Malaysia’s success in reducing child mortality was highlighted in the recent Unicef global report, ‘Progress for Children’. However, we continue to face challenges in protecting our children from injuries, abuse and HIV/AIDS, reports IVY SOON.
MANY of the illnesses that Datin Dr Rebecca George treated when she first started serving as consultant paediatrician in University Hospital in 1970 were no longer common by the time she retired in 1998.
“In the early 1970s, we were treating children for diseases such as diphtheria. Sometimes we had to perform a tracheotomy (so the child can breathe) on the trolleys because they were not enough beds. We were seeing about two to three cases a day,” Dr George related.
“We also saw children with polio, which led to paralysis of the lower limbs. There were also tetanus cases because midwives used contaminated scissors or knives to cut the birth cord. Many of the patients came to seek treatment late, and mortality rate was high.”
Although immunisation against diseases such as diphtheria (malignant sore throat), whooping cough, tetanus, hepatitis and polio had been carried out in Malaysia since the 1950s, it still had not been fully accessible in the early 1970s.
“We also treated children with severe cases of malnutrition, diarrhoea and worm infestations. An entire ward was devoted to such cases.
“The patients were from the urban poor community, with mothers who were also malnourished and did not have enough milk for their babies. Some mothers were not preparing food in a hygienic way, so there were children who died from diarrhoea,” added Dr George.
It was only by the late 1970s that the incidence of childhood diseases among children under five years old began to decline. By the 1990s, such illnesses were hardly seen in local hospitals.
Dr George attributed this to the government’s move to start widespread immunisation programmes in the 1970s.
“The director of Health Services (Planning), then Dr Abdul Wahab Mohd Arif, and Dr H. K. Virik were pioneers in planning the paediatric wards in hospitals and initiating immunisation programmes for children,” she said.
“The establishment of maternal and child health clinics in the rural and urban areas to provide antenatal care and health education to mothers has also been important in reducing child mortality.
“If the mothers could not bring their babies to the clinic for immunisation, the nurses – some on bicycles – would visit their homes,” said Dr George who retired in 1998 as associate professor in Universiti Malaya.
The incidence of vaccine-preventable diseases in Malaysia has dropped tremendously. As of last year, Malaysia has achieved BCG coverage of 99%, hepatitis third dose of 95% and measles coverage of 92%.
In 2000, we were accredited as a polio-free country.
In 1970, the mortality rate for children under five was 57 per 1000 live births.
“As a result of visionary leadership, a strong commitment to the well-being of children and investment in health and education, Malaysia has reduced its under five mortality rates from 21 per 1000 live births in 1990 to 8 per 1000 live births in 2002,” said Unicef Malaysia representative Gaye Phillips at the launch of the Progress for Children global report.
With an 8% reduction rate in the last decade, Malaysia’s progress in reducing under five mortality rate is second only to Malta in the world. Our 2002 infant mortality rate of 6.2% and under five-child mortality rate of 8.6% are comparable to those of highly developed countries.
“Malaysia’s success in the last 10 years is the result of 30 years of commitment in making children a priority, in healthcare and education. It takes courage and political will to put children high on the agenda because governments struggling with resource constraints often choose to invest in infrastructures, rather than health and education,” added Phillips.
There are, however, new threats and challenges in protecting our children.
Child injury is now the leading cause of child deaths and disability in Malaysia.
According to the Malaysian Vital Statistics Bulletin, road accidents claimed the lives of 1,232 children in 2001, which means that three children died each day in road accidents.
Phillips said the deaths could have been prevented.
“Countries like Australia had that kind of experience 20 years ago, but they have managed to bring down the death rate with measures such as slowing down speed, making baby car seats compulsory and increasing fines,” she said.
Unicef, in collaboration with the government and NGOs, will undertake the first comprehensive situation analysis on Malaysian child injury, Phillips said.
Abuse is another danger that threatens the lives of children. As it is largely a hidden affair, abuses are more difficult to tackle.
“The child abuse programme, with a child protection team, was started in Universiti Hospital in 1985. Before the 1980s, we did not recognise that child abuse, including sexual abuse, happened here until we started detecting them,” said Dr George.
The challenge, pointed out Phillips, lies in preventing physical and sexual abuse among our children.
Unicef is conducting a community-based study on behaviour and attitude towards child abuse in its efforts to get a clearer picture of the situation in Malaysia.
Another issue that will threaten to derail the progress Malaysia has made in protecting our children is the HIV/AIDS epidemic.
“Various reports indicate that Malaysian youths have limited knowledge of HIV/AIDS and how to protect themselves from the disease,” Phillips said.
“Unicef is working with children at a younger age to arm them with facts and knowledge to protect them from HIV/AIDS. The only tool we have is prevention.”
“We are also working with Prostar (the Health Ministry’s HIV/AIDS awareness campaign targeted at youths) to reach out to schoolchildren so they can have a place to access information on HIV/AIDS,” Phillips added.
The Health Ministry has also responded to the HIV/AIDS epidemic with their prevention of mother-to-child transmission programme, and by providing free anti-retroviral treatment for HIV+ children and HIV+ pregnant mothers screened at government antenatal clinics.
UNAIDS and the World Health Organisation global surveillance of HIV/AIDS has estimated that as many as 14,000 Malaysian children have lost at least one parent, or both, to AIDS.