National Health and Morbidity Survey 2019 Technical Report − Volume I 180 Table 13.5: Prevalence of Anaemia Level Among Women of Reproductive Age Group (15-49 years) in Malaysia by Socio-Demographic Characteristics (n=3,648) Sociodemographic Characteristics Mild Anaemia Moderate and Severe Anaemia Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 557 1,236,804 15.9 14.07 18.03 485 975,181 14.0 12.40 15.66 State Johor 35 104,063 13.6 10.51 17.46 36 115,946 15.2 10.99 20.56 Kedah 14 34,697 7.3* 2.93 17.04 32 84,129 17.7 12.43 24.60 Kelantan 31 70,042 16.3 12.43 21.13 24 57,901 13.5 9.27 19.22 Melaka 42 39,218 18.1 11.30 27.80 37 31,853 14.7 9.60 21.91 Negeri Sembilan 28 40,651 17.3 12.16 24.12 24 48,068 20.5* 10.50 36.18 Pahang 26 38,479 10.4 6.88 15.50 19 28,167 7.6 4.54 12.56 Pulau Pinang 33 103,958 25.3 16.74 36.21 31 52,747 12.8 7.14 21.92 Perak 25 63,759 13.1 8.01 20.59 34 97,148 19.9 12.99 29.26 Perlis 22 10,232 18.0 11.58 26.82 10 5,747 10.1* 3.96 23.42 Selangor 63 252,204 14.4 10.88 18.89 62 228,284 13.1 9.58 17.55 Terengganu 40 48,231 16.3 11.99 21.90 18 24,042 8.1 4.72 13.71 Sabah 60 238,948 21.7 14.43 31.23 51 164,828 15.0 10.62 20.63 Sarawak 44 122,036 17.6 12.68 24.01 38 90,711 13.1 9.41 17.99 WP Kuala Lumpur 24 60,813 14.6 8.45 24.00 16 44,131 10.6 5.92 18.21 WP Labuan 29 4,135 15.4 9.82 23.26 32 5,685 21.1 14.86 29.16 WP Putrajaya 41 5,336 18.8 12.55 27.29 21 2,531 8.9 5.62 13.91 Location Urban 364 951,224 15.7 13.58 18.17 307 837,581 13.9 12.03 15.92 Rural 193 285,579 16.7 13.17 20.92 178 244,340 14.3 11.81 17.16 Age Group 15-19 73 219,938 18.2 12.62 25.54 62 162,551 13.5 9.25 19.17 20-24 64 176,470 13.6 9.24 19.62 64 178,775 13.8 10.29 18.24 25-29 77 217,144 16.0 11.94 21.01 52 150,312 11.0 7.82 15.37 30-34 85 188,549 16.0 12.23 20.63 63 143,740 12.2 8.52 17.14 35-39 81 178,040 16.2 12.00 21.52 77 137,911 12.6 9.48 16.44 40-44 79 121,166 14.7 11.29 18.95 77 149,878 18.2 13.58 23.96 45-49 98 135,497 17.2 13.37 21.86 90 158,753 20.2 15.83 25.32 Ethnicity Malaya 358 658,972 15.6 13.55 17.88 301 592,097 14.0 12.00 16.29 Chinese 45 185,274 14.6 10.59 19.72 39 148,968 11.7 7.90 17.04 Indian 41 67,912 14.7 9.61 21.97 48 115,408 25.1 18.28 33.34 Bumiputera Sabah 53 115,843 19.7 13.71 27.59 48 105,923 18.1 12.22 25.86 Bumiputera Sarawak 25 51,832 14.4 9.46 21.28 22 35,170 9.8 5.66 16.33 Others 35 156,971 18.5 10.26 31.06 27 84,354 9.9 6.05 15.90 Marital Status Single 170 450,340 15.4 12.24 19.08 145 383,527 13.0 10.48 16.20 Married 361 751,435 16.5 14.10 19.28 315 646,928 14.2 12.38 16.31 Widow(er)/Divorcee 26 35,028 12.7 7.45 20.83 25 51,465 18.7 11.06 29.76
Non-Communicable Diseases: Risk Factors and other Health Problems 181 Table 13.5: Prevalence of Anaemia Level Among Women of Reproductive Age Group (15-49 years) in Malaysia by Socio-Demographic Characteristics (n=3,648) (cont’d) Sociodemographic Characteristics Mild Anaemia Moderate and Severe Anaemia Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper Education Level No Formal Education 11 45,510 24.6* 9.37 50.72 7 12,737 6.9* 2.69 16.50 Primary Education 54 99,824 11.4 8.08 15.97 69 133,732 15.3 10.98 21.01 Secondary Education 302 677,853 16.3 13.83 19.02 278 632,887 15.2 13.11 17.51 Tertiary Education 188 406,696 16.3 13.38 19.79 127 293,615 11.8 9.28 14.87 Occupation Government Employee 70 117,077 19.3 14.22 25.66 52 83,940 13.8 8.76 21.19 Private Employee 147 388,685 15.5 12.18 19.45 135 350,505 14.0 11.32 17.08 Self Employed 76 156,396 20.2 15.21 26.26 55 105,158 13.6 9.81 18.45 Unpaid Worker/Homemaker 176 379,780 16.7 12.88 21.37 149 317,536 14.0 11.43 16.94 Retiree 0
0
Student 63 141,133 12.7 9.43 16.84 66 171,485 15.4 11.08 21.03 Not Workingb 25 53,732 11.4 6.55 19.15 28 53,297 11.3 6.98 17.86 Household Income Group Less than RM 1,000 38 73,438 13.8 9.30 19.93 43 88,346 16.6 10.99 24.23 RM 1,000 - RM 1,999 101 205,229 14.1 10.89 18.12 94 201,613 13.9 10.61 17.93 RM 2,000 - RM 3,999 173 404,888 17.2 13.28 21.95 155 336,416 14.3 11.54 17.55 RM 4,000 - RM 5,999 90 214,743 16.5 11.44 23.27 89 196,168 15.1 11.02 20.32 RM 6,000 - RM 7,999 61 138,177 19.2 14.19 25.50 36 88,503 12.3 7.54 19.45 RM 8,000 - RM 9,999 29 65,827 17.6 10.21 28.68 15 41,322 11.1* 5.64 20.54 RM 10,000 and above 33 66,751 12.6 8.00 19.33 36 86,969 16.4 10.72 24.36 Household Income Quintile Quintile 1 81 161,480 12.3 9.48 15.81 99 220,076 16.8 12.94 21.44 Quintile 2 118 253,928 18.9 13.91 25.11 91 185,074 13.8 10.14 18.41 Quintile 3 104 247,274 16.0 12.25 20.73 95 203,463 13.2 10.09 17.09 Quintile 4 99 235,616 16.3 11.56 22.56 96 213,931 14.8 11.03 19.64 Quintile 5 123 270,754 16.7 13.27 20.79 87 216,794 13.4 10.08 17.52 Household Income Category Bottom 40% 341 720,841 15.6 13.09 18.55 326 682,207 14.8 12.71 17.15 Middle 40% 146 355,799 17.5 13.59 22.23 103 250,056 12.3 9.24 16.19 Top 20% 38 92,413 14.9 10.34 21.10 39 107,074 17.3 12.13 24.08 *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 183 Nutritional Status of Adults
National Health and Morbidity Survey 2019 Technical Report − Volume I 184 Nutritional Status of Adults Contributors to this section: Syafinaz Mohd Sallehuddin, Azli Baharudin, Munawara Pardi, Suhaila Abd Ghaffar, Ruhaya Salleh, Nur Shahida Abdul Aziz, Mohamad Hasnan Ahmad, Ahmad Ali Zainuddin, Norlida Zulkafly, Rusidah Selamat, Hamid Jan Jan Mohamed Introduction Nutritional status is an essential element of population health. Body Mass Index (BMI) and waist circumference (WC) are important and universally acceptable anthropometric measurements among adults age 18 years old and above. These are non-invasive methods that can assess size, proportion and composition of the human body [1]. The nutritional assessments are not only limited to individuals but also reflect the health status including cardiovascular risk, social and economic circumstances of population groups [2][3]. Anthropometric techniques have become indispensable instruments for the evaluation of the nutritional and health status of children and adults. Objectives General objective To determine the body mass index and waist circumference status among Malaysians aged 18 years old and above. Specific objectives
- To determine the prevalence of underweight, normal, overweight and obesity among Malaysian adults by socio-demography groups
- To determine the prevalence of abdominal obesity among Malaysian adults by socio-demography groups Methods Classification of nutritional status was made according to recommendation by World Health Organization (1998) [1] and World Health Organization (2000) [4]. The anthropometric measurements for this survey were done by trained researchers according to the standard protocol. Body Mass Index (BMI) was calculated as the ratio of weight in kilogram to the square of height in metres (kg/m2) and classified using two guidelines for this study as following: • The World Health Organization (1998) Classified BMI into 6 categories; underweight (<18.5 kg/ m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/ m2), obese I (30.0-34.9 kg/m2), obese II (35.0-39.9 kg/m2) and obese III (≥ 40 kg/m2). • The Malaysian Clinical Practice Guidelines of Obesity (2004) Classified BMI into 6 categories; underweight (<18.5 kg/ m2), normal (18.5 - 22.9 kg/m2), overweight (23.0 - 27.4 kg/ m2), obese I (27.5 - 34.9 kg/m2), obese II (35.0 - 39.9 kg/m2) and obese III (≥ 40 kg/m2). For assessment on abdominal obesity, the International Diabetes Institute / Western Pacific World Health Organization / International association for the study of Obesity / International Obesity Task Force (WHO/ IASO/IOTF) (2000) has recommended the use of waist circumference (WC) cut-off values of ≥90 cm for men and ≥ 80 cm for women [4]. Findings Underweight The national prevalence of underweight among adults was 6.5% (95% CI: 5.71, 7.45). Among states, Pulau Pinang [9.8% (95% CI: 6.50, 14.56)] had the highest prevalence of underweight. The results revealed that higher prevalence of underweight were observed among those from rural areas [8.5% (95% CI: 6.74, 10.68)], males [7.3% (95% CI: 6.05, 8.70)], aged 15 -19 years old [22.9% (95% CI: 17.38, 29.64)], Bumiputera Sarawak [7.9% (95% CI: 5.54, 11.05)], single [12.7% (95% CI: 10.68, 15.05], no formal education [10.7% (95% CI: 6.82, 16.51)], and private employees [7.1% (95% CI: 5.80, 8.73)]. The underweight prevalence was higher in students [15.2% (95% CI: 11.04, 20.59)], and from B40 income group [7.0% (95% CI: 6.00, 8.26)]
Non-Communicable Diseases: Risk Factors and other Health Problems 185 Normal weight Prevalence of normal weight was 43.3% (95% CI: 41.39, 45.23). Perak had the highest prevalence of normal weight [48.2% (95% CI: 41.70, 54.80)]. Urban areas [43.7% (95% CI: 41.36, 45.99)], males [46.7% (95% CI: 44.10, 49.33)], those aged 75 years and above [58.4% (95% CI: 50.86, 65.54)], Chinese [52.8% (95% CI: 47.76, 57.84)], single [48.3% (95% CI: 45.10, 51.45)], no formal education [46.0% (95% CI: 39.40, 52.79)], students [49.2% (95% CI: 41.46, 56.91)], and T20 income group [47.7% (95% CI: 41.93, 53.49)] had the highest prevalence of normal weight for their respective groups. Overweight The national prevalence of overweight was 30.4% (95% CI: 29.00, 31.90). WP Putrajaya [37.7% (95% CI: 32.40, 43.20)] had the highest prevalence of overweight. In term of locality, urban [30.6% (95% CI: 28.90, 32.43)] had slightly higher as compared to rural. The highest prevalence of overweight was among males [30.8% (95% CI: 28.80, 32.80)], those aged 45-49 years old [39.6% (95% CI: 34.80, 44.60)], Bumiputera Sabah [35.3% (95% CI: 30.83, 40.08)], married [33.9% (95% CI: 32.00, 35.80)], primary education [31.5% (95%CI: 28.30, 34.80)], government employees [39.5% (95% CI: 34.70, 44.50)] and those in the T20 income group [32.0% (95% CI: 27.50, 36.90)]. Obesity Prevalence of obesity was 19.7% (95% CI: 18.43, 21.13). The highest prevalence of obesity was observed in Perlis 27.5% (95% CI: 24.43, 30.83), from rural areas [19.8% (95% CI: 17.90, 21.79)], females [24.7% (95% CI: 22.86, 26.59)], aged 35-39 years old [25.3% (95% CI: 21.80, 29.23)], Indian [29.3% (95% CI: 23.40, 35.93)], married [21.2% (95% CI: 19.67, 22.82)], secondary education [21.2% (95% CI: 19.54, 22.89)], unpaid / home maker [26.5% (95% CI: 23.69, 29.55)], and those in the M40 income group [21.5% (95% CI: 18.53, 24.79)]. Abdominal obesity National prevalence of abdominal obesity among adults was 52.6% (95% CI: 50.54, 54.58). Negeri Sembilan has the highest prevalence of abdominal obesity [61.5% (95% CI: 51.58, 70.55)], urban [53.1% (95% CI: 50.65, 55.54)], female [64.8% (95% CI: 62.62, 66.94)], 60-64 years old [71.5% (95%CI: 66.59, 75.96)], Indians [68.3% (95% CI: 60.95, 74.80)], among widow(er) / divorcee [67.8% (95% CI: 62.73, 72.52)], no formal education [59.0% (95% CI: 51.74, 65.89)], unpaid worker / home maker [69.3% (95% CI: 65.90, 72.42)], and those in the M40 income group [53.4% (95% CI: 49.62, 57.14)]. Conclusion The findings from NHMS 2019 showed that the national prevalence of underweight, normal, overweight and obese among adults aged 18 years and above were 6.5%, 43.3%, 30.4% and 19.7% respectively. The prevalence of abdominal obesity among adults in Malaysia was found to be 52.6%. The current prevalence of underweight, normal, overweight, obese and abdominal obesity shows an increase compared to the previous study in 2015 (6.7%, 45.6%, 30.0%, 17.7% and 48.6%) [5]. Nevertheless, the prevalence of overweight in Malaysia is still lower than the global prevalence of 39% [6]. The alarming trend of obesity epidemic in Malaysia needs immediate action through public health policies to ensure the awareness and practice of a healthier living environment to reduce the risk of obesity and abdominal obesity.