nhms_2019.pdf

National Health and Morbidity Survey 2019 Technical Report − Volume I 128 Table 7.7: Prevalence of Awareness of Healthy Plate Concept Among Adults Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=10,462) Sociodemographic Characteristics Awareness of Healthy Plate Concept Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 2,346 4,345,817 20.4 18.93 22.03 State Johor 144 393,342 16.2 12.63 20.63 Kedah 109 252,902 19.7 15.69 24.39 Kelantan 105 206,536 18.4 15.13 22.27 Melaka 116 106,777 17.9 13.30 23.65 Negeri Sembilan 123 130,704 18.5 12.80 26.09 Pahang 116 211,930 20.8 16.55 25.81 Pulau Pinang 157 312,136 24.9 16.71 35.34 Perak 105 267,780 17.4 12.18 24.12 Perlis 162 50,346 31.5 25.21 38.54 Selangor 302 1,232,475 26.9 22.32 32.02 Terengganu 107 128,389 17.3 13.45 22.06 Sabah 103 333,867 13.0 9.79 17.01 Sarawak 153 407,870 22.1 18.36 26.35 WP Kuala Lumpur 97 258,295 19.9 14.74 26.33 WP Labuan 143 18,644 29.4 22.83 37.00 WP Putrajaya 304 33,824 59.1 53.71 64.26 Location Urban 1,588 3,564,319 21.5 19.64 23.43 Rural 758 781,498 16.8 14.74 18.98 Sex Male 710 1,456,859 13.3 11.80 15.02 Female 1,636 2,888,957 28.0 25.87 30.15 Age Group (Years) 18-19 66 140,029 15.9 11.73 21.08 20-24 202 538,457 18.8 14.97 23.26 25-29 260 631,462 21.1 17.77 24.81 30-34 315 665,746 25.0 20.63 29.99 35-39 337 640,456 27.0 22.88 31.58 40-44 251 458,333 25.0 21.05 29.47 45-49 212 356,931 21.5 17.94 25.46 50-54 219 314,459 20.5 16.94 24.54 55-59 190 246,503 18.4 15.00 22.46 60-64 147 171,012 15.5 12.38 19.13 65-69 81 88,039 11.0 8.01 14.85 70-74 36 53,756 9.8 6.20 15.07 75 & above 30 40,635 6.2 3.75 10.02 Ethnicity Malaya 1,781 2,766,439 25.4 23.63 27.29 Chinese 192 773,230 16.9 13.79 20.66 Indian 138 268,304 21.6 17.44 26.50 Sociodemographic Characteristics Awareness of Healthy Plate Concept Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sabah 99 204,745 14.9 11.34 19.40 Bumiputera Sarawak 90 195,592 20.5 15.63 26.42 Others 46 137,508 6.1 3.59 10.21 Marital Status Single 460 1,100,877 18.3 15.99 20.76 Married 1,721 3,030,548 22.1 20.26 24.02 Widow(er)/Divorcee 165 214,392 14.2 11.59 17.28 Education Level No Formal Education 36 43,390 4.0 2.43 6.48 Primary Education 260 388,963 9.5 7.67 11.67 Secondary Education 1,077 2,034,835 19.7 17.83 21.66 Tertiary Education 969 1,872,485 33.4 30.45 36.48 Occupation Government Employee 530 668,123 42.7 38.08 47.45 Private Employee 606 1,518,131 18.5 16.35 20.86 Self Employed 322 613,401 16.6 13.94 19.64 Unpaid Worker/ Homemaker 523 898,363 25.2 21.79 28.97 Retiree 104 154,370 19.4 15.00 24.82 Student 74 165,269 22.5 16.73 29.43 Not Workingb 185 324,279 12.1 9.69 14.89 Household Income Group Less than RM 1,000 164 255,432 14.9 11.92 18.43 RM 1,000 - RM 1,999 329 613,864 15.0 12.62 17.79 RM 2,000 - RM 3,999 616 1,208,994 18.9 16.73 21.38 RM 4,000 - RM 5,999 415 767,353 23.0 19.55 26.92 RM 6,000 - RM 7,999 285 501,565 25.6 21.20 30.50 RM 8,000 - RM 9,999 151 278,638 31.0 23.91 39.17 RM 10,000 and above 286 474,591 29.5 23.57 36.24 Household Income Quintile Quintile 1 333 546,683 14.4 11.90 17.30 Quintile 2 341 672,000 16.6 14.18 19.24 Quintile 3 395 784,181 19.7 16.93 22.80 Quintile 4 455 842,780 22.9 19.65 26.53 Quintile 5 722 1,254,794 28.1 24.56 31.91 Household Income Category Bottom 40% 1,340 2,378,636 18.3 16.66 20.05 Middle 40% 632 1,203,125 23.3 20.43 26.52 Top 20% 274 518,676 28.4 23.20 34.24 a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age

Non-Communicable Diseases: Risk Factors and other Health Problems 129 Table 7.8: Prevalence of Adequate Knowledge and Practice of Healthy Plate Concept Among Those with Awareness Among Adults Aged 18 Years and Above in Malaysia (n=2,346) Knowledge & Practice Count Estimated Population Prevalence (%) 95% CI Lower Upper With Adequate Knowledge (3 scores) 1,719 3,511,615 80.8 78.01 83.32 Practise Healthy Plate Concept Yes, Everyday 329 602,846 14.0 11.73 16.58 Yes, Sometimes 1,156 2,160,914 50.1 46.95 53.30 No 843 1,547,326 35.9 33.02 38.87

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Non-Communicable Diseases: Risk Factors and other Health Problems 131 Health Screening

National Health and Morbidity Survey 2019 Technical Report − Volume I 132 Health Screening Contributors to this section: Thamil Arasu Saminathan, Muhammad Fadhli Mohd Yusoff, Zakiah Mohd Said, Nor Saleha Ibrahim Tamin, Fatanah Ismail, Rajini Sooryanarayana, Shubash Shander Ganapathy, Hasimah Ismail, Norzawati Yoep, Rafidah Ali, Muhammad Faiz Mohd Hisham, Wan Shakira Rodzlan Hasani, Tania Gayle Robert Lourdes, Jane Ling Miaw Yn, Halizah Bt Mat Rifin, Nur Liana Ab Majid, Ahzairin Ahmad, Nor Hanizah Abu Hanit Introduction Health screening is widely advocated to be able to save lives or at least reduce morbidity. It is an effective way to detect a specific disease or condition early, even when there have been no symptoms or signs of the disease. Early detection of a condition means getting the right treatment at the right time, and this gives patients better control over their health. Furthermore, making people aware of their health status and risk factors is believed to enable them to exert greater control over their health. Since the 9th Malaysia Plan in 2006, our focus has changed from illness to wellness. Throughout the years, many policies and programs have been introduced and implemented to encourage regular health screening, the notable recent one being the PeKa B40 health screening initiative for the low-income B40 group aged 40-year-old and above. Other than cardiovascular disease risk screenings, Malaysia also has a national cancer screening program for breast cancer, cervical cancer, and colorectal cancer. Such notions should be highly encouraged, but the actual uptake of health screening practices in our nation is still vastly unknown. Accessing this can allow agencies involved to evaluate their current programs and make necessary improvements as required. • Breast Cancer

Breast cancer is the most common cancer among women in Malaysia. Breast self-examination (BSE), clinical breast examination (CBE), and mammogram screening are several methods suggested for early detection of breast lumps. Mammogram screening does exhibit the reduction of breast cancer mortality by approximately 15% for women aged 39-49 years old [1]. The most significant barriers of mammography among Malaysian women in the general population were lack of time, lack of knowledge, unaware of the facilities to run the test, and the fear of knowing the test result [2], which is similar to a finding from a meta-analysis [3]. • Cervical Cancer Cervical cancer is the most common cancer among women worldwide. In Malaysia, cervical cancer was the third most common cancer in women, with an incidence rate of 6.3 per 100,000 [4]. Pap smear screening program was introduced in Malaysia by the Ministry of Health in 1969. Women aged between 30 to 65-year-old and who are, or have been sexually active are recommended to undergo pap smear screening. • Colorectal cancer According to the Malaysia Cancer Registry Report 2012

• 2016, colorectal cancer (CRC) was the most prevalent cancer among males (14.8%) and second common among females (11.1%) [4]. Evidence exists that reductions in CRC mortality can be achieved through the detection and treatment of early-stage CRCs. In Malaysia, the CRC screening program was implemented using the WHO stepwise approach in 2014. The target group is asymptomatic males and females aged 50 to 75 years old. The screening method is using the immunological Faecal Occult Blood Test (iFOBT), followed by colonoscopy for those who were found to be positive for iFOBT. Colonoscopy is the gold standard for colorectal cancer diagnosis. The objective of the colorectal screening programme in Malaysia is to detect the pre-cancerous lesion and to detect cancer at the earliest stage possible.

Non-Communicable Diseases: Risk Factors and other Health Problems 133 Objectives General objective To determine the prevalence of medical check-up / health screening uptake in Malaysia. Specific objectives

1. To determine the prevalence of health screening among adults aged ≥ 18 years old in Malaysia.
2. To determine the prevalence of breast self-examination practice among female adults aged ≥ 18 years old in Malaysia.
3. To determine the prevalence of mammogram screening among female adults aged ≥ 40 years old in Malaysia.
4. To determine the prevalence of pap smear practice among female adults aged ≥ 20 years old in Malaysia.
5. To determine the awareness level on availability of the Human Papilloma Virus (HPV) self-sampling test as a cervical cancer screening tool among female adults aged ≥ 20 years old in Malaysia.
6. To determine the interest level to use the Human Papilloma Virus (HPV) self-sampling test as a cervical cancer screening tool among female adults aged ≥ 20 years old in Malaysia.
7. To determine the prevalence of faecal occult blood tests among adults aged ≥ 50 years old in Malaysia. Methods The target population consisted of respondents aged 18 years and above in Malaysia. Findings 8.1 Medical Check-Up / Health Screenings In total, 10,472 adults responded to this submodule. The prevalence of health screening/ medical check-up within the past 12 months was 49.0% (95% CI: 47.03, 50.94). The prevalence was higher among older age groups, with 77.3% (95% CI: 74.36, 79.95) among adults aged 60 years and above. Females also reported having a higher prevalence compared to males. Widower(er) / divorcee had higher uptake of medical check-up, as well as among retirees. 8.2 Breast Cancer
   Breast Self-Examination Overall, there were 5,687 females, aged 18 years and above, who responded to this submodule. The prevalence of breast self-examination practice was 49.0% (95% CI: 46.00, 51.00). Those who are married had a higher prevalence of practicing breast self-examination [56.2% (95% CI: 53.56, 58.89)]. Government employees showed a higher prevalence [71.5% (95% CI: 64.88, 77.33)] compared to other occupation categories. Respondents who had no formal education showed the lowest prevalence [25.7% (95% CI: 21.12, 30.97)] compared to other education levels. Mammogram There was a total of 3,411 females aged 40 years and above who responded to the survey. The prevalence of women who had done mammogram screening in the past three years was 21.0% (95% CI: 18.00, 23.00). There was a higher prevalence among those between the age of 55 to 59 years-old, Indian ethnicity, married, possessed tertiary educational level, and private employees, compared to the other categories in their respective group. Among all states, Kelantan showed the lowest prevalence [5.3% (95% CI: 2.96, 9.43)]. The prevalence of women who had ever done a mammogram screening was 25.0% (95% CI: 22.61, 27.46). Most of the mammogram screening was done in a public health facility [63.1% (95% CI: 57.08, 68.80)].