), Malnutrition, Food basket, Malnourished children.
15-17th May 2017
In conjunction with Nutrition Society of Malaysia
32nd Annual Scientific Conference
“Together In Advancing Public Health Nutrition”
INTRODUCTION
OBJECTIVES
METHODS
CONCLUSIONS
ACKNOWLEDGEMENT
1.Pejabat Kesihatan
Daerah Cameron Highlands, Pahang
Figure 2 Percentage of children referred to health clinic
in Cameron Highlands vs Negeri Pahang from 2012 to 2016
Figure 1 Prevalence of malnourished children referred to
health clinic in Cameron Highlands from 2012 to 2016
Year Total of
malnourished
children (N)
Total of
malnourished
children (with food
basket) (n)
Total of
malnourished
children (without
food basket) (n)
Total of
Recovery
cases
(n)
Total of
schooling
(n)
Others
(n)
Total of
children (not
recover)
(n)
2012 178 40 98 34 27 6 111
2013 123 18 49 49 3 8 63
2014 287 170 117 4 6 10 123
(49+121*) (115+8*)
2015 156 39 117 12 10 3 131
2016 180 34 149 35 7 10 115
Table 2 Total of malnourished children in Cameron Highlands from 2012 to 2016
0
500
1000
1500
2000
2500
3000
3500
4000
2012 2013 2014 2015 2016
5-6 year 205 225 218 266 281
1-4 year 1154 1691 1787 2089 1925
< 1 year 728 1087 1035 1309 950
Totalofchildren(n)
Figure 1 Total of children referred to health clinic
in Cameron Highlands from 2012 to 2016
Table 2 Nutritional status of children (under 5 year) referred to
health clinic in Cameron Highlands from 2012 to 2016
Year Age
Nutritional status (weight for age)
Total
(n)
TOTAL
(N)<-3SD
≥ - 3SD<-
2SD
≥ - 2SD
<+2SD
≥ +
2SD
2012
< 1 year 3 3 161 0 167
503
1 -5 year 4 12 320 0 336
2013
< 1 year 0 1 128 0 129
412
1 -5 year 8 39 236 0 283
2014
< 1 year 2 5 118 1 126
384
1 -5 year 6 23 221 8 258
2015
< 1 year 0 1 191 0 192
488
1 -5 year 0 9 287 0 296
2016
< 1 year 0 2 156 0 158
547
1 -5 year 5 30 354 0 389
Note: * Food basket 1 AZAM
0
10
20
30
40
50
2012 2013 2014 2015 2016
24.6%
46.7%
4.9%
10.3%
26.3%
Percentage,%
Figure 4 The total of recovered cases in
Cameron Highlands from 2012 to 2016
Secondary data was taken with measurements of weight and height to determine the
nutritional status of children aged less than 6 years since 2012 to 2016. The dependent
variables were the three anthropometric measurements: height-for-age (H/A), which indicates
the level of stunting, weight-for-age (W/A), which indicates the level of underweight, and
weight-for-height which indicates the level of wasting. Calculation of recovered cases using
the standard formula.
Malaysia is one of several ASEAN countries facing simultaneous crises of over and under-
nutrition, with some children overweight while their peers suffer from stunting and wasting.
This ‘double burden of malnutrition’, identified in a recent report from UNICEF, WHO and
ASEAN, is also happening in other middle income countries such as Indonesia, the
Philippines and Thailand. According to the latest statistics from the National Health Morbidity
Survey (NHMS 2015) as quoted in the report, 8% of children under 5 suffered acute
malnutrition, or wasting (1). Children in rural areas were more likely to be underweight and
less likely to be overweight than urban children. Long-term national monitoring and
longitudinal cohort studies will be critical for under-standing, preventing, and managing the
double burden of malnutrition among children in Malaysia (2). The majority of the underlying
contributing factors to malnutrition in children were manifested at an individual level – low
birth weight, frequency of clinic visit, age on complementary feeding, and protein intake
below recommended nutrient intakes. There is a need for appropriate public health
promotion and socio-economic improvement interventions towards improving the nutritional
status and health of children (3).
RESULTS AND DISCUSSION
The total of children aged less than 6
years referred to health clinic in
Cameron Highlands for 2016 was 3156
(Figure 1). In 2016, Nutrition
counseling sessions have shown that
malnourished children (under 6 years)
were the highest referred to the
Nutritionist (n=122 children).
The cases of malnourished children
which is actively received food basket
for the year 2016 was 115 cases.
The total is decreased compared to
the previous year. However, in 2016
the total of malnourished children
was increased (n=180) (Table 1). This
increase is due to the detection of
the new cases rising and quality
management of the children was
improve. The malnourished children
(without food basket) because of
high family income, intolerance with
the milk, family have chosen the
specific milk for their child or child
fully breastfeeding.
The percentage of children less than 6
years referred to health clinic in
Cameron Highlands in 2016 is 3.3%.
The children aged between 1 to 4 years
is the highest referred to health clinic
in 2015 (4.2%) and 2016 (3.4%)(Figure
2). In 2016, Nutrition counseling
sessions have shown that
malnourished children (under 6 years)
were the highest referred to the
Nutritionist (n=122 children).
Figure 2 The total of children under 6 years (n=122) referred to Nutritionist
at health clinic, Cameron Highlands from 2012 to 2016
0
20
40
60
80
100
120
Baby
(0-6 m)
Children
(6-12 m)
Children
(1-6 y)
Children
(7-9 y)
Adolescent
(10-12 y)
Adolescent
(13-17 y)
Adolescent
(18-19 y)
Adults
(20-59y)
Adults
(≥60y)
2015 7 32 117 1 0 1 0 37 7
2016 15 16 91 0 0 9 2 86 9
Totalofclients,(n)
0
2
4
6
8
10
2012 2013 2014 2015 2016
Prevalence (%) 6.3 4.1 9.2 4.2 5.7
Percentage,%
2012 2013 2014 2015 2016
< 1 year 2.3 2.2 2.0 4.2 3.1
1- 4 year 2.5 2.4 2.6 4.2 3.4
5-6 year 2.0 2.0 1.8 3.0 2.8
Total 2.4 2.3 2.3 4.1 3.3
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Percentage,%
0
20
40
60
80
100
2013 2014 2015 2016
Percentage (%) 4.35 82.61 60.7 22.2
Gain Weight (n) 1 19 34 8
Total, N 23 23 56 36
Percetange,%
Figure 3 The gain weight percentage of children
newly enrolled in the food basket (≤ 6 month)
To evaluate the prevalence of malnutrition among children aged between 6 months to 6
years referred to health clinic and to assess cases of children recovering in Rehabilitation
Programme for Malnourished Children (PPKZM).
Prevalence of malnourished
children referred to health
clinic in Cameron Highlands
2012 to 2013 is decreased
from 6.3% to 4.1%. In 2014,
prevalence of malnourished
children is 9.2% and
increased from 2015 (4.2%)
to 2016 ( 5.7%.) (Figure 1).
From 2013 to 2016, the gain
weight percentage of children
newly enrolled for Food
Basket was decreased into
22.2% (Figure 3). The total of
recovered case increased
from year 2014 to 2016
(Figure 4).
Malnutrition affects physical growth, morbidity, mortality, cognitive development,
reproduction, and physical work capacity, and it consequently impacts on human
performance, health and survival. By continued this program, children who meet the
eligibility criteria given food basket help them obtain a balanced and nutritious food, in
order to achieve optimal physical and mental development as well as can reduce the
incidence of malnutrition in children at Cameron Highlands.
N=2087
N=3003 N=3040
N=3664
N=3156
REFERENCES
1. National Health Morbidity Survey (NHMS 2015). Overcoming childhood obesity and malnutrition in Malaysia.
2. Amina Z. Khambalia, Siew S. Lim, Tim Gill, and Awang M. Bulgiba. Prevalence and sociodemographic
factors of malnutrition among children in Malaysia. Food and Nutrition Bulletin, vol. 33, no. 1 © 2012,
The United Nations University.
3. Eunice MJ, Cheah WL & Lee PY. Factors Influencing Malnutrition among Young Children in a Rural
Community of Sarawak. Mal J Nutr 20(2): 145 - 164, 2014.