1. Patterns of Disease in Malaysia and Worldwide
Dr. Lely Lubna Alaydrus
23 Nov’11

2. References : Consensus Report on HIV and AIDS in Malaysia, 2004.
Ministry of Health Malaysia & WHO.
WHO website : May 2009.
National Cancer Registry Report (Malaysia Cancer Statistics - Data and Figure) 2007.
Malaysia Cancer Statistics, Data And Figure Peninsular Malaysia 2006.
Cancer Incidence in Penincular Malaysia ( )
Health Facts 2008 and 2010.
available at :
Power Point slides : Immunization, by Dato’ Dr. Hasnah, 2010.

3. Changing the pattern of disease :
Developing countries Developed countries
Nutritional,
Perinatal,
Infectious diseases
Non-communicable diseases,
ex. CVD
transition
4 stages

4. 4 stages : 1 2 3 4 Predominant diseases :
Infectious, Nutritional deficiencies-related disorders.
Diseases related to hypertension, ex. Stroke, heart disease.
Hight-fat diets, cigarrette smoking, sedentary life-styles ex. CVD, IHD.
Increased effort to prevent, diagnose, and treat IHD.

5. Factors that play a role in changing patterns of disease :
Changing life styles and living standards
Demographic factors,urbanization, industrialization
Medical interventions
Widespread effects of technology on ecology

6. Leading causes of death in 2001
Developing Countries
Number of Deaths
Developed Countries
    1. HIV/AIDS
    1. Ischaemic heart disease
    2. Lower respiratory infections
    2. Cerebrovascular disease
  3. Ischaemic heart disease
    3. Chronic obstructive pulmonary disease
    4. Diarrhoeal diseases
    4. Lower respiratory infections
    5. Cerebrovascular disease
    5. Trachea/bronchus/lung cancers
    6. Childhood diseases
    6. Road traffic accidents
    7. Malaria
    7. Stomach cancer
    8. Tuberculosis
    8. Hypertensive heart disease
    9. Chronic obstructive pulmonary disease
    9. Tuberculosis
10. Measles
10. Self-inflicted
Source: WHO World Health Report Countries grouped by WHO Mortality Stratum,
with Developing Countries representing regions with High and Very High Mortality, and Developed Countries representing regions with Low and Very Low Mortality.

8. Regional Differences in Cause of Death
The radar graph shows regional differences in causes of death in year The bright blue line represents the world average for each category of cause.
The other colored lines show how different regions compare, whether above or below world average.

9. Regional Differences in Cause of Death
For example, the orange line shows that infectious and parasitic diseases, including measles and malaria, are more frequent causes of death in Sub-Saharan Africa than elsewhere.
Respiratory infection disproportionately effects people living in Southeast Asia and Sub-Saharan African. These two regions are also particularly hit by maternal conditions and perinatal conditions as well.

10. Regional Differences in Cause of Death
The Asia and the West Pacific region has a rate of non-communicable respiratory diseases, such as chronic bronchitis and emphysema, that is nearly 2.5 times higher than the rest of the world.

11. Regional Differences in Cause of Death
Western Europe has a greater proportion of deaths due to heart (cardiovascular) disease and cancer (malignant and other neoplasms).

12. Key facts (May 2009, www.who.int)
The proportion of under-nourished children under five years of age declined from 27% in 1990 to 20% in 2005.
Maternal mortality has barely changed since 1990.
One third of 9.7 million people in developing countries who need treatment for HIV/AIDS were receiving it in 2007.

13. Key facts (May 2009, www.who.int)
MDG target for reducing the incidence of tuberculosis was met globally in 2004.
27 countries reported a reduction of up to 50% in the number of malaria cases between 1990 and 2006.
The number of people with access to safe drinking-water from 4.1 billion in 1990 to 5.7 billion in About 1.1 billion people in developing regions gained access to improved sanitation in the same period.

14. Millennium Development Goals (MDGs)
In September 2000, 189 head of state adopted the UN Millennium Declaration and endorsed a framework for development.
The plan was for countries and development partners to work together to increase access to the resources needed to reduce poverty and hunger, and tackle ill-health, gender inequality, lack of education, lack of access to clean water and environmental degradation.

15. 8 Goals of MDGs: 1. Eradicate extreme poverty & hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria & other diseases.
7. Ensure enviromental sustainability.
8. Develop a global partnership for development.

16. MDGs:
They set target for 2015, and identified a number of indicators for monitoring progress,several of which relate directly to health. All goals and their targets are measured in terms of progress since 1990.

17. Cancer Fact (WHO) :
Cancer is a leading cause of death worldwide, it accounted for : 7,9 million deaths in 2007 (13 % of all deaths ).
72 % of all cancer deaths in 2007 occurred in : low and middle income countries.
Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

18. Cancer Fact (WHO) : The most cancer death each year : Lung Stomach
Liver
Colon
Breast Cancer

19. Cancer Fact (WHO) : 30 % of cancer deaths can be prevented.
Tobacco use is the single most important risk factor for cancer.

20. Distribution of new cases of cancer worldwide in 2004 :

21. The Western Pacific Region includes China, Malaysia, Japan, Australia and New Zealand.
The lowest numbers of cases were diagnosed in the Eastern Mediterranean region (includes Saudi Arabia, Egypt, Iraq, Morocco, Tunisia) and Africa.

22. The top three included lung cancer in all regions except Africa and included breast cancer in all except for the Western Pacific region.
Cervical cancer was in the top three in Africa and South-East Asia only and bowel cancer in the top three for Europe only. Prostate cancer was in the top three in Africa and the Americas.

23. Data comparing more and less developed countries :
Both sexes :
The rate for all cancers (for cancers that occur in men and women) was 1.7 times higher in more developed compared with less developed countries.
For melanoma of the skin, kidney cancer and multiple myeloma rates were more than 3 times higher in more developed compared with less developed countries.
For nasopharyngeal cancer the rate was nearly 4 times higher in less developed than more developed countries
Source: GLOBOCAN 2008 database (version 1.2)

24. Age-Standardised Rate per 100,000 (World)
Cancer
Age-Standardised Rate per 100,000 (World)
WORLD
More Developed
Less Developed
Lung
23.0
31.3
19.1
Colorectum
17.3
30.1
10.7
Stomach
14.1
11.4
15.3
Liver
10.8
5.2
13.1
Oesophagus
7.0
3.6
8.7
Bladder
5.3
9.1
3.3
Non-Hodgkin lymphoma
5.1
8.6
3.5
Leukaemia
5.0
7.3
4.0
Kidney
1.9
Pancreas
3.9
6.8
2.4
Lip, oral cavity
3.8
4.4
Brain, nervous system
3.0
Thyroid
3.1
6.1
2.2
Melanoma of skin
2.8
9.0
0.6
Larynx
2.0
Other pharynx
2.5
Gallbladder
1.8
Multiple myeloma
1.4
2.7
0.8
Nasopharynx
1.2
0.4
1.5
Hodgkin lymphoma
1.0
0.7
All cancers excl. non-melanoma skin cancer
181.6
255.8
147.8

25. Changing of disease pattern in Malaysia :

26. Malaysia Health Fact 2010 :

27. Health Fact 2010 :

28. Health Fact 2010 :

30. Top five main notifiable diseases in 2007 were: dengue fever, tuberculosis, food poisoning, hand foot and mouth disease (HFMD), and HIV/AIDS.
Cardiovascular disease, diabetes and cancer are the major causes of admissions
and death.

31.
The results of the National Health Morbidity Survey III (NHMS III) in 2006 showed that prevalence of Hypertension and Diabetes has increased significantly i.e. prevalence of known diabetes and hypertension among adult above 30 years old was 14.9% and 42.6% respectively.5,6

32.
NCDs including cardiovascular diseases (CVD), diabetes, obesity, cancer and respiratory diseases account for 59% of the 57 million deaths annually and 46% of the global burden of disease (WHO 2008)

33. MALAYSIA SOSIOECONOMIC INDICATOR 2007

34. Road Traffic Accident :
WHO : 18 November 2011
Road traffic accidents result in about 1.3 million deaths and up to 50 million injuries each year.
Road traffic injuries are the leading cause of death for young people aged 15 to 29.
The World Day of Remembrance for Road Traffic Victims, 20 November, is a means to draw attention to road traffic accidents, their consequences and the human cost, as well as measures that can be taken to prevent them.

35. Cancer Incidence in Malaysia :
Data 2007 :
18,219 cases were diagnosed :
8,123 males
10,096 females
18,8 % were from Penang, followed by Johor, Selangor, etc.
ASR 85,1 /100,000 males
ASR 94,4 /100,000 females

36. ASR by ethinicity : ASR for Chinese males : 111,9 / 100,000
ASR for Chinese females : 115 / 100,000
ASR for Indian males : 68,2 / 100,000
ASR for Indian females : 99,9 / 100,000
ASR for Malay males : 66,9 / 100,000
ASR for Malay females : 79 / 100,000

37. 5 leading cancers among population of Malaysia in 2007:
Breast Cancer
Colorectal Cancer
Nasopharynx
Cervix
Lymphoma

38. 5 most frequent cancers among Malaysian males in 2007 :
Lung Cancer
Colorectal Cancer
Nasopharynx
Prostate
Lymphoma

39. 5 most frequent cancers among Malaysian females in 2007 :
Breast Cancer
Colorectal Cancer
Cervix
Ovary
Lung

43. Number of misusers in Malaysia :
Between :
There were 274,420 registered substance misusers in Malaysia: around 1% of the general population.
Approximately :
65% = Malay ethnic group
19 % = Chinese
10 % = Indian
80% = between age years old.

44. Diabetes in Malaysia : Data 2006 : 1.5 million cases of diabetes.
Estimation for Dec’ 2011 : 3 million cases.
Slogan for World Diabetes Day : 14 Nov.
“ Act on Diabetes now = Cegah diabetes,
bertindaklah sekarang ”
WHO estimates : 346 million people worldwide have diabetes.
 80 % diabetes deaths occur in low and middle-income countries

45. Stroke :
In Kuala Lumpur Hospital, 1000 stroke cases are seen per year with 30% - 35%, deaths due to stroke.
The World Health Organization estimates that in 2001 there were over 20.5 million strokes worldwide, 5.5 million of these were fatal. (

46. Food and Water Borne Diseases :
Incidence Rate and Mortality Rate of Communicable Diseases (per 100,000 Population) in Malaysia (Health Fact 2008)
Food and Water Borne Diseases :
Communicable diseases
Incidence rate
Mortality rate
Cholera
0.34
0.01
Dysentery
0.33
Food Poisoning
62.47
Typhoid
0.72
Hepatitis A
0.13

47. Vector Borne Diseases :
Communicable diseases
Incidence rate
Mortality rate
Dengue
167.76
0.02
Dengue Haemorrhagic Fever
10.16
0.38
Malaria1
2.67
0.01
Typhus
0.05
Plague
Yellow Fever

48. Vaccine Preventable Diseases :
Communicable diseases
Incidence rate
Mortality rate
Acute Poliomyelitis
Diphtheria
0.01
Measles
1.20
Other Tetanus
0.06
Neonatal Tetanus2
0.03
Hepatitis B
3.20
0.05
Whooping Cough
0.04
1 per 10,000 population 2 per 1,000 live births Source: Disease Control Division, MoH

49. Sexually Transmitted Diseases :
Communicable diseases
Incidence rate
Mortality rate
Chancroid
Gonorhoea
2.85
Syphilis
3.16

50. Other Infectious Diseases :
Communicable diseases
Incidence rate
Mortality rate
HIV
13.31
0.54
AIDS
3.39
3.25
Ebola
Hepatitis C
3.35
0.07
Hand, Food & Mouth Diseases
56.13
0.02
Leprosy
0.84
Other Specified Viral Hepatitis
Rabies
Relapsing Fever
Tuberculosis
63.10
5.49
Viral Encephalitis
0.01

51. Latest news for Dengue and Chikungunya : week 33/2011 (14-20 August 2011)

53. Hepatitis A outbreak : 11Nov’2011
In 2 villages in Terengganu.
Infected 35 people.
Cause : might be due to dirty water, unclean environment, and food. (

54. Diphtheria cases in 2008 : Rank Country Name No 1 2 3 4 5 6 7 8 9 1011 12 13 14
Global
India
Indonesia
Nepal
Brazil
Angola
Phlilippines
Ukraine
Iran (Islamic Republic of)
Russian Federal
Bangladesh
Sudan
Pakistan
Latvia
Vietnam
7,088
6,081
219
149 85 69 65 61 52 50 43 38 32 28 17
Rank
Country Name No 15 16 17 18 19 20
Turkmenistan
Haiti
Combodia
Georgia
Thailand
Iraq
France
Kazakhstan UK
Yemen
Canada
Lithuania
Malaysia 11 10 7 6 5 4

55. Measles cases in 2008: Rank Country Number Global 281,972 1 China
131,441 2
India
48,181 3
Indonesia
15,369 4
Congo (Dem. Republic of)
12,461 5
Japan
11,015 6
Nigeria
9,960 7
Thailand
7,016 8
Iraq
5,494 9
Cambodia
4,211 10
Ethiopia
3,511 11
Tanzania (United Rep. of)
3,413
Bangladesh
2,660
Nepal
2,089
Rank
Country
Number 11
Switzerland
2,022 12
Italy
1617
Afghanistan
1,599 13
Morocco
1,455
United Kingdom
1,445 14
Uganda
1,319
Niger
1,317
Kenya
1,282
Paksitan
1,129
Somalia
1,081
Israel
931
Benin
928
Germany
917
Egypt
668 35
Malaysia
334

56. HFMD IN SARAWAK :
Hand-foot-mouth disease (HFMD) is endemic in Sarawak, with yearly occurrence, tends to increase from February to June.
Kuching, Sibu, Miri and Bintulu have been noted to be “hotspots” for HFMD.

57. Epidemic curve of HFMD 2005 :

58. TB EPIDEMIOLOGY IN MALAYSIA (DR
TB EPIDEMIOLOGY IN MALAYSIA (DR. FUAD BIN HASHIM,TB/ Leprosy Control Unit, Communicable Disease Section, Disease Control Division)
Malaysia has been classified by the World Health Organization (WHO) as an intermediate TB burden country (IR < / 100,000 pop).
In 2008 : 17,506 new cases were registered in Malaysia.

59. Latest news of TB :
TB cases had risen from 18,102 in 2009 to 19,337 in 2010.
As of September 2011, the figure stood at 14,791cases.
Factors: influx of illegal migrant workers, increase in the number of AIDS patients, because when the body's immune system is low, TB could creep in easily. (

60. New TB cases per 100,000 population 2008 by country
Rank
Country name
Rate per 100,000 28
Philippines
285 37
Indonesia
189 40
India
168 44
Thailand
137 49
Malaysia
100 84
Japan 22
105
Australia
6.6
118
U.S.A.
4.8
Rank
Country name
Rate per 100,000
Global
139 1
Swaziland
1,200 2
South Africa
960 3
Zimbabwe
762 4
Nambia
750 5
Bobwana
710 6
Lesotho
640 7
Djibouti
620 16
Myammar
404 21
Korea (north)
340
Source: Global health fact

61. TB Deaths 2008 by country : Rank Country name Number Global 1,324.487
India 2
China
160,086 3
Nigeria
94,826 6
Indonesia
62,246 9
Philippines
46,996 11
Myammar
28,219 15
Thailand
12,890 19
North Korea
9,300 42
Malaysia
4,000
101
Australia 89

62. Incidence Rate of TB (all types)/100,000 Population Year 1993 - 2008

63. Incidence Rate of TB (all types)/100,000 Population by District in Kedah Year 2008

64. TB Notification Rate Malaysia, 1985-2008 (mid year population : 27,173,700)

65. Percentage of TB Among Children in Malaysia, 2000-2008

66. TB Death Rate in Malaysia, 2000-2008

67. Number of TB-HIV Co-infection & Death in Malaysia, 1990 – 2008 (No
Number of TB-HIV Co-infection & Death in Malaysia, 1990 – (No. TB Cases = 17,496 .No. New TB-HIV = 1,787 (10.2%) Incidence rate of new TB-HIV =6.58 per 100,000)

68. Estimated TB Incidence, Prevalence and Mortality, source : Tuberculosis Infection and transmission (WHO)
Incidencea
Prevalencea
TB Mortality
All forms
Smear-positiveb
WHO region
number (thousands)
per 100 000 pop
(% of global total)
Africa
2 529 (29)
343
1 088
147
3 773
511
544 74
The Americas
352 (4) 39
157 18
448 50 49
5.5
Eastern Mediterranean
565 (6)
104
253 47
881
163
112 21
Europe
445 (5)
199 23
525 60 66
7.4
South-East Asia
2 993 (34)
181
1 339 81
4 809
290
512 31
Western Pacific
1 927 (22)
110
866
3 616
206
295 17
Global
8 811 (100)
136
3 902
14 052
217
1 577 24

69. From the figures above, you can see that:
South-East Asia had :
the highest total number for the incidence of new cases of the disease,
the highest number of active TB sufferers and the highest total prevalence in the population at that time, but not quite the highest mortality.

72. REPORTED HIV/AIDS CASES : Time trends of reported HIV/AIDS cases
As of December 2002, a total of 51,256 cumulative cases of HIV infection had been reported to the national HIV/AIDS case-reporting system, of which 7218 were
AIDS cases and 5424 AIDS deaths. There were 6978 cases of reported HIV infection
in 2002, a 17% increase compared with
the 5938 in 2001 (Figure 2), while the number of AIDS cases fell by 8.4% from 1302 in 2001 to 1193 in 2002 (Figure 3).
The increase in reported HIV infections is partially due to the active HIV screening programmes in the target populations.

75. Global trend HIV :
The number of people living with HIV has risen from around 8 million in 1990 to 33 million in 2008, and is still growing. Around 67% of people living with HIV are in Sub-Saharan Africa.

76. The latest statistics of the global HIV and AIDS were published by UNAIDS in November 2009, and refer to the end of 2008.
Estimate
Range
People living with HIV/AIDS in 2008
33.4 million
million
Adults living with HIV/AIDS in 2008
31.3 million
million
Women living with HIV/AIDS in 2008
15.7 million
million
Children living with HIV/AIDS in 2008
2.1 million
million
People newly infected with HIV in 2008
2.7 million
million
Children newly infected with HIV in 2008
0.43 million
million
AIDS deaths in 2008
2.0 million
million
Child AIDS deaths in 2008
0.28 million
million

77. More than 25 million people have died of AIDS since 1981.
Africa has over 14 million AIDS orphans.
At the end of 2008, women accounted for 50% of all adults living with HIV worldwide
In developing and transitional countries, 9.5 million people are in immediate need of life-saving AIDS drugs; of these, only 4 million (42%) are receiving the drugs.

78. Regional statistics for HIV & AIDS, end of 2008
Adults & children living with HIV/AIDS
Adults & children newly infected
Adult prevalence*
Deaths of adults & children
Sub-Saharan Africa
22.4 million
1.9 million
5.2%
1.4 million
North Africa & Middle East
310,000
35,000
0.2%
20,000
South and South-East Asia
3.8 million
280,000
0.3%
270,000
East Asia
850,000
75,000
<0.1%
59,000
Oceania
3900
2,000
Latin America
2.0 million
170,000
0.6%
77,000
Caribbean
240,000
1.0%
12,000
Eastern Europe & Central Asia
1.5 million
110,000
0.7%
87,000
North America
55,000
0.4%
25,000
Western & Central Europe
30,000
13,000
Global Total
33.4 million
2.7 million
0.8%

79. During 2008 more than 2,5 million adults and children became infected with HIV (Human Immunodeficiency Virus), the virus that causes AIDS.
By the end of the year 2008, an estimated 33.4 million people worldwide were living with HIV/AIDS.

80. Four Targets for AIDS 2015:

81. Malaria in Malaysia :

82. Data on current climate-sensitive disease burdens :
Common communicable diseases that are sensitive to climate and are endemic in
Malaysia are: cholera and malaria (climate is the primary factor); and meningococcal
meningitis, dengue, Japanese encephalitis, leptospirosis and rickettsial infections (climate
plays a significant role).

84. Influenza Virus Surveillance :
A study conducted from September 1997 to April 1998 found that even though the influenza virus circulated throughout the year, a higher incidence of influenza A and influenza B infection occurred from October to December and March to April respectively (Figure 1). Most positive specimens were obtained from children less than 10 years of age.

86. Malaysian influenza surveillance from 1997 to 2005 showed that more influenza viruses are isolated from March to April, June to July and October to November than other periods of the year (Figure 2). The incidence of influenza virus infection is typically higher during March and July than during other months of the year. In 2001, however, an atypical increase in the number of influenza cases occurred during November.

87. The seasonal occurrence of influenza cases for 1997 until 2005 mirrored the pattern seen in the southern hemisphere as a whole. Hence, it will be prudent to initiate a programme to increase the use of inter-pandemic influenza vaccine from the months of March/April utilising the southern formulation.

88. Figures 6 to 8 show trends for many of these climate-sensitive diseases.

90. THE PANDEMIC THREAT: 1918: Spanish Flu (H1N1) 1957: Asian Flu (H2N2)
1968: Hong Kong Flu (H3N2)
Each century has witnessed an average of three pandemics of influenza occurring at intervals ranging from 10 to 50 years, starting without warning and spreading rapidly worldwide causing illness in more than 25% of the total population, with an estimated million deaths within a year. Most deaths occurred in young and healthy persons in the age range of 15 to 35 years. Pandemic of 1957 and 1968 respectively were caused by the milder viruses,each killed 1-4 million people.
Since 1997-now : H5N1 (Avian Influenza/Bird Flu)
in Cambodia, Indonesia, Thailand, Vietnam, Hong Kong and China.
2009 : H1N1 (Swine Flu)

91. THE IMPACT OF PANDEMIC INFLUENZA :
Pandemics are unpredictable and highly variable in terms of severity mortality and patterns of spread.
Most pandemics have originated in Asia. An exponential increase in the number and geographic spread can occur in a matter of weeks.
Some public health interventions (quarantine, travel restrictions) have delayed the spread but could not stop it; nevertheless delay of spread is important to allow for medical services to develop a vaccine
Vaccines have a significant impact but global manufacturing capacity is limited and takes too long (at least 4-6 months after the pandemic starts).

92. H1N1 Post Pandemic Period :
Official statement of WHO : 10 August 2010  “ the world is no longer in Phase 6 of the Influenza Pandemic Alert and we are now moving into the post-pandemic period.” (

93. H1N1 Post Pandemic Period :
This means that we are moving into a situation where:
The H1N1 virus has spread to all countries,
Many people in all age groups have developed some immunity to the virus,
No large and unusual summer outbreaks have occurred in either the Northern or Southern Hemispheres, and
Seasonal influenza A (H3N2) and influenza B viruses are now being reported in many countries.

94. Global situation H1N1:
Infection of H1N1 are still active, especially in South-east countries, West and East Africa, some countries in East and South Europe, South and East Asia.
Until 21 March 2010, total number of deaths of H1N1 : 16,931 deaths.
( cited 21 Nov’2011)

97. Assignment : STEPS IN PREPARATION OF PANDEMIC PREPAREDNESS PLANS.
LEVEL OF INFLUENZA PANDEMIC ALERT
( 1 – 6 ) .

98. National Health Accounts ( 2007 ) :
Total Expenditure on Health (Public & Private)
Total Expenditure on Health as a Percentage of GDP
Public Expenditure as a Percentage of Total Expenditure on Health
RM 30,227,929,810.20
4.70%
44.81%

99. Financial Allocation :
Total MoH Budget
MoH Operating Budget
MoH Development Budget
Per Capita Allocation
Per Capita Income (current prices ) (estimate)*
Percentage of Total MoH
Allocation to National Budget
RM 12,901,865,000
RM 10,679,587,000
RM 2,222,278,000 RM
RM 25,274
7.29 %
Source : *Economic Report 2008/ 2009, MoF

100. Thank you