Non-Communicable Diseases: Risk Factors and other Health Problems 159 Table 10.2: Prevalence of Drug Use by Types Among Adults Aged 18 Years and Above in Malaysia (n=9,648)
Sociodemographic Characteristics Ever Use Current Use Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper Opiate (Heroin/morphine) 20 45,623 0.2 0.14 0.39 4 7,993 0.03* 0.01 0.13 Marijuana 63 145,819 0.7 0.53 1.01 10 26,051 0.1* 0.06 0.29 Amphetamine/ Methamphetamine 40 101,906 0.5 0.32 0.80 8 19,401 0.1* 0.04 0.22 Inhalant 7 33,314 0.2* 0.07 0.42 1 229 0.001* 0.00 0.01 Kratom 65 128,035 0.6 0.46 0.90 34 70,537 0.4 0.22 0.56 *Prevalence with high RSE, interpret with caution
Table 10.4: Proportion of Sources of Obtaining Drugs by Respondents with Current Drug Use Among Adults Aged 18 Years and Above in Malaysia Sociodemographic Characteristics Current Drug Use Count Estimated Population Percentage (%) 95% CI Lower Upper Source of Obtaining Drugs Bought from someone 12 24,951 34.4 18.55 54.73 Gave someone else money to buy 2 4,250 5.9* 0.75 33.89 Stole or got it without permission 0
Got from friend 14 27,801 38.3 18.60 62.87 Got from family 8 15,503 21.4* 10.34 39.07 Got some other way 0
*Prevalence with high RSE, interpret with caution
Table 10.3: Proportion of Age of Initiation and Types of First Started Drug by Respondents with Ever Drug Use Among Adults Aged 18 Years and Above in Malaysia Sociodemographic Characteristics Ever Use Drug & Substance Count Estimated Population Percentage (%) 95% CI Lower Upper Age of Initiation 14 years or younger 1 3,780 1.4* 0.19 9.70 15 – 17 years 28 62,972 23.5 14.41 35.89 18 – 24 years 58 154,520 57.6 45.52 68.91 25 years or older 32 46,802 17.5 11.50 25.60 Type of First Started Drug / Substance Opiate (Heroin / Morphine) 9 20,931 7.0* 3.32 14.33 Marijuana 51 113,476 38.2 26.61 51.29 Amphetamine / Methamphetamine 28 68,903 23.2 13.20 37.46 Inhalant 2 11,836 4.0* 0.74 18.70 Kratom 44 82,006 27.6 19.80 37.05 *Prevalence with high RSE, interpret with caution
National Health and Morbidity Survey 2019 Technical Report − Volume I 160 This page has been intentionally left blank.
Non-Communicable Diseases:
Risk Factors and other Health Problems
161
Benign Prostatic
Hyperplasia
(BPH)
National Health and Morbidity Survey 2019 Technical Report − Volume I 162 Benign Prostatic Hyperplasia (BPH) Findings The prevalence of probable BPH (moderate to severe symptomatic) was 16.3% (95% CI: 14.14, 18.81). Both urban and rural prevalence of probable BPH was similar to the national prevalence. Prevalence of probable BPH increased from 40- 44 years old [10.5% (95% CI: 7.21, 14.95)] until 75 years and above [33.4% (95% CI: 23.04, 45.62)]. Almost a quarter of separated / widowed men reported to had probable BPH. Men who were retiree and not working due to unemployment, health problems or old age showed higher prevalence which was 25.9% (95% CI: 20.04, 32.86) and 22.2% (95% CI: 16.02, 30.01) respectively. Among ethnicity, 1 out of 4 Bumiputera Sabah reported to have probable BPH. Of note, men among M40 income category had higher prevalence reported for probable BPH. Also, 17.6% (95% CI: 15.24, 20.33) among men aged 40 years and above perceived their urination was poor and unsatisfied. By BPH status, 1 in 10 among none BPH status and 3 in 5 men with probable BPH had poor QoL and unsatisfied with their urination experience. Conclusion BPH is a common condition among older men resulting in lower urinary tract symptoms (LUTS). The prevalence of BPH in Malaysia was reported lower compared to lifetime global estimates of 26.2% (95% CI: 22.8, 29.6) with worldwide prevalence ranging from 22.4% to 28.8% [1]. Similar findings were found in several countries such as Korea (21.0%) and Ghana (19.9%) based on their latest survey [1][6]. Even so, the prevalence of poor quality of life due to urinary symptoms among men was slightly higher compared to other study findings [1]. Also, the prevalence of self-reported urination quality of life was not high as we expected. Lim 2017 had suggested a decreased risk of BPH in Asian men compared to western men. Moreover, for Asians, there was no clear association found between BPH and ethnicity [7]. BPH is mostly associated with age, comorbidities, and risky lifestyles [8]. Observational studies from Europe, US, and Asia also demonstrated older age to be a risk factor for clinical BPH onset and progression [7]. Our findings also show the increasing prevalence by age and this results is agreeable with other studies [6][8-11]. In summary, BPH should be highlighted as one of the men’s health problems that needs to be monitored and controlled, with counter measures being implemented. Contributors to this section: Mohamad Fuad Mohamad Anuar, Chong Zhuo Lin, Mohamed Ashraf Mohamed Daud, Shaiful Bahari Ismail, Zakiah Mohd Said, Noor Ani Ahmad, Mohd Shaiful Azlan Kassim, Azli Baharudin, Ridwan Sanaudi Introduction Benign prostatic hyperplasia (BPH) or also known as benign prostatic enlargement (BPE), is one of the most common urological diseases among men [1]. BPH is defined as benign overgrowth of prostatic tissue around the prostatic urethra which ultimately constricts the urethral opening, resulting in lower urinary tract symptoms (LUTS) [1]. BPH usually starts to occur at an early age of 40 and the prevalence of BPH increases with age [2]. Objectives General Objective To determine the prevalence of benign prostatic hyperplasia / enlargement (BPH) among adult men age 40 years and above in Malaysia. Methods BPH’s LUTS was measured using International Prostate Symptom Score (IPSS), a well-established diagnostic screening tool which has been translated into Malay language and also validated for use in Malaysia [3]. The IPSS is based on the seven questions concerning urinary symptoms. Each answer is scored from 0 to 5 for a maximum score of 35 points (asymptomatic to severely symptomatic). The probable severities of BPH can be divided into normal (Score 0), Mild BPH (Score 1-7), Moderate BPH (Score 8-19) and Severe BPH (Score 20-35) [3-5]. One additional question is regarding the perceived quality of life in relation to urination, which is assigned a score if 0 (delighted) to 6 (terrible). The quality of life (QoL) for the urination can be accessed by good (Score 0-1) and poor (Score 2-6) [6].
Non-Communicable Diseases: Risk Factors and other Health Problems 163 Recommendations These findings indicate an urgent need to address BPH. Thus, the following recommendations are made:
- To advocate public health policies to support the establishment of age-friendly primary health care especially for men’s health clinic.
- To establish collaboration for comprehensive care, especially among elderly people.
- Need to encourage healthy lifestyle and create campaign focusing on awareness of signs and symptoms of BPH among the target group. References
Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis. Scientific Reports 2006; 7(1):7984-7994. doi: 10.1038/s41598-017-06628-8 2. Teh GC, Sahabudin RM, Lim TC, Chong WL, Woo S, Mohan M, Khairullah A, Abraham PP. Prevalence of Symptomatic BPE among Malaysian Men aged 50 and above attending screening during Prostate Health Awareness Campaign. Medical Journal of Malaysia 2001; 56(2): 186-195 3. Quek KF, Low WY, Razack AH, Loh CS. Reliability and validity of the International Prostate Symptom Score in a Malaysian population. British Journal of Urology International 2001; 88(1):21-25. 4. Khoo EM, Tan HM, Low WY. Erectile dysfunction and comorbidities in aging men: An urban cross-sectional study in Malaysia. The journal of sexual medicine 2008; 5(12):2925-2934 5. Mariappan P, Chong WL. Prevalence and correlations of lower urinary tract symptoms, erectile dysfunction and incontinence in men from a multiethnic Asian population: Results of a regional population-based survey and comparison with industrialized nations. British Journal of Urology International 2006; 98(6):1264-1268. 6. Christopher Ho CK, Praveen S, Goh EH, Tan GH, Badrulhisham B, Zulkifli MZ, Khoo HW, Su XV, Ng JY, Chong LL, Lim DW, Chen ES, Teoh SY. Prevalence and Awareness of Lower Urinary Tract Symptoms among Males in the Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Centre. Medicine & Health 2011; 6(2): 98-106. 7. Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology 2017; 4 (148-151) 8. Parsons JK. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Current Bladder Dsyfunction Reports 2010 5:212–218. 9. Chukwunonso ECCE, Kingsley CE. Prevalence of Symptoms of Benign Prostatic Hyperplasia in Umudike and its Relationship with Measures of Obesity. Asian Journal of Clinical Nutrition 2015; 7 (1): 1-8 10. Vuichoud C & Loughlin KR. Benign Prostatic Hyperplasia: Epidemiology, Economics, and Evaluation. Canada Journal of Urologist 2015; 22(Supp 1):1-6 11. Suzuki K. Epidemiology of Prostate Cancer and Benign Prostatic Hyperplasia. Japan Medical Association Journal 2009; 52(6): 478–483.
National Health and Morbidity Survey 2019 Technical Report − Volume I 164 Table 11.1: Prevalence of Probable Benign Prostatic Hyperplasia (BPH) Among Males Aged 40 Years and Above in Malaysia by Socio-Demographic Characteristics (n=2,251)
Sociodemographic Characteristics None BPH Probable BPH Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 1,855 3,363,917 83.7 81.19 85.86 396 657,058 16.3 14.14 18.81 Location Urban 1,117 2,704,106 83.8 80.82 86.36 242 523,513 16.2 13.64 19.18 Rural 738 659,811 83.2 79.35 86.40 154 133,545 16.8 13.60 20.65 Age Group (Years) 40-44 307 762,167 89.5 85.05 92.79 40 89,075 10.5 7.21 14.95 45-49 299 677,361 88.6 82.37 92.82 41 87,130 11.4 7.18 17.63 50-54 329 551,792 84.8 78.57 89.40 59 99,201 15.2 10.60 21.43 55-59 281 483,135 82.5 76.74 87.09 58 102,377 17.5 12.91 23.26 60-64 239 343,882 76.5 68.60 82.85 67 105,826 23.5 17.15 31.40 65-69 165 230,152 75.6 65.99 83.19 53 74,278 24.4 16.81 34.01 70-74 127 173,937 86.0 76.76 91.98 26 28,258 14.0 8.02 23.24 75 & above 108 141,492 66.6 54.38 76.96 52 70,912 33.4 23.04 45.62 Ethnicity Malaya 1,211 1,705,352 83.9 81.23 86.18 250 328,275 16.1 13.82 18.77 Chinese 302 964,133 85.5 79.31 90.05 63 163,700 14.5 9.95 20.69 Indian 114 194,078 84.4 74.01 91.14 21 35,873 15.6 8.86 25.99 Bumiputera Sabah 92 172,681 75.1 64.70 83.28 33 57,144 24.9 16.72 35.30 Bumiputera Sarawak 74 162,587 82.4 66.25 91.82 13 34,646 17.6* 8.18 33.75 Others 62 165,086 81.5 65.34 91.17 16 37,420 18.5* 8.83 34.66 Marital Status Single 98 242,596 89.9 81.54 94.67 16 27,399 10.1* 5.33 18.46 Married 1,656 2,979,982 83.6 80.87 85.95 353 586,066 16.4 14.05 19.13 Widow(er)/Divorcee 101 141,339 76.4 63.53 85.78 27 43,593 23.6 14.22 36.47 Education Level No Formal Education 58 95,685 89.9 80.10 95.18 11 10,728 10.1* 4.82 19.90 Primary Education 502 817,111 81.1 77.18 84.40 134 191,043 18.9 15.60 22.82 Secondary Education 965 1,823,521 85.5 82.35 88.12 183 309,992 14.5 11.88 17.65 Tertiary Education 326 617,432 81.4 75.31 86.28 66 140,995 18.6 13.72 24.69 Occupation Government Employee 218 336,550 87.9 80.98 92.53 46 46,341 12.1 7.47 19.02 Private Employee 547 1,225,881 85.1 80.71 88.68 85 214,129 14.9 11.32 19.29 Self Employed 563 938,959 86.9 82.96 89.96 96 142,142 13.1 10.04 17.04 Unpaid Worker/ Homemaker 32 94,042 91.2 77.05 96.95 7 9,102 8.8* 3.05 22.95 Retiree 238 372,757 74.1 67.14 79.96 83 130,568 25.9 20.04 32.86 Not Workingb 254 392,260 77.8 69.99 83.98 78 112,176 22.2 16.02 30.01