Experts Highlight 2 Lesser-Known Breastfeeding Issues & How to Overcome Them

WORDS DR AISHAH MOHD HAFIZ & DR DURGA VETTIVEL

FEATURED EXPERTS

DR AISHAH MOHD HAFIZ
Senior Lecturer in Emergency Medicine
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
DR DURGA VETTIVEL
Senior Lecturer in Family Medicine
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
Lesser-Known Breastfeeding Issue 1
DYSPHORIC MILK EJECTION REFLEX (D-MER)
  • This describes a sudden, intense, onset of negative emotions, just before a ‘let down’ or the release of milk occurs.
  • It is estimated that 5% to 9% of breastfeeding mothers experience this at some point.
  • It can take place during direct feeding, expressing of milk, or whenever let down occurs—for example in response to a crying child.
  • Not much is known as to why D-MER occurs, but it could be due to a sudden drop in the level of dopamine or ‘happy hormones’ in the brain. What could have happened is that the suckling action during direct feed or mimicked by a breast pump secretes the hormone oxytocin, which stimulates milk production and release. Studies have shown that it also inhibits dopamine release.
  • Symptoms last only for a few minutes and disappear when the milk flow is established.
  • Most women who have experienced D-MER reports decreased frequency after the first 3 months, although it can persist as long as the mother breastfeeds or pumps her breast milk.
SYMPTOMS OF DYSPHORIC MILK EJECTION REFLEX (D-MER)
  • Sudden anxiety and irritability.
  • Sadness or hopelessness.
  • Anger.
  • Self-hate or low self-esteem.
  • Asinking feeling in the stomach or dread.
  • In some cases, the symptoms can be severe, such as suicidal ideation.
Lesser-Known Breastfeeding Issue 2
BREASTFEEDING AVERSION RESPONSE (BAR)
  • This describes a feeling of aversion (strong dislike or wanting to stop) while breastfeeding, which occurs the entire time the child is latched on to the mother’s breast. This can result in the mother developing a compulsion to unlatch.
  • Currently, there isn’t much research done into this matter.
  • An empirical study done in Australia concluded that BAR is unexpected and difficult for mothers. It may result in detrimental effects on maternal identity, mother-child bonds, and intimate family relationships. Some of the participants in this study described the experience as ‘skin crawling’ while others reported negative sensations that were ‘visceral’, ‘overwhelming’ and ‘uncontrollable’.
  • As of now, there has been no research done to study the prevalence of BAR among Malaysian women. We can only speculate whether BAR may be a key factor for the low rate of exclusive breastfeeding.
FACTORS THAT COULD UP THE RISK OF DEVELOPING BAR
  • Breastfeeding for the first time.
  • Breastfeeding 2 or more children at the same time.
  • Menstruation.
  • Breastfeeding during pregnancy.
WHAT TO DO IF YOU THINK YOU HAVE D-MER OR BAR
  1. Recognizing these conditions is an important first step.
  2. Experts recommend self-help strategies such as meditation, positive self-talk, and personal distraction (listening to music, etc) during the feeding or pumping sessions to better manage the negative emotions associated with these conditions. These little actions can help increase the mother’s levels of happy hormones.
  3. Don’t face these challenges alone. Talk about these negative emotions with your partner and loved ones and seek help from healthcare professionals such as lactation consultants, counsellors, or therapists.

You Aren’t Alone When It Comes to Infertility, Experts Say, So Here’s What You Can Do About It

WORDS DR KHINE PWINT PHYU & ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN

FEATURED EXPERTS

DR KHINE PWINT PHYU
Senior Lecturer in Obstetrics and Gynaecology
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
Head of School
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
THE INCIDENCE OF INFERTILITY IS ON AN UPWARD TREND WORLDWIDE
  • Infertility is defined as not being able to conceive after 1 year of unprotected sexual intercourse.
  • In women above 35, this duration is sometimes shortened to 6 months.
  • The World Health Organization estimates that 1 in 6 people are affected by infertility.
  • In Malaysia, there is a drop in fertility rates from 4.9 children per woman of childbearing age in 1970 to 1.7 in 2021.
CAUSES ARE VARIED, INVOLVING ISSUES IN EITHER PARTNER OR BOTH AND IN SOME CASES, THE CAUSES ARE DIFFICULT TO IDENTIFY

Female factors of infertility

  • Anovulation, or ovulation disorders, are situations where no eggs are released from the ovaries during the menstrual cycle. These disorders can be caused by:
    • Hormonal imbalances such as seen in polycystic ovary syndrome (PCOS) and excessive prolactin secretion.
    • Eating disorders.
    • Extremes of body weight.
    • Strenuous exercises.
    • Stress.
    • Chronic illnesses.
  • Blockage of fallopian tubes, caused by previous pelvic infections, inflammation of tubes, and pelvic adhesions which may be related to past surgery at the abdomen and pelvis. When the tubes are blocked, it will affect the transport of sperm to meet the eggs to achieve successful implantation and pregnancy.
  • Endometriosis, which is the presence of tissue that is normally found in the inner lining of the uterus, outside the uterine cavity, which may affect the function of the ovaries, uterus, and fallopian tubes.
  • Congenital abnormalities (malformations that develop before birth) of the uterus.
  • Uterine fibroids (non-cancerous growths which develop in and around the womb).

Male factors of infertility

  • Low sperm count, which can be seen in men with genetic defects, chronic health problems such as diabetes, liver or kidney diseases, or sexually transmitted infections like gonorrhoea. Abnormalities such as undescended testis and varicoceles (swollen veins within the scrotum) can also be causes.
  • Premature ejaculation.
  • Blockage or injury to the reproductive organs.
  • Usage of certain medications can affect sperm movement, quality, or lead to coital dysfunction.
  • Environmental and lifestyle factors such as use of tobacco, heavy alcohol, marijuana or steroids, exposure to toxins and exposure of the external genitalia to high temperatures.
BOTH PARTNERS NEED TO BE INVOLVED WHEN IT COMES TO FERTILITY TREATMENT

To support health education and increase awareness regarding numerous infertility issues faced by couples across the globe, World Infertility Awareness Month is observed every year in June. Many couples are not even aware they are infertile; hence this month serves to alert them of issues that may affect them as well as their available solutions.

While the causes of infertility are varied and can affect both partners, the burden and stigma are often shouldered by the female partner. In our part of the world, both issues are particularly pronounced.

Couples with fertility issues should therefore see a doctor in a timely manner to receive a proper assessment and effective treatment. As age is an important factor in conceiving, early medical intervention often leads to positive outcomes in a couple’s fertility journey.

Both partners should be involved in fertility consultation and management. The primary issues to address include if the woman is ovulating regularly, if the sperm cells in semen are healthy, if there are coital issues and any problems with fertilization and implantation, and if the woman is able to maintain the pregnancy.

To answer these questions, thorough evaluation should be done through taking a detailed medical and personal history, sexual history and performing a physical examination for both partners. The next steps would then be to test the couple with baseline investigations as well as specific evaluations.

Some common assessments include tests to ensure the fallopian tubes are patent (open and lacking blockage), tests to confirm ovulation, sperm counts, and ultrasound to look for abnormalities in the uterus, fallopian tubes, and ovaries.

MANAGING & TREATING INFERTILITY

Sometimes, simple lifestyle modification measures such as weight management, adequate exercise, cessation of smoking, and the limitation on alcohol consumption can solve infertility.

As for natural methods, frequency of sexual intercourse can be an issue and it is recommended that at least 3 times a week increases the probability of conceiving.

Timed intercourse during a women’s fertile period may be a strategy as well. Women usually ovulate about 12 to 14 days before the start of a next menstrual cycle and the fertile period is the five days before ovulation, the day of ovulation, and the day after ovulation.

The treatment for fertility issues depends on the cause. For women who experience problems with ovulation, medications to induce ovulation may be employed. As for women with endometriosis, fibroids, or other tubal diseases, surgery may also improve outcomes. For men, prescribing medications to improve sperm quality may help and surgery may be employed for men with structural abnormalities in their reproductive system.

When more simple methods are not successful, more complex procedures may be employed such as intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI). For couples with unexplained infertility, increasing coital frequency in combination with IUI often results in successful pregnancies.

References:

  1. Ferlin, A., Raicu, F., Gatta, V., Zuccarello, D., Palka, G., & Foresta, C. (2007). Male infertility: role of genetic background. Reproductive biomedicine online, 14(6), 734–745. https://doi.org/10.1016/s1472-6483(10)60677-3
  2. Lipshultz, L. I., Howards, S. S., & Niederberger, C. (2009). Infertility in the male (4th ed.). Cambridge University Press. http://dlib.sbmu.ac.ir/site/catalogue/134959
  3. Krausz C. (2011). Male infertility: pathogenesis and clinical diagnosis. Best practice & research. Clinical endocrinology & metabolism, 25(2), 271–285. https://doi.org/10.1016/j.beem.2010.08.006
  4. Poongothai, J., Gopenath, T. S., & Manonayaki, S. (2009). Genetics of human male infertility. Singapore medical journal, 50(4), 336–347.

#GiveBack Campaign Calls for Proper & Safe Medical Waste Disposal

WORDS LIM TECK CHOON

On 15 June 2023, the second phase of the nationwide #GiveBack campaign was launched to promote responsible disposal of medical waste.

#GiveBack is a nationwide Environmental, Social and Governance (ESG) effort of GSK Malaysia in collaboration with pharmacy chains Alpro Pharmacy, AM PM Pharmacy, BIG Pharmacy, CARiNG Pharmacy Group, FirstCare Pharmacy, Health Lane Family Pharmacy, Mega Kulim Pharmacy, Park@city Pharmacy & Medical Supplies, Straits Pharmacy, and Sunway Multicare Pharmacy.

It is supported by the Malaysian Pharmacists Society (MPS).

FEATURED EXPERT
DR JONATHAN PAN
Vice President and General Manager
GSK Malaysia & Brunei

Dr Jonathan Pan, the Vice President and General Manager of GSK Malaysia & Brunei, says. “Our #GiveBack campaign supports these goals by offering the Malaysian public a convenient way to dispose of their used inhalers and leftover medicine blister packs responsibly, lessening their impact to our environment.”

In line with this goal, the campaign expanded its partnership with additional pharmacy partners and headthcare groups this year.

WHY #GIVEBACK IS IMPORTANT TO US
  • All around the world, healthcare systems contribute around 5.9 million tonnes of solid waste to landfills and over 4% of carbon emissions.
  • One significant issue is the disposal of pressurized asthma inhalers, as people often discard them before they are completely empty. As a result, the greenhouse gases in the propellants of these discarded inhalers are released into the environment, contributing to global warming.
  • Unfinished pills left in discarded blister packaging—the “packaging” of pills—can lead to leaching of chemicals into the ground or waterways, contaminating plants and animals and, eventually, people that consume these plants and animals.
FEATURED EXPERT
PROFESSOR AMRAHI BUANG
President
Malaysian Pharmacists Society (MPS)

Professor Amrahi Buang, President of the Malaysian Pharmacists Society (MPS) further adds, “GSK’s #GiveBack campaign is aligned with the Ministry of Health Malaysia’s ‘Returning Medicines’ campaign, and we urge all Malaysians to support this effort by bringing their used or unfinished asthma inhalers and blister packs to any of the collection points for proper disposal.”

MAKING AN ART OUT OF DISCARDED MEDICAL WASTE

During the launch, students from The Design School at Taylor’s University unveiled a sculpted art made of discarded blister packs and asthma inhalers.

This art serves to highlight the importance of proper medical waste disposal and its impact on the environment, while also providing an opportunity for the next generation to get involved in environmental advocacy.

The installation will be displayed during the GSK #GiveBack Roving Truck roadshow at high-traffic venues across the Klang Valley, stoking greater awareness and increased interest in sustainability.

HOW YOU CAN #GIVEBACK TO MOTHER EARTH

Any time of the year
Drop off your used blister packs and asthma inhalers (make sure that they are empty) at any of the following pharmacy outlets:

  • Alpro Pharmacy
  • AM PM Pharmacy
  • BIG Pharmacy
  • CARiNG Pharmacy Group
  • FirstCare Pharmacy
  • Health Lane Family Pharmacy
  • Mega Kulim Pharmacy
  • Park@city Pharmacy & Medical Supplies
  • Straits Pharmacy
  • Sunway Multicare Pharmacy

17 to 26 June 2023
Drop them off at the #GiveBack Roving Truck roadshow.

For more information about the campaign, visit your nearby pharmacy or hospital, or drop by the The Design School @ Taylor’s University’s Instagram (link opens in a new tab).

Here Is Everything You Need to Know About Inguinal Hernia

WORDS ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH & ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON

FEATURED EXPERTS
ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

You may have heard of the term ‘hernia’ or ‘angin pasang’ once or twice before. Affecting both women and more commonly, men, many seek medical attention for reducible swellings which were discovered incidentally or swelling which suddenly appears during a period of physical straining.

WHAT IS HERNIA?

A hernia is defined as a protrusion, bulge, or projection of an organ or a part of an organ through the body wall that normally goes away on lying down.

They are extremely common and often seen in the groin.

Types of hernia. Click on the image to view a larger, clearer version.
Common risk factors 
  • Being a male
  • Family history
  • Smoking
  • Chronic obstructive pulmonary disease or COPD
  • Low body mass index or BMI
  • High intra-abdominal pressure
  • Collagen vascular disease
  • Thoracic or abdominal aortic aneurysm
  • History of open appendectomy
  • Undergoing peritoneal dialysis
INGUINAL HERNIA
  • The protrusion occurs through the inguinal canal in the body’s anterior abdominal wall.
  • By far the most common medical conditions in which primary care physicians refer patients for surgery, comprising approximately 96 percent of all groin hernias.
  • Generally, inguinal hernia affects all ages, but the incidence increases with regards to age.
  • Women manifest inguinal hernia later with a median age of 60 to 79 years, unlike that of men which is 10 years earlier.

Inguinal hernias are traditionally classified as one of the following three types:

  • Direct hernia. The hernia sac bulges directly through the posterior wall of the inguinal canal. It usually occurs in men over 40 years of age.
  • Indirect hernia, which passes through the internal inguinal ring alongside the spermatic cord, following the coursing of the inguinal canal.
  • Combined hernia. The hernia sacs are on both sides of the inferior epigastric vessels.
SIGNS THAT YOU MAY HAVE INGUINAL HERNIA
  • A bulge in the area on either side of the pubic bone; there may be a burning, gurgling or aching sensation at the bulge.
  • For male patients, pain and swelling can occasionally occur around the testicles, when the protruding intestine descends into the scrotum.
  • Pain or discomfort in the groin, especially when bending over, coughing, or lifting.
DIAGNOSING INGUINAL HERNIA
Physical examination

Most early inguinal hernias can be diagnosed by careful physical examination.

The physical examination begins by carefully inspecting the inguinal areas for bulges while the patient is standing.

Then, the patient would be asked to cough or strain down (Valsalva manoeuvre) while the physician observes for bulges.

Imaging

Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations such as suspected sports hernia, recurrent hernia, uncertain diagnosis, and surgical complications, (especially chronic pain).

Magnetic resonance imaging (MRI) provides the most sensitive detection of a hidden hernia in a patient with clinical suspicion for hernia.

TREATING INGUINAL HERNIA

There is currently no medical recommendation about how to manage an inguinal hernia condition.

Wait and see

Watchful waiting is a recommended reasonable option, especially for hernia with minimal symptoms.

Repair

Most inguinal hernia repairs can be performed safely, accurately, and cost-effectively using local anaesthesia, through an open anterior approach.

Hernia repair using prosthetic mesh would be a good choice in patients with a direct hernia or older patients with a longstanding hernia and attenuated fascia.

What about surgery?

Traditional hernia surgery carries a high risk of chronic pain, and as many as 17% of patients can have significant pain for years.

This high incidence is likely due to the location of the mesh used for this kind of surgery. It may also be related to nerve scarification, mesh contraction, chronic inflammation, or osteitis pubis.

Fortunately, there are procedures that lower this chronic pain, for example, the open pre-peritoneal repair, where the nerves responsible for the chronic pain are avoided, leading to a lower incidence of this problematic complication.

There are also minimally invasive surgical procedures involving transabdominal preperitoneal (TAPP) repair and total extraperitoneal repair (TEP). These procedures facilitate the placement of the mesh without any need for suturing, allowing passive pressure of the peritoneal contents to keep the mesh in place.

CAN WE PREVENT INGUINAL HERNIA FROM HAPPENING TO US?

Yes, you can reduce the risk of developing an inguinal hernia by reducing the pressure on the abdominal wall.

  • Maintain a healthy weight. Extra weight will put more stress and pressure over the abdominal walls especially when one stands or moves.
  • Be active and do the right exercises. Many exercises are available but doing the right exercises without overexertion is the key. Exercises like increasing core strength, sit ups, cycling and yoga are helpful.
  • Avoid heavy lifting. Try not to lift objects if they are too heavy. If you must, adopt the right technique such as bending knees and lifting with your legs.
  • Consume foods high in dietary fibre to reduce incidence of constipation; constipation can trigger a hernia when one strains during the passing of stools.
  • Get treatment if you have urinary problems due to an enlarged prostate gland or if you have a chronic cough.

References:

  1. Onuigbo, W.I.B., & Nieze, G.E. (2016). Inguinal hernia. A review. Journal of surgery and operative care, 1(2). https://doi.org/10.15744/2455-7617.1.202
  2. Jenkins, J. T., & O’Dwyer, P. J. (2008). Inguinal hernias. BMJ (Clinical research ed.), 336(7638), 269–272. https://doi.org/10.1136/bmj.39450.428275.AD
  3. Öberg, S., Andresen, K., & Rosenberg, J. (2017). Etiology of inguinal hernias: A comprehensive review. Frontiers in surgery, 4, 52. https://doi.org/10.3389/fsurg.2017.00052
  4. Köckerling, F., & Simons, M. P. (2018). Current concepts of inguinal hernia repair. Visceral medicine, 34(2), 145–150. https://doi.org/10.1159/000487278

How Blockchain Technology Can Improve Malaysian Healthcare

WORDS ASSOCIATE PROFESSOR TS DR AFIZAN AZMAN

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.

Should We Be Worried About COVID-19 in Our Wastewater?

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.

Children More Vulnerable to Infections During These Post-Pandemic Times?

WORDS DR LIM YIN SEAR & DR MAHFUZAH MOHAMED

FEATURED EXPERTS
DR LIM YIN SEAR
Senior Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
DR MAHFUZAH MOHAMED
Guest Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
NEW NORMAL LEADS TO NEW ‘CULTURE SHOCK’ FOR A CHILD’S IMMUNE SYSTEM

For the duration of the COVID-19 pandemic, children were predominantly confined to their home and as a result, were less exposed to common bacteria and viruses. This will render younger children’s immune system to develop poorly.

From March 2022 onwards, as life seemed to make its way back to normality, children started to attend school, enrichment classes, and sports activities again.

This has led to many young kids falling ill with diseases such as influenza, hand-foot-and-mouth disease, and lung infections. An elevated frequency of visits to the doctor has worried many parents that their children may have weakened immune system (we say that these children are then immunocompromised).

ARE CHILDREN REALLY MORE PRONE TO INFECTIONS POST-PANDEMIC?

Currently, there is no scientific data to show that children are more prone to infections after the pandemic.

HOWEVER, THERE ARE CERTAIN FACTORS THAT CAN INDIRECTLY UP THE RISK OF INFECTIONS IN CHILDREN

A briefing by UNICEF on the impact of COVID-19 on children has shown that the prevalence of unhealthy diets such as snacking has increased. This may be due to a lack of easy access to fresh food and financial constraints, possibly leading to childhood obesity and malnourishment.

Additionally, a sedentary lifestyle and the lack of exercise could contribute to childhood obesity, escalating vulnerability to infections.

Another major issue that arose during the MCO period was the disruption of essential health services including childhood immunisations. In a recent WHO pulse survey, 90% of countries reported disruptions to routine immunisations. Immunisations are of utmost importance for preventing certain infectious diseases.

Another important issue that needs to be taken seriously is the mental health of children and their caretakers. The Adverse Childhood experience (ACE) study showed that adverse childhood experiences in categories of abuse, household challenges, and neglect are not only associated with worse mental health outcomes, but also with chronic health conditions such as diabetes, heart disease, chronic obstructive pulmonary disease, liver disease, and cancer.

POSSIBLE SIGNS THAT YOUR CHILD MAY HAVE A WEAK IMMUNE SYSTEM 
  • Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis, or skin infections
  • Inflammation and infection of internal organs
  • Blood disorders, such as low platelet count or anaemia
  • Digestive problems, such as cramping, loss of appetite, nausea, and diarrhoea
  • Delayed growth and development
  • Autoimmune disorders, such as lupus, rheumatoid arthritis, or type 1 diabetes
TOO CLEAN ISN’T ALWAYS GOOD

Some parents go to the extreme to create a “super clean” environment to protect their children and forbid the children to play or touch anything or anyone that has not been sanitised. This isn’t necessarily a good thing, and here’s why.

In the early years, our immune system is a blank canvas. Although infectious disease is a legitimate cause for concern, and a certain level of cleanliness is necessary, children need to develop an immunity to common pathogens.

Overprotecting children from germs is detrimental to their development. Therefore, parents need to balance between a clean environment rather than a sterile environment.

HOW ABOUT HAND-WASHING AND SANITISING?

Studies have shown that soap and water are better equipped to remove more germs from one’s hand than hand sanitiser does.

However, it is still recommended to use hand sanitisers when washing with soap is not an option.

LET’S TALK ABOUT VITAMIN D

Generally speaking, children with a balanced diet and outdoor activities would attain the daily requirement of nutrients.

A minimum of 400 IU (10 µg/day) of vitamin D is recommended for children and adolescents, especially among exclusively breastfed infants and all children and adolescents who are not routinely exposed to sunlight.

Vitamin D supplementation is only recommended to those who are unable to obtain an adequate amount of vitamin D from their diet or have inadequate exposure to sunlight.

Care should be taken while consuming vitamin D supplementation. A daily vitamin D intake of 2,000 IU or more puts one at risk of vitamin D toxicity. The signs and symptoms of toxicity include headache, a metallic taste in one’s mouth, pancreatitis, nausea, and vomiting.