Non-Communicable Diseases: Risk Factors and other Health Problems 233 Table 16.7: Prevalence of Pro-Social Skills Among Children Aged 5 - 15 Years in Malaysia by Socio-Demographic Characteristics (n=3,185) Sociodemographic Characteristics Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 781 1,496,791 27.7 24.65 31.01 State Johor 117 236,574 40.0 29.46 51.57 Kedah 11 31,530 8.6* 4.56 15.50 Kelantan 84 140,801 36.3 30.45 42.54 Melaka 43 37,012 28.1 18.39 40.36 Negeri Sembilan 24 31,896 10.6 6.08 17.73 Pahang 36 81,591 28.7 20.92 37.91 Pulau Pinang 31 52,380 22.1* 7.41 50.27 Perak 50 100,670 28.8 15.96 46.34 Perlis 60 15,889 40.0 29.42 51.58 Selangor 100 388,442 38.0 29.37 47.54 Terengganu 40 44,087 17.3 11.35 25.44 Sabah 40 89,735 13.2 9.00 18.89 Sarawak 62 162,813 34.8 28.40 41.84 WP Kuala Lumpur 36 78,515 32.2 23.24 42.79 WP Labuan 33 3,383 20.6 12.75 31.61 WP Putrajaya 14 1,472 6.1 3.54 10.25 Location Urban 459 1,136,817 28.8 24.89 33.06 Rural 322 359,974 24.8 21.15 28.76 Sex Male 415 797,777 29.6 25.98 33.40 Female 366 699,013 25.9 21.84 30.37 Age Group (Years) 5-9 410 753,735 31.0 27.33 34.97 10-15 371 743,056 25.0 21.20 29.25 Ethnicity Malaya 562 901,008 26.0 23.30 28.90 Chinese 81 352,139 44.3 32.70 56.50 Indian 38 62,780 23.6 14.90 35.40 Bumiputera Sabah 48 62,744 14.6 9.90 21.10 Bumiputera Sarawak 40 85,424 31.2 24.80 38.30 Others 12 32,696 19.0* 7.90 38.80 Household Income Group Less than RM 1,000 79 117,520 19.6 14.92 25.37 RM 1,000 - RM 1,999 181 290,209 29.6 23.64 36.29 RM 2,000 - RM 3,999 234 420,656 24.5 20.55 28.84 RM 4,000 - RM 5,999 119 247,730 28.0 22.08 34.79 RM 6,000 - RM 7,999 89 184,124 35.3 24.92 47.32 RM 8,000 - RM 9,999 34 67,182 24.9 15.34 37.86 RM 10,000 and above 45 169,369 39.8 20.52 62.95 Sociodemographic Characteristics Count Estimated Population Prevalence (%) 95% CI Lower Upper Household Income Quintile Quintile 1 153 232,293 22.4 18.27 27.05 Quintile 2 180 321,832 32.0 25.24 39.55 Quintile 3 142 249,624 22.6 18.08 27.93 Quintile 4 163 346,409 29.5 23.46 36.43 Quintile 5 143 346,633 32.1 23.06 42.76 Household Income Category Bottom 40% 530 934,715 26.8 23.39 30.58 Middle 40% 197 466,395 31.8 25.10 39.25 Top 20% 54 95,680 21.3 13.15 32.65 *Prevalence with high RSE, interpret with caution a - Malay includes Orang Asli
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Non-Communicable Diseases: Risk Factors and other Health Problems 235 Disability
National Health and Morbidity Survey 2019 Technical Report − Volume I 236 Disability Contributors to this section: Noor Ani Ahmad, Salimah Othman, Yusniza Mohd Yusof, Rajini a/p Sooryanarayana, Chan Ying Ying, Nur Azna Mahmud, Norhafizah Sharil, Rasidah Jamaludin, Nor’Ain Ab Wahab, Norazizah Ibrahim Wong Introduction Disability among adults continues to be a major health issue in our country, urging for more reliable data and association factors on disability for development of policies, programs and strategies in Malaysia. Ministry of Health Malaysia (MOH), recognizes disability as a major health issue and has incorporated Plan of Action (POA) for Health Care of Person with Disabilities (PWDs) 2011-2020 and National POA for PWDs 2016-2022. The World Health Organization (WHO) Global Disabilities Action Plan, 2014–2021 aims to strengthen collection of relevant and internationally comparable data on disability and support research on disability [1]. National Health and Morbidity Survey (NHMS) 2019 continues to focus on the prevalence of disability and addition on the usage of assistive devices among persons with disabilities. Objectives
- To determine the prevalence of difficulty in six different domains (i.e. seeing, hearing, walking, remembering, self-care and communicating) among adults in Malaysia by socio-demographic characteristics
- To determine the prevalence of overall difficulty among adults in Malaysia by socio-demographic characteristics
- To determine the prevalence of overall disability among adults in Malaysia by socio-demographic characteristics
- To determine the assistive devices usage among adults with overall difficulty in Malaysia by socio-demographic characteristics as part of WHO universal health coverage indicators Methods Data on disability was obtained from adult respondents aged 18 years and above via face-to-face interviews by trained research assistants using the Washington Group Questionnaire (short version).
Variable Definition
- Difficulty was defined as having some difficulty or worst in an individual domain.
- Overall difficulty was defined as having some difficulty or worst in any domain.
- Overall disability was defined as having a lot of difficulty in two domains or cannot do at all in one domain. Findings Difficulty By domains, the most common type of difficulty was difficulty in seeing, with a prevalence of 14.9% (95% CI: 13.75, 16.12); of which 13.6% (95% CI: 12.55, 14.73) having some difficulty, 1.2% (95% CI: 0.89, 1.61) having a lot of difficulty, and 0.1% (95% CI: 0.05, 0.19) cannot do at all. Prevalence of difficulty in hearing was 7.6% (95% CI: 6.71, 8.68); with 7.3% (95% CI: 6.37, 8.28) having some difficulty, 0.8% (95% CI: 0.55, 1.04) having a lot of difficulty, and 0.1% (95% CI: 0.05, 0.18) cannot do at all. Prevalence of difficulty in walking was 10.4% (95% CI: 9.51, 11.46); with 8.5% (95% CI: 7.67, 9.40) having some difficulty, 1.5% (95% CI: 1.24, 1.82) having a lot of difficulty, and 0.4% (95% CI: 0.33, 0.60) cannot do at all. Prevalence of difficulty in remembering was 7.0% (95% CI: 6.21, 7.96); with 6.4% (95% CI: 5.68, 7.29) having some difficulty, 0.5% (95% CI: 0.32, 0.66) having a lot of difficulty, and 0.1% (95% CI: 0.08, 0.24) cannot do at all. Prevalence of difficulty in self-care was 2.1% (95% CI: 1.81, 2.54); with 1.6% (95% CI: 1.29, 1.88) having some difficulty, 0.2% (95% CI: 0.16, 0.38) having a lot of difficulty, and 0.3% (95% CI: 0.22, 0.53) cannot do at all. Prevalence of difficulty in communicating was 2.0% (95% CI: 1.65, 2.38); with 1.6% (95% CI: 1.31, 1.98) having some difficulty, 0.2% (95% CI: 0.12, 0.35) having a lot of difficulty, and 0.2% (95% CI: 0.09, 0.30) cannot do at all.
Non-Communicable Diseases: Risk Factors and other Health Problems 237 The national prevalence of overall difficulty was 27.3% (95% CI: 25.56, 29.06); with 25.9% (95% CI: 24.28, 27.69) having some difficulty, 3.6% (95% CI: 3.17, 4.19) having a lot of difficulty, and 0.9% (95% CI: 0.67, 1.10) cannot do at all. Negeri Sembilan showed the highest prevalence of overall difficulty [48.5% (95% CI: 43.14, 53.98)], followed by Sarawak [44.8% (95% CI: 36.95, 52.89)] and Wilayah Persekutuan Putrajaya [44.0% (95% CI: 38.02, 50.25)], while the lowest was in Wilayah Persekutuan Kuala Lumpur [10.8% (95% CI: 8.07, 14.37)]. The prevalence was significantly higher in the rural areas [34.4% (95% CI: 31.68, 37.22)] compared to the urban areas [25.0% (95% CI: 22.89, 27.16)]. Females reported a significantly higher prevalence [31.6% (95% CI: 29.56, 33.75)] compared to males [22.9% (95% CI: 20.81, 25.06)]. The prevalence of overall difficulty significantly increased with increasing age, with the highest prevalence among adults aged 80 years and above [91.0% (95% CI: 85.05, 94.67)]. In terms of ethnicity, Bumiputera of Sarawak reported the highest prevalence of overall difficulty [46.6% (95% CI: 38.65, 54.72)], followed by Bumiputera of Sabah [35.3% (95% CI: 27.93, 43.45)] and Indians [29.8% (95% CI: 24.90, 35.15)]. By marital status, those being widow(er) / divorcee showed a significantly higher prevalence [54.6% (95% CI: 50.14, 58.94)] compared to those being single [16.8% (95% CI: 14.44, 19.55)] and married [28.6% (95% CI: 26.74, 30.55)]. By education level, the prevalence was significantly higher among those with no formal education [47.5% (95% CI: 40.24, 54.83)] compared to those with a secondary [23.1% (95% CI: 21.24, 25.13)] or tertiary education level [20.3% (95% CI: 17.90, 22.97)]. Adults who were not working (unemployed, those with health problem & old age) showed a significantly higher prevalence of overall difficulty [51.3% (95% CI: 47.19, 55.31)] compared to their respective counterparts. Respondents with household income of less than RM1,000 also reported a significantly higher prevalence of overall difficulty [45.2% (95% CI: 40.52, 49.93)] compared to those with a higher household income level. Disability The national prevalence of overall disability was 11.1% (95% CI: 10.10, 12.21). Negeri Sembilan showed the highest prevalence of overall disability [23.9% (95% CI: 19.64, 28.64)], followed by Sarawak [21.2% (95% CI: 15.57, 28.09)] and Perak [19.2% (95% CI: 14.61, 24.93)], while the lowest was in Wilayah Persekutuan Kuala Lumpur [4.1% (95% CI: 2.91, 5.83)]. The prevalence was significantly higher in the rural areas [16.1% (95% CI: 14.23, 18.15)] compared to the urban areas [9.5% (95% CI: 8.33, 10.81)]. By sex, females showed a significantly higher prevalence of overall disability [13.7% (95% CI: 12.33, 15.29)] compared to males [8.4% (95% CI: 7.33, 9.71)]. The prevalence showed an increasing trend with age, from 3.5% (95% CI: 2.41, 4.95) in 18- 29 years age group, reaching a peak of 78.4% (95% CI: 69.05, 85.53) among the 80 years and above. Among ethnic groups, Bumiputera of Sarawak reported the highest prevalence [20.4% (95% CI: 15.14, 26.91)], followed by Indians [14.3% (95% CI: 11.24, 18.02)] and Bumiputera of Sabah [13.4% (95% CI: 9.68, 18.30)]. In terms of marital status, the prevalence was significantly higher among widow(er) / divorcee [32.7% (95% CI: 28.88, 36.81)] compared to those being married [10.8% (95% CI: 9.59, 12.05)] and single [5.9% (95% CI: 4.55, 7.67)]. Regarding education level, the prevalence of overall disability was significantly higher among those with no formal education [35.9% (95% CI: 29.15, 43.28)] compared to their respective higher education counterparts. Respondents who were not working (unemployed, those with health problem & old age) showed a significantly higher prevalence of overall disability [34.9% (95% CI: 31.35, 38.71)] compared to their respective counterparts. Respondents with household income of less than RM1,000 also reported a significantly higher prevalence of overall disability [25.9% (95% CI: 22.39, 29.77)] compared to those with a higher household income level. Use of Assistive Device Among Adults with Overall Difficulty Among adults with overall difficulty, 56.6% (95% CI: 53.76, 59.14) use assistive devices. The highest prevalence was in the state of Malacca [74.6% (95% CI: 63.37, 83.32)], while the lowest was in Sabah [35.1% (95% CI: 27.64, 43.29)]. The prevalence was significantly higher in the urban areas [59.2% (95% CI: 55.82, 62.50)] compared to the rural areas [50.3% (95% CI: 45.79, 54.71)]. Females showed a significantly higher prevalence of assistive device usage [60.3% (95% CI: 57.00, 63.47)] compared to males [51.2% (95% CI: 46.97, 55.32)]. The prevalence also increased with increasing age.