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Appendix III - Supplementary Tables

from 6 - Health Service Delivery

Published online by Cambridge University Press:  04 September 2021

Edited by
Jo. M. Martins ,
Indra Pathmanathan ,
David T. Tan ,
Shiang Cheng Lim  and
Pascale Allotey
Jo. M. Martins
Affiliation:
International Medical University, Malaysia
Indra Pathmanathan
Affiliation:
United Nations University - International Institute for Global Health
David T. Tan
Affiliation:
United Nations Development Programme
Shiang Cheng Lim
Affiliation:
RTI International
Pascale Allotey
Affiliation:
United Nations University - International Institute for Global Health

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Systems Thinking Analyses for Health Policy and Systems Development
A Malaysian Case Study
 , pp. 202 - 220
Publisher: Cambridge University Press
Print publication year: 2021
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - SA
This content is Open Access and distributed under the terms of the Creative Commons Attribution licence CC-BY-NC-SA 4.0 https://creativecommons.org/cclicenses/

Appendix III Supplementary Tables

Supplementary Table 6.a Ten principal causes of admissions and deaths, 1960, 1974 and 1996

Causes1960, rank (%)1974, rank (%)1996, rank (%)
AdmissionsDeathsAdmissionsDeathsDeaths
Accidents1 (10.14)7 (5.63)1 (13.48)3 (10.53)3 (9.44)
Skin diseases2 (4.11)−6 (2.58)−−
Gastroenteritis/digestive system diseases3 (3.90)3 (8.93)3 (3.71)8 (2.87)7 (4.60)
Complications of pregnancy4 (3.72)10 (2.64)2 (4.97)−−
Tuberculosis5 (2.88)5 (7.36)−7 (4.40)−
Malaria6 (2.65)−−−−
Mental illness7 (2.42)−4 (3.10)−−
Bronchitis8 (2.34)−10 (1.95)−−
Pyrexia of unknown origin9 (2.21)−8 (2.16)−−
Heart diseases10 (1.77)2 (9.94)5 (2.59)2 (15.02)1 (15.61)
Disease of early infancy−1 (15.2)7 (2.29)1 (18.99)6 (7.82)
Cardiovascular/cerebrovascular diseases−8 (3.17)9 (2.08)4 (7.32)4 (9.27)
Pneumonia−4 (8.48)−6 (6.50)8 (4.17)
Neoplasms−6 (6.03)−5 (6.71)5 (8.92)
Deficiency diseases9 (2.81)−−10 (1.43)−
Liver diseases−−−9 (2.32)−
Septicaemia−−−−2 (10.12)

Supplementary Table 6.b Infant and child mortality rates, 1957–2017

1957197019831990200020102016/2017
Infant mortality rate (per 1,000 live births)68.939.420.213.166.77.3
Neonatal mortality rate (per 1,000 live births)29.621.412.38.53.14.34.2
Toddler mortality rate (per 1,000 population aged 1–4 years)84.21.70.90.50.40.4
Under-5 mortality rate (per 1,000 live births)110.455.926.616.87.98.58.6

Supplementary Table 6.c National disease control programmes

Disease control programmeKey strategiesSupporting strategiesOutcomes
PreventionScreening/ detectionTreatment and managementHuman resource and capacity buildingSurveillance systemCommunity participation
Yaws Elimination Campaign, 1954 – with assistance from WHO and UNICEF (UN Children’s Fund)

  • Mass survey campaign, with annual re-surveys.

  • When the incidence rates declined, modified school surveys were deployed

  • every 6 months. If infectious cases were found, the entire area would be studied.

Mass treatment using procaine penicillin for open cases, latent cases and contact.Yaws elimination unit was set up.

  • Incidence rate declined from 140.85 per 100,000 population in 1958 to <2 in 1974.

  • Yaws control activities were integrated into the general health services in 1974. All health workers were trained to recognise yaws cases.

Filariasis Control Programme, 1960Case detection: House and population censuses and nocturnal mass blood survey. Whenever a nocturnal survey was not feasible, the diethylcarbamazine (DEC) stimulation technique was used during follow-up of cases or in school surveys.Mass treatment in the locality using DEC: Individual case follow-up was carried out after 3–5 months while the locality was resurveyed after about 2–3 years.

  • Peninsular Malaysia: Control team (medical assistant, public health auxiliary, junior laboratory technician, driver and vehicle).

  • Sabah and Sarawak: Ad hoc team to conduct surveys and treatment in specific areas.

  • 1988–90: There appeared to be a decreasing trend in the number of filariasis cases detected countrywide.

  • 1983: incorporated into the Vector-Borne Disease Control Programme.

  • National TB Control Programme, 1961 –

  • monitored and co-ordinated by the Division of TB and National TB Control Centre

  • National health education campaigns: To increase public awareness of TB signs and symptoms and early diagnosis.

  • BCG vaccination programme: Between 1961 and 1974, at least 75% of the susceptible population had been vaccinated (total BCG vaccinations performed: 4,965,982).

Case finding programme: Early case detection among symptomatic and high-risk groups (at least 66%) in the community using mass miniature radiography (MMR), X-ray, bacteriological and sputum examination and referred for appropriate treatment.

  • Treatment programme: 20-month standard treatment regimen (streptomycin with isoniazid or isoniazid with para-aminosalicylic acid or thiacetazone) for patients to render them non-infective (at least 95%).

  • The National TB Control Centre served as the national referral hospital for patients with complicated TB.

  • Countrywide training programme conducted by the National TB Centre, supported by hospitals, for different categories of personnel (doctors, nurses, hospital assistants, health inspectors, medical students and lab technicians).

  • Formation of State TB Control/Managerial Teams in 1973 to supervise and monitor the treatment programme and contact tracing.

1973: The TB registry was established.Working with MAPTB to provide socio-economic aid and increase community participation to reduce defaulter rates for treatment.

  • TB is no longer the major cause of death.

  • The National TB Control Programme was integrated with public health and general medical services in 1995.

Malaria Eradication Programme, 1967–82: Part of the Global Malaria Eradication Programme

Vector control:

Residual insecticide spraying using DDT (started with DDT wettable powder and replaced by DDT emulsion)

  1. - Abate 500 E was applied in drains and canals

  2. - Automatic siphons, tidal gates and sluice gates were constructed to manage water movement.

Health education for the community.

  • Active case detection in high-risk areas.

  • Passive case detection in patients seeking medical and health services.

  • Mass blood screenings

  • every 6 months in areas with increase of cases, influx of foreign workers, interior Orang Asli settlements and where there were cases in non-endemic areas.

  • Presumptive treatment (Darachlor (chloroquine/pyrimethamine)) was given to suspected cases, especially those from malarious areas before blood examination.

  • Radical and follow-up treatment (sulfadoxine/pyrimethamine, chloroquine and primaquine) was given for all reported cases.

Vertical organisational structure:

  1. - Director and deputy director

  2. - Administration bureau

  3. - Spraying bureau

  4. - Health education and training bureau

  5. - Epidemiology bureau

  6. - Entomology bureau

  7. - Malariologist

  8. - District chief and multi-purpose/special team

Specially trained personnel deployed to map and spray all houses and structures, perform

census counts, perform mass blood surveys and general

surveillance activities.

  • Case registries

  • Entomological surveillance activities to study vector habits.

  • Substantial decline in reported cases in West Malaysia and Sarawak, from 150,000 at the start of the programme to <50,000 a year in the late 1970s.

  • Did not succeed in eliminating malaria, re-orientated strategy to malaria control.

  • 1985: Incorporated into the Vector-Borne Disease Control Programme.

National Leprosy Control Programme Peninsular Malaysia (1969), Sarawak (1974), Sabah (1985)Early case finding by staff of the ‘skin clinics’.

  • Introduction of multiple drug therapy (MDT) and decentralisation of treatment:

  • patients were hospitalised only during the intensive phase of treatment, and follow-up treatment was available at 23 skin clinics throughout the country.

  • Institutional treatment only for infectious cases and non-infectious cases with severe reactions from drug cases requiring reconstructive surgery.

 A Central Registry of cases was established at the National Control Centre: it registered 50% or 8,710 estimated cases in 1969.Worked with MaLRA to reduce stigma and facilitate social integration of patients.1994: achieved WHO elimination status of <1 per 10,000 population.

  • National Immunisation Programme – Expanded Immunisation Programme was adopted as part of the National Immunisation Programme in the late 1980s.

  • Smallpox (early 1950s)

  • DPT (1958)

  • BCG (1961)

  • Poliomyelitis (1972)

  • Measles (1984)

  • Rubella (1988)

  • Hepatitis B (1989)

  • Immunisation campaigns jointly organised with NGOs.

  • Dissemination of health education messages through mass media.

  • Delivered through the rural health units or the MCH clinics in urban areas as part of MCH services.

  • Focus on low-coverage groups:

  • Estate population

  • Indigenous people

  • Religious subgroups

  • Urban poor

  • Defaulter tracing

  • Missed opportunities

  • Strengthening of the cold chain:

  • Provision of suitable refrigerators, ice packs and vaccine carriers

  • Training on the management, maintenance and monitoring of the cold chain

Development of a mapping system and improved monitoring system at district and local levels.

  • Almost 90% childhood immunisation coverage for BCG, DPT, polio and MMR in 1990

  • Decline of the infant and children mortality rate.

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