Treating the future

  • Health
  • Sunday, 21 Nov 2004

The Malaysian Paediatric Association strives to set standards in paediatric care as well as educate the public on health and social issues relevant to the children of the nation

MALAYSIA is way up there, along with the developed nations, when it comes to paediatric (medical care related to children) care. According to the United Nations Children’s Fund (Unicef) representative to Malaysia, Gaye Phillips, the death rate of children under the age of five in Malaysia is eight in 1,000. This is lower than quite a number of countries, even the United States. 

A doctor who has special training in the medical care of children is called a paediatrician. In many countries all over the world, the paediatric age limit has been set at 18 years. Hence, paediatricians are involved in the medical care of a child from birth to 18 years. From the pre-term infant to the difficult adolescent, the paediatrician focuses on the child and the family, working to minimise the adverse effects of disease and to allow the child to live a normal life. 

Paediatrics is an area of medicine that is stimulating, challenging and rewarding. It has a varied scope, from the technology intensive areas such as neonatal intensive care to the more holistic approaches necessary when treating a disabled child or a child with cancer.  

There are a large number of paediatric specialities covering similar subjects as in adult medicine, with additional areas such as neonatal and developmental medicine. Paediatricians who specialise in these areas concentrate on a narrower field of care, and often carry out more research than their general paediatric colleagues.  

Dr Zulkifli Ismail

Malaysian Paediatric Association 

The Malaysian Paediatric Association (MPA) was formed in 1979, and currently has about 450 members. It is made up of paediatricians, paediatric nurses and others involved in the care of children. 

The association is actively involved in the organisation of educational activities in the community. This doesn’t only cover the issue of health, but also social issues as well.  

This is one important aspect of the association’s role. As individual health care practitioners, each doctor can only influence his or her patients and their families. The sphere of influence is limited, to a certain extent.  

As a body comprising healthcare specialists, the association’s role evolves into one that can influence the health of not only individual patients, but the society and nation as a whole. 

President of the MPA, Dr Zulkifli Ismail, aptly describes this role when he discusses some of the body’s collaborations with the Health Ministry. “On various occasions, we have worked closely with the Health Ministry to ensure the appropriate input into various health programmes. We thank the Health Minisrty for including us and similar professional organisations in major projects and policies and listening to our input.” 

Immunising against Haemophilus influenza B 

Immunisation has long been recognised as one of the most cost beneficial public health measures. The success stories with immunisation have been long and varied.  

In Malaysia, immunisation has been integral to the nation’s health policies. Vaccination against smallpox (which has now been eradicated worldwide, theoretically) was instituted in the middle of the last century. This was followed by diphtheria, tetanus and pertussis in the late 50s, BCG (for tuberculosis) in the 60s and oral polio in the 70s. Vaccination against measles was introduced in the 80s. Later, rubella immunisation for girls was introduced, followed by hepatitis B.  

Haemophilus influenza B (Hib) infections can cause a severe and potentially fatal illness. The illnesses caused by Haemophilus b bacteria include meningitis, pneumonia and infections of the blood, bones, and joints. Serious Haemophilus b infections are most common in children six to 12 months old, but may also occur in older children. 

The first working paper proposing the introduction of Hib vaccines into the nation’s immunisation programme was put forward to the Health Ministry in the early 90s. “This was initially rejected, and the question of disease burden was brought up,” says Dr Zulkifli. It was felt that the disease burden due to Haemophilus influenza B was inadequate to justify the cost of the vaccine. 

Subsequently, members of the MPA in the Health Ministry undertook studies to try and map out the disease burden caused by the bug. “The studies clearly showed that the bug was a major player in the causation of meningitis,” observes Dr Zulkifli.  

In 2001, the Health Ministry agreed to the recommendations for Hib vaccination. The Hib vaccine has been a great public health success story. The vast majority of infants receiving three doses of the Hib vaccine gain long-term protection 

Since May 2003, government clinics have started giving HiB vaccines to newborn babies. It is incorporated with the DTP/Polio vaccine according to the Malaysian immunisation schedule at two, three and five months.  

Treating thalassaemia 

Another example of the association’s work for public health involved treatment of thalassaemia, specifically, desferal. 

Thalassaemia is an inherited disorder in which there is an abnormality in one or more of the globin genes. This means that there is an inherent defect in the oxygen-carrying haemoglobin in red blood cells, leading to anaemia.  

The disease includes a number of different forms of anaemia. Most children with thalassaemia major appear healthy at birth, but during the first year or two of life, they become pale, listless, and have a poor appetite.  

Without treatment, the spleen, liver, and heart soon become greatly enlarged. Heart failure and infection are the leading causes of death among children with untreated thalassaemia major.  

The only treatment is regular blood transfusions, usually every three or four weeks. However, with such transfusions, the child runs the risk of too much iron in the body. This is because the red blood cells in the “new” blood are broken down slowly over a period of a few months. The iron from the red blood cells stays in the body. If this iron is not removed, it builds up and can damage the liver, the heart and other parts of the body.  

The only way to remove the extra iron from the body is to give injections of a drug called desferal (desferrioxamine). This is injected under the skin using a portable battery operated pump.  

Dr Zulkifli says that the MPA has been trying to get the Government to supply desferal to patients. However, this is not as simple as it may seem. The cost can be quite prohibitive, and according to Dr Zulkifli, “the Health Ministry has indicated that subsidising the treatment may be possible if there are no new cases of thalassaemia in the population.” 

Dr Zulkifli adds: “The MPA has carried out studies on selected school populations of children aged 14 to 16 years looking at the prevalence of thalassaemia. The Health Ministry is also undertaking such a study. 

“Our study showed a prevalence of about 7% of thalassaemia trait in about 500 school children.  

“In certain countries, such as Cyprus, where the incidence of thalassaemia is very high, the government enforces strict population screening and antenatal screening to ensure that there is no new birth of thalassaemia major patients. 

“Here, we propose population screening and subsequently advise those tested positive as to what to look out for when the time comes for them to have families. Do they want to have children? Are they willing to make sure that their potential partners be tested for thalassaemia trait so as to ensure that their children will not run the risk of having thalasssaemia major? These are all factors that have to be taken into account,”comments Dr Zulkifli. 

Continuing medical education 

One of the highlights of the MPA’s annual activities is the annual scientific congress. This is an important meeting that attracts paediatricians and paediatric nurses all over the country.  

The congress not only serves to update knowledge and keep up with issues relevant to the practice of paediatrics, it also serves as a sounding board for ideas that can be implemented nationally. One such example is the issue of intensive paediatric care in the country.  

According to Dr Zulkifli, one such congress quite a few years ago resulted in the submission of a paper to the Health Ministry about the need for such paediatric intensive care facilities in various locations all over the country. It’s currently in the nation’s health blueprint plans, and now Kedah, Penang, Kuala Lumpur, Johor Bahru and Sabah have such facilities. 

“Paediatrics has developed quite extensively. We now have better infant mortality, better infant survival rates,” observes Dr Zulkifli. “As a non-governmental health professional organisation, we might not have the ‘teeth’ to implement programmes and make the necessary changes to ensure better overall healthcare services in the country. The Health Ministry has that power, that responsibility. We can work with the Health Ministry to achieve this objective.”  

The children are our future, and in a manner of speaking, the paediatric healthcare community have in their hands the future of the nation.  

It’s a responsibility that can be quite daunting, but one which the MPA has embraced wholeheartedly. 

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