Malaysia's Orang Asli need more help improving their health

Orang Asli children listen as a mobile clinic volunteer teaches them how to brush their teeth properly. A significant number of such children suffer from malnutrition, resulting in stunting and underweight. — Filepic

The Orang Asli are the indigenous people of Peninsular Malaysia.

The Aboriginal Peoples Act 1954 (Act 134) defined the Orang Asli as “any person whose male parent is or was a member of an aboriginal ethnic group, who speaks an aboriginal language and habitually follows an aboriginal way of life and aboriginal customs and beliefs and includes a descendant through males of such persons”.

Data from the Statistics Department and the Orang Asli Development Department (also known by its Malay acronym Jakoa) estimate that the Orang Asli and natives of Sarawak and Sabah comprise about 14% of the country’s population.

There are three major Orang Asli groups, i.e. Negrito, Senoi and Proto-Malay, which includes various subgroups or tribes, numbering about 180,000, according to Jakoa.

It is well accepted that the Orang Asli are behind the general population in their education, health and socioeconomic status.

This column provides snippets from some of the published data on the health status of this community.

Nutrition

The poor nutritional status of the Orang Asli is well-documented.

A 2015 study of Orang Asli in the Krau Wildlife Reserve in central Pahang found the double burden of malnutrition among them, with about 26% of overweight and obese adults coexisting with high percentages of stunted (64%) and underweight (49%) children.

There was a higher occurrence of overweight/obese mother with underweight and/or stunted child(ren) (20%) and overweight/obese mother with stunted child(ren) (19.4%) households than those with overweight/obese mother with underweight child(ren) (12.5%).

Households of overweight/obese mothers with stunted child(ren) were linked to boys, older mothers, mothers with higher education, and households with income per capita of less than RM97.

The Jah Hut tribe and a higher number of children were significantly associated with a lower likelihood of overweight/obese mothers with underweight child(ren).

A 2018 report of Temiar adults in Kuala Krai, Kelantan, found that the frequency of overweight was 28%, obese 23% and underweight 9%.

It also found that 69% of these adults had a high, as well as very high, body fat.

A 2020 report of the Jah Hut tribe revealed that 26.3% had suboptimal vitamin D levels, with 24.9% being insufficient and 1.4% considered deficient.

Meanwhile, a 2020 report of adult Orang Asli women in Perak found that the frequency of overweight was 32.4%, obesity 26.2%, and malnutrition 3.7% .

And a 2021 report of Negritos and those in resettlement areas found the frequency of underweight was 59.1% in children and adolescents, while stunting was 45.8% and wasting 42.3%.

Children in resettlement areas were more affected by these conditions than Negritos as a whole.

In addition, the reported frequency of anaemia (low red blood cells) was 68.4% in children and adolescents.

Infections

Infections are common in the Orang Asli.

They include soil-transmitted helminths (STH), i.e. hookworm, ascaris and whipworm, infections; blastocytosis; giardiasis; amoebiasis; and malaria.

The prevalence of STH ranged from 14.1% to 98.4%.

The former statistic is from a study of 71 Orang Asli schoolchildren in Pos Lenjang, Pahang, and the latter from a study of 122 Orang Asli from seven tribes in Perak, Selangor, Johor and Pahang.

The majority of studies report an STH occurrence of more than 70%.

Non-communicable diseases

A 2020 report of non-communicable diseases (NCDs) in Orang Asli found the frequency of abdominal obesity to be 15.9-72.6%, hypertension (high blood pressure) 10.9-73.8%, raised blood glucose 2.8-68% and raised HbA1C (an indicator of blood glucose control) 21.3-47.8%.

The NCD prevalence of Orang Asli who reside in semi-urban areas was similar to that of the general population.

The recent increase in NCDs have been attributed to changes in diets, as well as changes in lifestyle and social behaviours.

Liver disease

Hepatitis B and hepatitis E infections have been reported in the Temuan, Jah Hut, Mah Meri and Negrito tribes.

A 2021 report found that the frequency of non-alcoholic fatty liver disease (NAFLD) in the Orang Asli community was 19.6%, with the 36-53 years age group the most affected.

Generational impact

A 2023 report of Orang Asli children in the Kuala Pilah and Jempol districts of Negri Sembilan stated that 21.2% were anaemic and 20.4% had a low birth weight.

The incidence of stunting was 35.2%, underweight 27.7%, wasting 6.1%, and overweight 5.7%.

Nearly all (96.3%) were food- insecure and 35% had parasitic infections.

Their risk of anaemia was increased by parasitic infections, not wearing shoes outside their homes, and maternal anaemia.

The incidence of overweight/obesity in their mothers was 39%, abdominal obesity 58.9%, and anaemia 39%.

An earlier report in 2019, also looking at Orang Asli children – 269 of them – in the Kuala Pilah and Jempol districts, found that sociodemographic, nutritional and environmental factors were associated with their cognitive performance.

Similarly, 35% of the children had parasitic infections, while 36% were stunted, 28% underweight, 22% anaemic and 6% wasted.

There were significant links with the father’s years of education, availability of learning materials at home and responsiveness of parent to child, with the three measurements of working memory index, processing speed index and cognitive proficiency index.

A helping hand

The Orang Asli are known for their poor maternal health, deficiency disorders, anaemia, malnutrition, infectious diseases, and more recently, NCDs in certain communities.

More needs to be done by the authorities and the public to help them address these issues.

The DrsWhoCare is a community programme of the Federation of Private Medical Practitioners Associations, Malaysia (FPMPAM).

The FPMPAM was given permission to utilise the unused Health Ministry’s Community Feeding Centre in Kg Dayok, Pahang, in 2019.

This centre has since been developed and is now manned by trained Orang Asli for the delivery of emergency care to the local Orang Asli community, who have embraced it.

Volunteer doctors from FPMPAM have been conducting regular clinics providing primary, and even selected specialist, care at the centre.

Continuous telemedicine support is also now available to cater for emergencies at the centre.

This shows that healthcare and health promotion are welcomed by the Orang Asli community when its delivery is culturally sensitive – something that other healthcare stakeholders can take into consideration.

Dr Milton Lum is a past president of the FPMPAM and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.