First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

Top Dengue-Related Highlights from the Dengue Prevention Advocacy Malaysia Launch

WORDS LIM TECK CHOON

ABOUT THE DENGUE PREVENTION ADVOCACY MALAYSIA (DPAM) GROUP
  • DPAM is an independent advocacy group co-jointly led by the Malaysian Paediatric Association (MPA), the Malaysian Society of Infection Control and Infectious Disease (MyICID), the Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC), and the Malaysian Public Health Physicians Association (PPPKAM).
  • DPAM collaborates with the Malaysian Society of Parasitology and Tropical Medicine (MSPTM), the Malaysian Medical Association (MMA), Asia-Pacific Academic Consortium for Public Health Kuala Lumpur (APACPH-KL) and Rotary International District 3300.
  • DPAM is established to support the efforts of the Ministry of Health in strengthening dengue prevention, management, and control in Malaysia.
WHY DPAM IS NECESSARY: A POTENTIAL EMERGING DENGUE EMERGENCY
FEATURED EXPERT
DR HUSNINA IBRAHIM
Deputy Director of Disease Control Division (Communicable Diseases)
Ministry of Health Malaysia
  • Malaysia had its worst dengue outbreak in 2019, over 130,000 cases and 182 deaths.
  • The numbers declined during the MCO a few years ago. During this new normal, however, dengue numbers are once again on the rise.
  • From January to epidemiology week-22 this year, there has been a 158% rise in dengue cases and 183% increase in the deaths compared with the same period last year.

Dr Husnina Ibrahim, the Deputy Director of Disease Control Division (Communicable Diseases), said: “As Malaysia typically experiences a surge in dengue cases every 4 to 5 years, it was projected that an outbreak is due around this or next year, with an estimated number of cases potentially surpassing the historic 2019 outbreak.”

RECENT ADVANCES YIELD POSITIVE RESULTS IN THE PREVENTION & CONTROL OF DENGUE
Wolbachia-infected mosquitoes
  • The introduction of Wolbachia-infected mosquitoes has significantly reduced dengue cases in 16 out of 19 localities, by 33% to 100%.
  • Wolbachia is a type of bacteria that can infect many species of invertebrates—organism with no backbone—including mosquitoes such as Aedes aegypti, the mosquito that carries and spreads the dengue viruses.
  • Male Aedes aegypti infected with Wolbachia will mate with female mosquitoes, but the resulting eggs will not hatch.
  • This reduces the number of Aedes aegypti mosquitoes.
Implementation of comprehensive guidelines, proper training, and a critical review of dengue mortality

These efforts have reduced the case-fatality rate by 87.3% from 2000 to 2022.

SETTING TARGETS FOR FUTURE DENGUE PREVENTION & CONTROL EFFORTS
  • The Ministry of Health has in place the National Dengue Prevention and Control Strategic Plan 2022-2026, which aims to annually reduce the number of dengue cases by 5% while maintaining the proportion of deaths compared to the number of cases (case fatality rate or CFR) below 0.2%.
  • The Ministry aims to reduce the CFR to 0% by 2030—which is to say, there should be no deaths due to dengue by that year.
DPAM TO PLAY AN ACTIVE ROLE IN SUPPORTING THE EFFORTS OF THE MINISTRY OF HEALTH TO ACHIEVE THESE TARGETS
FEATURED EXPERT
PROFESSOR DATUK DR ZULKIFLI ISMAIL
Consultant Paediatrician and Paediatric Cardiologist
Chairman of the Dengue Prevention Advocacy Malaysia (DPAM)

Professor Datuk Dr. Zulkifli Ismail expresses his optimism that the Ministry of Health’s aforementioned targets are achievable with the active involvement of key stakeholders such as the government, civil society, academia, private sector, media, and the community.

DPAM aims to synergize efforts by various of these stakeholders in assisting the Ministry of Health to achieve its national and global dengue targets through the strengthening of dengue prevention, management, and control in Malaysia.

He said, “DPAM will focus its efforts on healthcare professional and public education and communication, local research, guideline recommendations, as well as policy recommendations.”

To foster and strengthen regional collaborations, DPAM will work closely with the Asian Dengue Voice & Action (ADVA), a regional advocacy group. Their first collaborative initiative is the hosting of the 7th Asia Dengue Summit in Malaysia next year.

DPAM also released a Resolution Paper that contained key strategies for all relevant stakeholders to create a “whole of society” approach.

Medical Professionals Galvanize to Tackle Obesity Pandemic in Malaysia with Release of Revised Clinical Practice Guidelines

WORDS LIM TECK CHOON

We’ve all read about it and probably memorized the statistics by now: Malaysia is among the heaviest countries in Asia, if not the world. Perhaps unsurprisingly, there is also a high prevalence of chronic diseases such as type 2 diabetes, high blood pressure, and others that are linked to obesity.

AN URGENT IMPETUS TO CURB THE OBESITY PANDEMIC IN MALAYSIA

Obesity is classified as a chronic or long-term disease. As such, Malaysian healthcare professionals have banded together in their commitment to provide Malaysians with the best treatment options and accessibility to these treatments.

A milestone in this commitment took place on 9 June 2023, with the release of the 2nd edition of the Clinical Practice Guidelines for the Management of Obesity.

The clinical practice guidelines are jointly published by the Ministry of Health Malaysia, the Malaysian Endocrine & Metabolic Society (MEMS), the Malaysian Society for the Study of Obesity (MASO), the Malaysian Dietitians’ Association (MDA), and Family Medicine Specialists Association of Malaysia (FMSA)—a multidisciplinary collaboration comprising endocrinologists, dietitians, and more.

The launch of the clinical practice guidelines was officiated by Dr Mohd Ridzwan Shahari, the Deputy Director of Medical Development Branch of the Medical Development Division, representing Dato’ Dr Asmayani Khalib, Deputy Director-General of Health (Medical) of the Ministry of Health Malaysia.

AN UPDATED BLUEPRINT OF NEW & ROBUST STRATEGIES TO PREVENT & MANAGE OBESITY

The initial edition of the clinical practice guidelines was released in 2004. With almost 20 years since then, much had changed when it comes to prevalence of, attitude towards, and management approaches for obesity.

As Dr Nurain Mohd Noor the President of MEMS, puts it: “Overweight and obesity in Malaysia is growing with every passing year. Based on the National Health and Morbidity Survey, in 2011, the prevalence was already at 44.5%, and in 2019, it has risen to a staggering 50.1%, whereby half of the population is now classified as overweight or obese.”

As such, the revision of the existing clinical practice guidelines is most timely and necessary. Professor Dr Norlaila Mustafa, Chairperson of the CPG Development Committee, reveals that the committee attracted experts from diverse field—endocrinology, psychology, dietetics, sports medicine, family medicine, paediatric endocrinology—to revise the existing guidelines to incorporate breakthroughs and advances that offer promising solutions in the last 20 years.

Some of the revisions and expansions include:

  • Expanding the range of recommended medications and medical procedures to treat obesity.
  • Updates on medical nutrition therapy to introduce successful and effective changes to a patient’s diet.
  • Emphasis on psychological interventions, such as cognitive behavioural therapy, to motivate patients into adopting and maintaining lifestyle changes to maintain a healthy weight.

With regards to the third point, Prof Dr Norlaila brings up tools include the Binge Eating Scale, which helps to identify individuals with binge eating disorder, ‘SMART’ strategy that aids in a patient’s goal setting, and problem-solving techniques such as ‘IDEAL’ to support patients when faced with setbacks in their weight management journey.

A NEW BASIS FOR BODY MASS INDEX

A key issue raised during the launch was the need for a lower cut-off point for diagnosis of overweight and obesity among Asians.

This is because the current body mass index or BMI system was initially based on the physiology and fat composition of Caucasians.

Asians, on the other hand, typically have shorter height and higher body fat percentages. Research has shown that the risk of type 2 diabetes, high blood pressure, and other weight-associated chronic diseases tend to rise for Asians at a lower BMI point.

Hence, based on evidence gathered from research on Asians, the following BMI categories are recommended for use in Malaysia:

BMI CATEGORY
23 to 27.4 kg/m2 Overweight
27.5 kg/m2 and above Obese
A FOUNDATION FOR A ROLLOUT OF IMPROVED PREVENTION & MANAGEMENT OF OBESITY PROGRAMME IN MALAYSIA

Prof Dr Norlaila shares her hopes that the release of the revised Clinical Practice Guidelines for the Management of Obesity will become a primary cornerstone for treatment and prevention, as well as health awareness programmes in Malaysia.

She reveals that future plans include making weight management and obesity treatment services available in more primary healthcare points such as general practitioners, educational talks and programmes in schools, and more.

Interested healthcare professionals can download a digital copy of the Clinical Practice Guidelines for the Management of Obesity (2nd Edition) at the Academy of Medicine of Malaysia here (link opens in a new tab).

Great News! Now More Children Are Eligible for Free Pneumococcal Vaccination!

WORDS LIM TECK CHOON

In conjunction with World Immunization Week from 24 to 30 April, the Ministry of Health held a National Immunisation Day 2023 on 31 May 2023.

The event was a collaboration between various divisions in the Ministry of Health’s Public Health Programme and Immunise4Life (link opens in a new tab).

THE BIG CATCH-UP

The theme of National Immunisation Day this year is ‘Tingkatkan liputan, kurangkan keciciran’ or ‘The Big Catch-up’.

Dr Zaliha Mustafa, our Minister of Health, revealed that this theme is in line with the expansion of Malaysia’s free pneumococcal vaccination programme to those born between 2018 and 2019. This expansion will commence from June 1.

Pneumococcal vaccine was included in the National Immunisation Programme (link opens in new tab) to initially cover children born from January 1 in 2020.

With this expansion, our Ministry of Health hopes to target 70% or 700,000 of the 1 million children aged 4 to 5 under the two-year programme.

“The nationwide pneumococcal vaccination programme will start on June 1 until May 31 next year and it will involve the ministry’s primary healthcare facilities,” she explained.

Interested parents can set an appointment for their children’s vaccination using the MySejahtera app.

WHY KIDS SHOULD GET THE PNEUMOCOCCAL VACCINE

Pneumococcal disease, an infection caused by bacteria called Streptococcus pneumoniae is contagious and may cause severe illness, so early diagnosis and treatment is important.

Children 2 years old or younger are vulnerable to such infection.

Hence, these children are also at risk of developing serious, potentially life-threatening complications such as:

  • Pneumonia, which is the infection and inflammation of the air sacs in our lungs
  • Ear infections
  • Meningitis, which is the inflammation of a membrane called meninges in the spinal cord and brain
  • Bacteraemia, or infection of the bloodstream
Pneumococcal pneumonia is a lung infection caused by the bacteria responsible for pneumococcal disease. Click on the image for a larger, clearer version.

Once the bacteria infect the bloodstream, they can find their way to parts of the body that are normally sterile, such as the peritoneum—that’s the membrane lining our abdominal cavity—as well as our joints and heart. This can lead to many more invasive diseases, such as peritonitis, arthritis, and endocarditis (inflammation of the inner layer of the heart) respectively.

Hence, parents with children that are eligible for the free vaccination should consider taking advantage of the expansion of Malaysia’s free pneumococcal vaccine programme. They can consult a doctor should they have any doubts and concerns about the vaccine.

Read All About It: Drug Control Authority Recalls a Cough Medicine!

WORDS LIM TECK CHOON

FEATURED EXPERT
LIM EN NI
Chief Pharmacist
Alpro Pharmacy

Recently, the Drug Control Authority under the Ministry of Health Malaysia issued a circular on the cancellation and product recall of pholcodine, an opioid medicine that is used in adults and children for the treatment of non-productive or dry cough. It is also used in combination with other active substances for the treatment of symptoms of cold and flu.

In Malaysia, you’ll need a doctor’s prescription to obtain pholcodine.

You can read more about the recall at the National Pharmaceutical Regulatory Agency website here (link opens at a new tab).

According to Lim En Ni, this recall is due to a possible drug interaction with neuromuscular blocking agents.

WAIT, WHAT ARE NEUROMUSCULAR BLOCKING AGENTS?

These are medications that are commonly used for general anaesthesia during medical surgeries.

There are a few types of neuromuscular blocking agents, but generally, they prevent normal transfer of information through nerves at your neuromuscular junction.

This keeps you from moving the skeletal muscles connected to the affected neuromuscular junction, hence the use of these medications as anaesthesia.

SO, WHAT DOES PHOLCODINE HAVE ANYTHING TO DO WITH THESE AGENTS?

Lim En Ni explains that people that take pholcodine-containing products in the past 12 months are at risk of experiencing anaphylaxis should they also receive neuromuscular blocking agents.

“Anaphylaxis is a serious, life-threatening allergic reaction,” she says.

ANAPHYLAXIS IS A SERIOUS MATTER
  • It can occur within seconds or minutes of exposure to something you’re allergic to.
  • When you experience anaphylaxis, your immune system will release chemicals that can cause your blood pressure to experience a sudden drop. Also, your airways to block and you will experience problems breathing normally. You will also typically experience weak blood pulse, skin rashes, nausea, and vomiting.
  • You will need an injection of epinephrine to stabilize your condition and then immediately proceed to an emergency room for quick treatment. Delays in getting treatment can lead to death!

WHAT YOU CAN DO ABOUT THIS MATTER

En Ni advises the following:

  • If you have purchased the medication but have not consumed it, you can return it to the pharmacy or healthcare facility that you obtained the medication from.
  • If you have used pholcodine in the last 12 months, visit a pharmacy and ask the pharmacist to help you prepare a medication list to show your surgeon or doctor should you need to undergo surgery. 
  • If you’re not sure whether you have taken pholcodine or your medicine contains pholcodine, consult a pharmacist for help.

Minister of Health Officiates New Child Health, Safety, and Well-being Programme

WORDS LIM TECK CHOON

On September 15 2022, our Minister of Health YB Tuan Khairy Jamaluddin officiated the launch of Healthy Little Bloomers programme and the roll-out of its maiden campaign Junior Germ Busters. 

The Healthy Little Bloomers programme aims to promote child health, safety and well-being through a network more than 30,000 early childhood care and education centres nationwide, potentially benefiting more than 800,000 children.

This is an initiative led by the Malaysian Paediatric Association (MPA) in collaboration with 10 prominent early childhood care and education organisations from both private and government sectors. These organisations are Jabatan Kemajuan Masyarakat (KEMAS), ECCE Council, Malaysian Association of Professional Early Childhood Educators (MAPECE), Persatuan Tadika Malaysia (PTM), Jabatan Kebajikan Masyarakat (JKM), Persatuan Pengasuh Berdaftar Malaysia (PPBM), National Association of Special Education, Malaysia (PPKK), Majlis Kebajikan Kanak-Kanak Malaysia (MKKM), Persatuan Tadika Sabah (PTS) and Association of Kindergarten Operators Sarawak (AKO).

In his speech during the launch, YB Tuan Khairy highlighted the following:
  • Young children, especially those under the age of 5, are vulnerable to health and safety threats, such as infectious diseases, injuries, abuse and neglect
  • Children who are overweight or obese are 5 times more likely to become overweight and obese adults
  • Child abuse survivors are at higher risk of becoming abusers or getting involved in abusive relationship during adulthood
  • Unmet emotional and mental health needs during childhood will lead to difficulties and problems during adolescence and adulthood
PROGRAMME IN STEP & LINE WITH MALAYSIAN GOVERNMENT DEVELOPMENT GOALS

YB Tuan Khairy is pleased with the launch of Healthy Little Bloomers because, as he puts it: “Children are the nation’s future. Therefore, addressing their health, safety and well-being needs holistically is one of the government’s key priorities. It has been part of the Malaysian government development goals since the 1960s and outlined in our latest Child Health 2021-2023 national framework”.

He applauds the campaign as an initiative that brings together MPA and partner organisations for bringing together medical professionals and early childhood care and education experts in a systematic and potentially long-term collaboration to help bring to fruition the goals of the government.

This is a vital programme as many young children spend most of their waking hours in kindergartens and children centres every week, abd studies have shown that health promotion intervention in kindergarten and childcare centres can be effective, especially if parental engagement is involved.

THE PROGRAMME IN MORE DETAIL

Professor Datuk Dr Zulkifli Ismail, Chairman of Healthy Little Bloomers, shares that the programme is meant to be cover all key domains and aspects of child health, safety and well-being in a holistic manner.

He further elaborates that the programme will take an annual thematic approach.

WHAT THE HEALTHY LITTLE BLOOMERS PROGRAMME OFFERS
  • Training for early childhood care and education operators and personnel
  • Fun, exciting, and interactive lessons for children; the programme is inclusive and will cater to children from various population segments, including those that are underprivileged and with special needs
  • Information and educational materials for parents and primary caregivers; available in Bahasa Malaysia and English
  • Roadshows to cater to less advantaged children, featuring activities that will consider the needs of those with hearing or vision impairments.

Visit healthylittlebloomers.my to get more information as well as free educational materials.