Non-Communicable Diseases: Risk Factors and other Health Problems 171 Table 12.1: Prevalence of Probable Erectile Dysfunction (ED) Among Sexually Active Males Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=2,403) (cont’d) Sociodemographic Characteristics Probable Moderate-Severe ED Probable Mild ED Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper Household Income Group Less than RM 1,000 61 105,398 56.3 43.18 68.67 33 59,681 31.9 20.37 46.18 RM 1,000 - RM 1,999 182 369,145 33.6 26.45 41.61 192 561,635 51.1 41.93 60.25 RM 2,000 - RM 3,999 275 569,710 32.3 27.42 37.64 338 792,729 45.0 38.90 51.20 RM 4,000 - RM 5,999 104 259,650 27.2 21.36 33.86 210 416,500 43.6 37.02 50.35 RM 6,000 - RM 7,999 88 197,231 34.4 26.27 43.45 117 296,386 51.6 42.29 60.84 RM 8,000 - RM 9,999 29 64,557 23.3 14.88 34.57 61 137,798 49.8 36.78 62.76 RM 10,000 and above 53 128,941 24.2 17.87 31.79 109 268,915 50.4 42.21 58.52 Household Income Quintile Quintile 1 161 305,470 44.9 36.24 53.93 119 285,933 42.1 33.67 50.92 Quintile 2 172 346,920 29.5 22.94 37.00 210 598,890 50.9 40.93 60.80 Quintile 3 173 370,823 34.2 28.37 40.50 210 461,644 42.5 36.87 48.43 Quintile 4 116 280,689 26.4 21.01 32.65 234 484,078 45.6 39.15 52.12 Quintile 5 170 390,730 28.2 23.44 33.53 287 703,099 50.8 45.03 56.49 Household Income Category Bottom 40% 546 1,090,600 33.1 29.15 37.26 628 1,548,633 47.0 42.29 51.72 Middle 40% 190 463,661 30.5 25.24 36.27 316 698,838 45.9 39.84 52.15 Top 20% 56 140,372 24.6 18.34 32.12 116 286,173 50.1 42.20 58.04 *Prevalence with high RSE, interpret with caution a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age
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Non-Communicable Diseases: Risk Factors and other Health Problems 173 Anaemia
National Health and Morbidity Survey 2019 Technical Report − Volume I 174 Anaemia Contributors to this section: Nik Adilah Shahein, Muhd. Hafizuddin Taufik Ramli, Noor Ani Ahmad, Sharifah Nazeera Syed Anera, Nor’Ain Ab Wahab, Ruhaya Salleh, Rasidah Jamaluddin, Nur Amalina Muhamad, Nurul Zaiza Zainudin. Introduction Anaemia is a common blood disorder affecting the population worldwide and is a public health issue as it can contribute to morbidity and mortality. The health effects are worrying particularly among women of reproductive age, as anaemia is associated with poor birth outcomes such as preterm birth, low birth weight and miscarriage [1]. In the National Health and Morbidity Survey (NHMS) 2015, the overall prevalence of anaemia was 24.6% (95% CI: 23.6, 25.6) [2]. From NHMS 2015, it was also found that the prevalence of anaemia among women of reproductive age was 34.5% (95% CI: 33.09, 36.36) [3]. This figure was higher than the World Health Organization (WHO), which estimated the prevalence to be 29% worldwide [4,5]. A goal in reducing the prevalence of anaemia among women of reproductive age by 50% by the year 2025 was set by the World Health Assembly as part of the global nutrition target [6]. Objectives General objective To determine the prevalence of anaemia in Malaysia Specific Objectives
- To determine the overall prevalence of anaemia by socio- demographic profile
- To determine the prevalence of anaemia in women of reproductive age group (15-49 years)
- To determine the prevalence of anaemia by level of severity (mild, moderate and severe) for overall and for women in reproductive age group. Methods The target population for this study was all respondents aged 15 years and above. Haemoglobin level was measured using HemoCue Hb201+ system point of care testing (POCT). The cut off point for the levels of anaemia was based on the 2011 WHO guideline as below [4]: Haemoglobin levels to diagnose anaemia at sea level (g/l)2 Population Non-Anaemia Anaemia Mild Moderate Severe Non-pregnant women (15 years of age and above) 120 or higher 110-119 80-109 Lower than 80 Men (15 years of age and above) 130 or higher 110-129 80-109 Lower than 80
Non-Communicable Diseases: Risk Factors and other Health Problems 175 Findings The overall prevalence of anaemia was 21.3% (95% CI: 19.91, 22.85). Prevalence of mild, moderate and severe anaemia was 13.5% (95% CI: 12.33, 14.84), 6.8% (95% CI: 6.18, 7.58) and 1.0% (95% CI: 0.72, 1.29) respectively. By gender, the prevalence was higher among females at 30.4% (95% CI: 28.44, 32.47) compared to males at 12.6% (95% CI: 10.91, 14.51). The prevalence of anaemia in rural was higher at 22.9% (95% CI: 20.43, 25.51) compared to urban at 20.9% (95% CI: 19.2, 22.69). By ethnicity, Indians had the highest prevalence at 26.7% (95% CI: 21.72, 32.28). The state with the highest prevalence of anaemia was Kelantan at 27.2% (95% CI: 23.24, 31.55) and the lowest was Pahang at 14.4% (95% CI: 10.59, 19.20). The prevalence of anaemia was highest among those with monthly household income of less than RM1000 at 29.6% (95% CI: 25.65, 33.78) and those with no formal education at 28.4% (95% CI: 23.00, 34.55). Retirees and those who were not working had the highest prevalence at 28.5% (95% CI: 22.93, 34.82) and 29.8% (95% CI: 26.49, 33.27) respectively. Among women of reproductive age group, the prevalence of anaemia was 29.9% (95% CI: 27.53, 32.39). The prevalence of mild anaemia among women of reproductive age group was 15.9% (95% CI: 14.07, 18.03) whilst moderate and severe anaemia was 14.0% (95% CI: 12.40, 15.66). By ethnicity, the highest prevalence was among Indian women at 39.8% (95% CI: 31.41, 48.86). Conclusion Anaemia still remains a public health issue especially in women of reproductive age group, younger and older Malaysians, Indian ethnicity, people in the lower income group and those with low education level. Recommendations
- To develop a national plan of action in managing anaemia which include: • Implement the national fortification of wheat flour with folic acid and iron as mandatory regulation. • Provision of micronutrient supplementation in settings where iron is known to be deficient in the diet and anaemia is prevalent, particularly among vulnerable groups. • Strengthening advocacy on promoting dietary improvement through increasing consumption of vegetables, fruits and animal-source foods high with iron and folic acid. • Advocate public the importance of preventing anaemia and knowing their haemoglobin status through smart partnership with relevant agencies and NGO. • Develop programs to empower women to be aware of their haemoglobin status by doing screening regularly from young age (Self-Care).
- To conduct qualitative and quantitative research to identify the main barriers and factors that causes anaemia among women at reproductive age. Table 13.1: Anaemia Trend in Malaysia 2015 2019 Anaemia 24.6 21.3 Anaemia Among Women in Reproductive Age (15-49) 34.5 29.9 References
- World Health Organization (2008) Worldwide prevalence of anaemia 1993- 2005 of WHO global database of anaemia.
Institute for Public Health (IPH) (2015) National health and morbidity survey 2015: Vol I: Methodology and general findings; 2015. Ministry of Health Malaysia, Malaysia. 3. Awaluddin SM, Ahmad NA, Naidu BM, Mohamad MS, Yusof M et al. (2017). A Population-based Anaemia Screening using Point-of-care in Estimating Prevalence of Anaemia in Malaysian Adults: Findings from A Nationwide Survey. J Community Med Health Educ; 7: 513. doi:10.4172/2161-0711.1000513 4. World Health Organization (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. 5. World Health Organization. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015. 6. World Health Organization (2014) Global Target Indicators: What is measured gets done. Geneva: World Health Organisation.
National Health and Morbidity Survey 2019 Technical Report − Volume I 176 Table 13.2: Prevalence of Anaemia Among Respondents Aged 15 Years and Above in Malaysia by Socio-Demographic Characteristics (n=10,590) Sociodemographic Characteristics Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 2,511 4,644,149 21.3 19.91 22.85 State Johor 183 472,455 20.7 17.49 24.43 Kedah 115 247,284 17.8 13.83 22.65 Kelantan 183 325,475 27.2 23.24 31.55 Melaka 194 144,934 23.9 18.20 30.72 Negeri Sembilan 126 145,802 20.0 15.81 24.93 Pahang 116 157,499 14.4 10.59 19.20 Pulau Pinang 167 338,636 26.6 22.17 31.45 Perak 185 430,110 26.6 21.22 32.88 Perlis 139 40,885 24.6 18.79 31.48 Selangor 233 834,312 18.0 14.20 22.45 Terengganu 142 159,549 20.1 17.54 22.95 Sabah 220 641,262 23.0 18.01 28.98 Sarawak 199 471,553 23.9 19.59 28.82 WP Kuala Lumpur 100 208,368 19.2 14.59 24.76 WP Labuan 111 14,331 21.6 18.04 25.75 WP Putrajaya 98 11,694 20.1 14.88 26.53 Location Urban 1,484 3,501,885 20.9 19.20 22.69 Rural 1,027 1,142,264 22.9 20.43 25.51 Sex Male 732 1,396,160 12.6 10.91 14.51 Female 1,779 3,247,989 30.4 28.44 32.47 Age Group (Years) 15-19 171 507,321 20.5 16.67 24.98 20-24 157 478,202 17.6 13.43 22.81 25-29 163 496,238 17.3 13.95 21.15 30-34 188 423,616 16.7 13.80 20.15 35-39 205 428,240 19.4 16.12 23.27 40-44 199 389,321 22.5 18.73 26.70 45-49 233 361,507 22.8 19.59 26.47 50-54 211 325,387 22.8 19.12 26.93 55-59 217 270,249 21.3 18.10 24.93 60-64 207 272,651 25.8 21.65 30.36 65-69 185 238,870 31.6 25.70 38.73 70-74 158 180,171 34.4 28.62 40.59 75 & above 218 272,376 44.4 38.65 50.22 Ethnicity Malaya 1,633 2,484,256 21.8 20.43 23.28 Chinese 282 904,863 21.2 16.96 26.07 Indian 204 335,849 26.7 21.72 32.28 Sociodemographic Characteristics Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sabah 187 353,101 24.4 19.62 29.96 Bumiputera Sarawak 105 211,044 20.4 16.31 25.21 Others 100 355,037 15.1 9.82 22.44 Marital Status Single 458 1,252,948 17.2 14.90 19.69 Married 1,669 2,878,721 22.1 20.59 23.78 Widow(er)/Divorcee 384 512,480 35.1 30.78 39.65 Education Level No Formal Education 197 299,561 28.4 23.00 34.55 Primary Education 666 967,498 22.6 19.99 25.49 Secondary Education 1,166 2,335,633 21.1 19.26 23.11 Tertiary Education 473 1,021,473 19.5 17.19 22.00 Occupation Government Employee 203 319,338 21.2 17.38 25.62 Private Employee 497 1,261,655 16.4 14.14 18.94 Self Employed 389 679,344 18.9 16.17 21.90 Unpaid Worker/ Homemaker 569 1,000,600 28.3 24.91 31.87 Retiree 135 211,446 28.5 22.93 34.82 Student 159 408,121 19.4 15.91 23.55 Not Workingb 557 762,200 29.8 26.49 33.27 Household Income Group Less than RM 1,000 315 524,914 29.6 25.65 33.78 RM 1,000 - RM 1,999 506 824,638 19.1 16.70 21.81 RM 2,000 - RM 3,999 743 1,376,923 20.7 18.38 23.29 RM 4,000 - RM 5,999 349 724,849 21.2 17.59 25.31 RM 6,000 - RM 7,999 192 433,372 22.4 16.35 29.97 RM 8,000 - RM 9,999 90 208,036 23.1 16.33 31.60 RM 10,000 and above 122 253,808 16.6 12.28 21.99 Household Income Quintile Quintile 1 581 953,692 23.9 21.31 26.65 Quintile 2 502 867,776 20.7 17.83 23.84 Quintile 3 443 837,211 20.1 17.43 23.06 Quintile 4 387 792,646 20.9 17.55 24.69 Quintile 5 404 895,216 20.5 16.89 24.68 Household Income Category Bottom 40% 1,644 2,864,816 21.4 19.83 23.07 Middle 40% 511 1,120,338 21.0 17.74 24.75 Top 20% 162 361,386 20.00 15.65 25.32 a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age