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.
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).
On May 17, 2023. Malaysian digital health and e-prescription provider DOC2US and the Malaysian AIDS Council officially launched the first ever Virtual HIV Clinic in this country.
Associate Professor Dr Raja Iskandar Shah Raja Azwa, President of the Malaysian AIDS Council, said, “It is great to see a significant increase in telemedicine and virtual platforms available for medical consultations for persons with or at risk of HIV post-COVID.”
ABOUT THE VIRTUAL HIV CLINIC
It provides accessible, equitable, and inclusive healthcare to people living with HIV and key populations through technology, in line with UN’s Sustainable Development Goal 3 (SDG 3).
It offers free medical consultations on HIV or STD-related matters through teleconsultations with licensed and board-approved doctors.
Allows PLHIV and key populations to obtain self-test kits, lab test referrals and e-prescriptions for medication.
HOW TO ACCESS THE VIRTUAL HIV CLINIC
Download the DOC2US telehealth app from either the Google Play Store, Apple App Store, Huawei App Gallery, or the DOC2US website (link opens in new tab) for desktop use.
OPENING HOURS
The clinic operates every Wednesday from 1.00 pm to 5.00 pm.
FEATURED EXPERT IRIS CHIN
Sales Director
Wistron Medical Technology Malaysia
Malaysia’s healthcare system is underinvested, overburdened, and has faced increasingly urgent calls for improvements to our national healthcare policies and strategies.
While public concern surrounding COVID-19 has largely fizzled out, the pandemic has brought to light the fractures in our public healthcare system.
This includes specialist shortages, chronic under-funding, and the need to future-proof our health infrastructure to alleviate the burden borne by hospitals.
BUDGET 2023 YET TO ADDRESS POLICY FOCUS IMBALANCE
Budget 2023 has allocated RM36 billion to strengthen the capacity of public health services. However, this has yet to address the imbalance in policy focus between hospital care and primary care. Primary care involves extending beyond healthcare facilities to continue serving a patient’s medical needs, such as through treatment and rehabilitation.
With the proper investment and development, primary care has the potential to reduce the overall cost of care and to make positive health outcomes more accessible to all Malaysians — which is why more needs to be urgently done to grow the local rehabilitation industry.
WHY GROW THE LOCAL REHABILITATION INDUSTRY?
Based on my experience in expanding primary care, rehabilitation departments tend to have the smallest budget allocation or be the most neglected in the eyes of hospital management. Some hospitals may not even be equipped with a proper setup for patient rehabilitation treatment.
But in truth, rehabilitation is—and this cannot be stressed enough —an incredibly crucial step in the recovery process.
I would go so far as to say rehabilitation can do something that traditional medicine or operational procedures would not be able to: empowering patients to live with a changed body and independently manage their health condition while recovering.
This is especially important in cases such as brain injuries (where rehabilitation can come in the form of speech and language therapy), impaired movement and flexibility, patients of advanced age, or cancer and stroke survivors.
CHALLENGES TO THE GROWTH OF THE REHABILITATION INDUSTRY
The main issue currently plaguing the industry is accessibility.
Rehabilitation services are often provided only at high-cost specialist centres in urban areas, often with long waiting lists and long waiting times too. This also indirectly means that there are fewer trained rehabilitation professionals compared to other types of medical caregiving.
Even when rehabilitation services are available, patients face high out-of-pocket expenses as they are billed on specialist hours. Rehabilitation programmes are also less commonly covered by medical financial support such as insurance plans. Referral pathways to rehabilitation services are affected by this, preventing the industry as is from growing and patients from accessing the support they need.
Taking into account the country’s ageing population, there is a greater need now than ever for rehabilitation to share a greater burden of care with healthcare facilities at large.
To fill these gaps and drive primary care growth more quickly, I believe we need to look at a game-changer that can help lower barriers to rehabilitation and make it more easily accessible — a role that technology and robotics has already started to play.
INTEGRATING ROBOTICS INTO REHABILITATION
Contrary to the name, robotic rehabilitation doesn’t mean that it removes the quintessential human element of care. Instead, it comes in the form of robotic devices that patients can wear or use during rehabilitation programmes, complementing the instructions and advice of trained physiotherapy professionals.
This technical support, so to speak, is a game-changer for rehabilitation for a number of reasons.
Not only does this open up opportunities for more treatment options, it is also easier to make global technology more readily available to a larger number of people—as compared to a mad rush to train rehabilitation specialists or accommodate geographical restrictions.
At the same time, it is a cost-effective way to offload partial tasks from physical therapists. They would have more time to meet or assist particularly complex cases, applying their knowledge to specific rehabilitation programmes that may need more specialised input.
In sum, advanced technology-assisted rehabilitation has the potential to more quickly shift the focus to growing primary care within Malaysia.
With robotics, we are now able to bring global rehabilitative technology directly to the people who need it most—with portable devices that are not only available in specialist centres but also community clinics in non-urban areas.
With increased access also comes increased awareness among the general population, which can play a significant role in improving overall health literacy and the everyday Malaysian’s perception of physical therapy.
We already have the demand for rehabilitation. A little nourishment with the right talent, policies, and funding could be all it takes to lead a new and improved rehabilitation industry within Malaysia’s medical ecosystem. It is high time we harness that potential.
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.
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.
FEATURED EXPERT ASSOCIATE PROFESSOR TS DR AFIZAN AZMAN
School of Computer Science
Faculty of Innovation and Technology
Taylor’s University
BLOCKCHAIN TECHNOLOGY UNBLOCKS LIMITATIONS IN MANY INDUSTRIES
Created in 2008, blockchain technology is a decentralized ledger that can be used to verify and trace multi-step transactions in healthcare, retail, supply chain, financial industries, and more.
Having reduced compliance costs and speed-up data transfer processing, users can also confirm secured transactions using this technology without the requirement for a central clearing authority.
Closer to home, Malaysia started its efforts in blockchain technology in 2015, with the Securities Commission (SC) and Bank Negara Malaysia (BNM) as important parties in the movement.
Moving forward, the Malaysian Industry-Government Group for High Technology (MIGHT) has said that Malaysia would be adopting blockchain by 2025 and many banking institutions are requested to explore and adopt this technology into their financial systems.
CURRENT PROBLEMS IN THE POST-COVID-19 HEALTHCARE SECTOR
Privacy issues when it comes to medical data
From a healthcare perspective, every healthcare institution treats medical data as a highly privacy-sensitive element. The thought of giving patients control of access to their records and the exchange of health data between institutions raises the risks of data exposure and opens up issues around trust and security.
However, currently the problems of the medical record system include a lack of security, difficulty in transferring medical records between multiple healthcare institutions due to system complications, human errors when recording, storing, and transferring patients’ data, and unwanted tampering of data.
Indeed, post-COVID-19, Malaysia for one has been dealing with issues related to the healthcare system. MySejahtera turned into a national scandal after the Public Accounts Committee (PAC) revealed that the COVID-19 contact tracing mobile application had been developed for the government without a contract with the application developers.
Inefficiencies of an outdated medical record system
When medical records are mixed-up, not up to date or stored incorrectly, this can severely endanger the well-being and health of a patient.
Hence, the inefficiency of an antiquated medical record system will surely jeopardize the patient’s transfer process between different medical institutes due to complications with the patient’s medical data exchange.
These issues can lead to more serious issues down the line
These issues can become a stumbling block that contributes greatly to even bigger, unfavourable problems such as heavy monetary losses to healthcare institutions due to complications with patient’s medical data, which can lead to legal consequences.
HOW BLOCKCHAIN TECHNOLOGY CAN ADDRESS THESE ISSUES
Ensures medical data integrity and privacy
Blockchain’s distributed ledger technology in healthcare makes it easier to:
Transfer patient medical records securely
Improve healthcare data security
Control the medication supply chain
Aid genetic code study in the medical field
It is known that the MySejahtera application had infused blockchain technology into its system during its conceptualization. The application could have functioned better had it covered the whole process ranging from user registration, vaccines supply-chain, contact to Pusat Pemberian Vaksin (PPV), medical officers, and more.
Help address major shortages in medications
The private general practitioner (GP) clinics, pharmacies, and hospitals in Malaysia suffered major shortages of various prescription and over-the-counter medications since last May, due to COVID-19 lockdowns in Shanghai, China, and Russia’s war in Ukraine.
More than an acute problem, the extraordinarily severe drug shortage in Malaysia this year revealed the need to boost the country’s medicine security for future international issues in the global pharmaceutical supply chain, as Malaysia is a net importer of pharmaceutical products.
Blockchain technology can help with medicine shortages through proper analysis at hospitals. Through this data analysis with untampered data, it can help to solve the issue in the pharmaceutical supply chain by establishing proof of ownership. Before reaching patients, drug ownership changes from the manufacturer to the distributor, and then to the pharmacist by easily cloning Radio Frequency Identification (RFID) tags. Using blockchain’s ability, more features can be periodically added to the chain.
Aid in improving overwork and toxic working culture in hospitals
The issue on the over workload and toxic working culture in public hospitals also can be solved if the Ministry of Health integrates digital innovation into its systems. Many manual processes can be automated and data transfer from one doctor to another can be updated timely at their fingertips, fostering a favourable environment between patients and doctors.
LOOKING AHEAD
There are several processes and new regulatory procedures related to blockchain that need to be standardized and coordinated.
As a catalyst for change, Malaysia should look into this as a core pillar to move the needle forward. Blockchain technology is ready, and so are we.
In conjunction with International Women’s Day, the Mental Illness Awareness and Support Association (MIASA) hosted a half-day event at Royale Chulan, The Curve (Kuala Lumpur) on March 11, 2023.
TRANSCENDING ALL BOUNDARIES: BE REVOLUTIONARY
The theme of International Women’s Day this year, ‘Transcending All Boundaries: Be Revolutionary’, calls for the championing of efforts that will empower women in spite of continuing challenges faced across many sectors of society.
The Founder and President of MIASA, Puan Anita Abu Bakar, outlines the different barriers faced by women due to various cultural and societal norms, which are further compounded and exacerbated for those who have a particular disability or struggles with their mental health.
“When women find it hard to talk about difficult feelings, they tend to internalize them,” she says. “This can lead to depression, eating disorders, and self-harm.”
She shares that past statistics indicated that around 1 in 5 women faces a mental health challenge such as depression and anxiety.
“So, today, we want to let every woman know that there is help, there is support, there is recovery when facing mental health issues. No one has to struggle alone. You don’t have to struggle alone,” she asserts.
BREAKING DOWN BARRIERS ACROSS ALL GENDERS, BECAUSE MENTAL HEALTH ISSUES DON’T DISCRIMINATE
While MIASA champions and supports the efforts to empower women across various social and political sectors of life in Malaysia, the association also is well aware that mental health issues do not discriminate based on one’s gender.
Hence, to achieve the goals and objectives of the association, Puan Anita highlights that broad discussions of gender stereotypes and gender equity should not be restricted to only barriers faced by women.
“In our work within the mental health field in particular, we have a front-row seat to witness the harmful effects gender stereotypes can have not only on women but men too, namely when it comes to expressing one’s feelings. For example, we know that many young boys are implicitly taught to believe that they need to ‘man up’ and that crying is a sign of weakness for example,” she explains.
“So let’s take this opportunity to acknowledge those barriers and boundaries as well, and ensure that all of us, man and woman alike, work harmoniously together to ensure gender equity from all sides,” she concludes.
LAUNCH OF YOUNG ADVOCATES FOR MENTAL HEALTH PROGRAMME TO ACHIEVE GENDER EQUITY THROUGH A ZERO-STIGMA GENERATION
This inaugural programme from MIASA will build on the importance of building a generation free of stigma and discrimination—the zero stigma generation.
The MIASA Young Advocates for Mental Health programme is a 6-month programme that provides a platform for young people to:
Learn about mental health and mental health conditions
Understand the stigma and discrimination around mental health
Acquire qualities and skills of an effective advocate
Receive access to the different resources that support people struggling with mental health issues.
“It is a programme that also goes beyond acquiring knowledge; it provides participants hands-on experience with mental health peers through the shadowing sessions,” Puan Anita further elaborates.
For more information on MIASA and its mental health services as well as programmes, you can visit their website by clicking here (link opens in a new tab).
As we welcomed 2023, China reported a huge spike in daily COVID-19 cases during the end of year holiday seasons 2022.
After a period of pandemic fatigue and indifference, the event sparked sudden and short-lived fear and caution among the global as well as Malaysian community.
The news triggered some Malaysians to be up in arms, calling for a ban on travelers from China and reinforcement of pandemic SOPs such as the mandatory wearing of mask in public areas.
Nonetheless, the interest soon died down as other headlines made their way in the news.
It appears that it is only when crises are about to hit our shores that we react.
In fact, as highlighted by the World Health Organisation (WHO), we need to always be prepared and cannot afford to be reactive.
On January 27, 2023, it announced and reminded member countries that COVID-19 remains a public health emergency of international concern.
WHO compared 28-days data between Dec 5, 2022 to Jan 1, 2023 and Jan 2 to Jan 29, 2023.
It found that although the number of cases reported decreased by 78%, the number of deaths increased steeply by 65%.
This result is mainly due to the large wave of cases and deaths in the Western Pacific Region, especially in China.
WHO further states that the numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.
STAY VIGILANT & PROTECT THE VULNERABLE
3 years into the pandemic, Malaysia has reported more than 5 million cases and over 36,000 deaths.
In 2021, it became the main cause of death in Malaysia, overtaking heart disease.
The risk of death is higher among:
Those above 60 years
Individuals with underlying health conditions
Unvaccinated individuals
According to MOH data between Jan 1, 2022 to July 31, 2022, 75% of COVID-19 deaths were among individuals 60 years and above, and 86% of deaths were among those with at least one underlying health condition .
Compared to the first year of pandemic, we are now more prepared to curb COVID-19 due to advancement in preventive measures, rapid diagnoses, and management tools such as vaccination, rapid test kits (RTK) as well as early treatment with antivirals.
These tools are important particularly to prevent severe COVID-19, keeping individuals especially those with risk factors away from hospitalization, intensive care unit (ICU) admissions and ultimately death.
Nonetheless, these tools will only be useful if they are being utilized optimally.
While Malaysians were quick on the uptake of primary COVID-19 vaccination doses, the uptake of booster doses are very poor with only 49.7% uptake of the 1st booster and a mere 1.6% of the 2nd booster (as of Feb 7, 2023) .
While no concrete data is available, there are good reasons to believe that due to pandemic fatigue, people are now less likely to test and seek treatment for COVID-19.
It is also important to note that antiviral treatment needs to be taken within the first 5 days of symptom onset. Thus, speed is of the essence.
We cannot risk another surge of COVID-19 globally or locally as it would put a toll on our healthcare system and risk overwhelming it.
As it stands, we are currently experiencing overcrowding in Emergency Departments.
Hence, it is crucial that we answer the calls of WHO and the Ministry of Health Malaysia to continue urging the public especially those who are in the high-risk groups (older persons, individuals with underlying medical conditions) to take precautions against COVID-19.
OUR CAMPAIGN
The Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia (FMSA) and Malaysian Medical Association (MMA) are organising an educational campaign themed COVID-19: QUICKLY TEST & TREAT.
Our objectives
This campaign aims to urge the public especially individuals who are at high-risk as well as their family members to continue protecting themselves and others from severe COVID-19 by:
Getting primary and booster doses
Testing immediately upon onset of symptoms
Seeking early treatment, within the first five days of symptoms
Our campaign’s panel of experts
Dr Alif Adlan Mohd Thabit Infectious disease physician
Dr Ang Peng Peng Infectious disease physician
Dr Suriani Sulaiman Family medicine specialist
Dr Balachandran S Krishnan General practitioner
THIS IS A PUBLIC COMMUNITY MESSAGE BROUGHT TO YOU BY
WORDS DR SAPNA SHRIDHAR PATIL & ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN
FEATURED EXPERTS
DR SAPNA SHRIDHAR PATIL School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
Recently, our Ministry of Health detected SARS-CoV-2, the virus responsible for COVID-19, during wastewater surveillance at airports in the country. It was also reported that China has begun SARS-CoV-2 wastewater surveillance for selected cities after the cessation of the country’s zero COVID policy.
WASTEWATER SURVEILLANCE EXPLAINED
In wastewater surveillance, samples of untreated sewage from selected communities and institutions are routinely collected and sent to laboratories for identification and quantification of virus content and testing for different or new virus variants.
Benefits of wastewater surveillance
It provides a rapid real-time ‘snapshot’ of the disease prevalence in the community where the wastewater was sampled from.
Wastewater surveillance also addresses challenges of disease under-reporting due to asymptomatic infections, self-home treatment, and delayed or absent notifications from medical practitioners.
Information from wastewater surveillance can be used to monitor disease burden patterns, reintroduction or emergence of a new pathogen/variant, and even evaluate the impact of community behavioural campaigns such as masking and physical distancing.
An example of the importance of wastewater surveillance is the detection, in 2022, of wild polio virus in sewage samples during routine testing in London and New York before any clinical cases were reported. This prompted the local health authorities to implement immediate measures to enhance the coverage of primary polio vaccination together with polio boosters in at-risk communities.
Limitations of wastewater surveillance
However, wastewater surveillance cannot replace the existing disease notification system and clinical testing as the wastewater comes from pooled community sewage samples and cannot be used for individual diagnosis.
Apart from this, technical and logistic challenges can also affect the accuracy of the results of wastewater surveillance.
Nonetheless, the information from an effective wastewater surveillance system can greatly complement existing notification system, as it provides an early warning alert for local health authorities to implement prompt targeted interventions in the communities at risk.
WASTEWATER SURVEILLANCE & COVID-19 DETECTION
Since the emergence of the COVID-19 pandemic in 2020, there has been ongoing research into the transmission dynamics and ways to curb the disease spread.
It is known that the SARS-CoV-2 virus spreads mainly through oral and nasal secretions. However, the virus is also shed in stools for prolonged periods of time. Individuals infected with the virus can shed the virus in their stools, irrespective of whether they have symptoms of COVID-19.
Wastewater surveillance has been implemented in many countries as an environmental monitoring tool to rapidly detect the presence of the SARS-CoV-2 virus in a community and enable local health authorities to be aware of the transmission risk factors, emergence of new variants, and the impact of community preventive measures.
Hong Kong
Hong Kong detected the delta variant in the sewage samples since the end of December 2020 and strengthened public health interventions by informing the public about the common symptoms, and the importance of continuing physical distancing and masking, in addition to hand hygiene and respiratory etiquette.
United States
In July 2022, California researchers reported that sampling of community wastewater in San Diego detected the presence of the alpha, delta, epsilon, and omicron COVID-19 variants up to 14 days before they started appearing on nasal swabs. This implies that wastewater surveillance applied to transportation-based sanitation systems can serve as an early indicator of possible community transmission.
SO, SHOULD WE BE WORRIED ABOUT COVID-19 IN OUR WASTEWATER?
The general public need not be alarmed by the news regarding the detection of the SARS-CoV-2 virus in human waste.
As COVID-19 has now become endemic across most countries around the world, the detection of the SARS-CoV-2 virus in sewage samples is not an unusual finding.
From the Ministry of Health’s initial reports, the variants isolated are already in circulation in Malaysia and the risk posed to human health and the environment is minimal.
However, being aware of such a system enables all of us to be better receptive of updated information shared by the Ministry of Health from time to time.
On January 17, 2023, Malaysian Osteoporosis Society (MOS), the Academy of Medicine Malaysia, and our Ministry of Health launched their jointly-published 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis.
In the media briefing held in conjunction with this launch, our Director General of Health Tan Sri Dato’ Seri Dr Noor Hisham Abdullah shares that:
Malaysians are now growing older and living longer. As a result of this, many of us will be affected by age-related non-communicable diseases, which includes osteoporosis.
Osteoporosis results in bone fractures, which are associated with disability and premature death.
An illustration of osteoporosis. Click on the image for a larger, clearer version.
WHY IS OSTEOPOROSIS SUCH A CONCERN?
A 2020 study revealed that all people with hip fractures, upon treatment and discharge from the hospital, need walking aids.
6 months later, only 24% (that’s about 1 out of 4 people) regain their mobility and their ability to live independently.
Another 26% die within one year after the fracture.
Tan Sri Dato’ Seri Dr Noor Hisham Abdullah voices his concern that osteoporosis is a serious disease that requires early detection, intervention, and management even at later stages.
This is especially relevant, as the incidence of hip fractures is projected to rise from 5,880 in 2018 to 20,893 in 2050, a 3.6-fold increase!
THE KEYSTONES TO IMPROVING THE AWARENESS OF & TREATMENT OUTCOME OF OSTEOPOROSIS
Dr Yeap Swan Sim, the current President of the Malaysian Osteoporosis Society, states that the cornerstone principles in ensuring that Malaysians can age healthily and gracefully while minimizing the threat of osteoporosis are:
Understanding the disease
Taking preventive measures
Good management of osteoporosis
Knowing the appropriate surgical options, should these options become necessary
FRACTURES & OSTEOPOROSIS ARE NOT “NATURAL” AGEING PROCESS, SO TAKE THEM SERIOUSLY!
Dr Terence Ong Ing Wei points out that osteoporosis usually happens in older people and is almost as common as diabetes. “Diabetes evokes fear and concern, yet most people wouldn’t give osteoporosis a second though,” he muses.
Many people often assume that bones weaken and falls and fractures become more common because all these are a ‘natural’ part of ageing.
Dr Terence disagrees, stating that there is nothing natural about osteoporisis.
In fact, it is actually a very complex condition influenced by many factors. “Some things that we do not think too much about in our everyday lives have a huge impact on our bone health. These include physical inactivity, fad diets, cigarette smoking, and age-related hormonal changes such as oestrogen in ageing women and testosterone in men. All these increase the rate of bone loss at a time when strong bones are most needed.”
DIAGNOSIS AT LATE STAGE OSTEOPOROSIS FORCES DOCTORS TO RULE OUT IDEAL TREATMENT OPTIONS
Dr Yeap says, “We usually only see osteoporosis at its late stages—after a fracture has occurred. By then, the patient would have incurred significant amounts of bone loss. At that stage, it is no longer possible to offer treatments to replace the lost bone, which is the ideal scenario. Instead, treatment options will instead attempt to minimize the detrimental effects of a fracture experienced by the patient.”
“Clearly, we should be giving more emphasis to screening and early detection, followed by suitable interventions so that we can protect the most vulnerable persons from this terrible illness,” she adds.
EARLY DETECTION CAN ALLOW FOR EARLY PREVENTIVE MEASURES
Professor Emerita Chan Siew Pheng concurs with the other experts. “This is because mainly because you don’t even realise osteoporosis is there until you suffer from a fracture. So, the only way to know if you have osteoporosis before a fracture occurs, is by going for a bone density scan, also called dual-energy x-ray absorptiometry, DEXA or DXA.”
More about bone density scan Prof Chan explains that the bone density scan is a quick and painless X-ray procedure that allows doctors to find out whether osteoporosis is present.
It also allows doctors to predict the risk of future fractures in order to provide timely and suitable treatment. “This would save you so much trouble in the future!” she says.
According to Prof Chan, women aged 65 years or older and men 70 years or older should have a DXA scan done every two years.
Younger individuals may also need to be screened if they have certain conditions such as diabetes, thyroid disorders, nutritional malabsorption, eating disorders, rheumatoid arthritis, or are taking certain medications (like steroids) long term.
If you fall into any of these categories, you should consult your doctor for more information as to how you can benefit from a DXA scan.
With the right steps at the right time, osteoporosis can be effectively managed
Prof Chan explains: “There are effective medicines that can be tailored to suit all sorts of patients based on their disease stage and lifestyle. Moreover, whenever pharmacological treatment is necessary, the medications that are available in Malaysia can reduce the risk of fractures from 15% up to 70%!”
She adds that these anti-osteoporosis medicines are generally well-tolerated and effective.
THIRD-EDITION CLINICAL PRACTICE GUIDELINES LAUNCHED TO IMPROVE SCREENING, DIAGNOSIS, & TREATMENT OF OSTEOPOROSIS
Dr Yeap Swan Sim shares that this clinical practice guidelines, meant for healthcare professionals in Malaysia, consists of evidence-based statements intended to assist healthcare providers in optimizing patient care.
“We must first recognize the fact that osteoporosis is a multi-factorial condition,” she says. “Nutrition, age, hormone, lifestyle and the presence of pre-existing disease are some of the aspects that can affect bone health. All these requires not only input from one profession but multiple of them in order to provide patients with proper and effective care.”
She adds: “As such, the clinical practice guidelines had to be written by a panel of experts from all the related disciplines, such as nutrition, geriatrics, endocrinology, orthopaedic surgery, obstetrics and gynaecology, rheumatology, primary care and pharmacy. The wide variety of expertise involved in the writing of the clinical practice guidelines ensures extensive coverage so that the guidelines will be able to inform all types of healthcare professionals who would be involved in the screening, diagnosing and treatment of osteoporosis.”
The 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis was the fruit of the labour of the CPG Working Group comprising:
Dr Yeap Swan Sim (Chairperson)
Dr Terence Ong Ing Wei (Co-chairperson)
Associate Professor Dr Lim Lee Ling (Co-chairperson)
Professor Emerita Dr Chan Siew Pheng
Professor Datuk Dr Sabarul A Mokhtar
Interested healthcare professionals can download the 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis by clicking here. This link will open in a new tab.
FEATURED EXPERT
FEATURED EXPERT
FEATURED EXPERT
DR SAPNA SHRIDHAR PATIL
ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN
