Basic Family Health – an

introduction
Datuk Dr Hj Ahmad Tajudin Jaafar
PJN,DSDK,KMN,MBBS(AU),MHP(NSW), AM(Malaysia), FCME
Faculty of Medicine and Health Sciences
UCSI University
 Learning Objectives
 Explain the demographic basis for family
health program
 Describe the MOH program on family health
 Describe maternal health, school health,
adolescent health, women health and health
of the elderly
 Explain the concept of food pyramid and some
nutritional issues e.g. obesity and
micronutrient deficiency
Dropping Fertility Rate and
Population Growth Rate
Towards an Ageing Population
 Types of Families
Extended
Family (Joint
Family)
Nuclear
Three
Family
Generation
(Elementary
Family
Family)

Types
of
Families
 SERVICE
PROVISION
 Pengarah
Bahagian Pembangunan Kesihatan Keluarga

Timbalan Pengarah Timbalan Pengarah Unit Pentadbir

Timbalan Pengarah &Kewangan
Cawangan Kesihatan Cawangan Kesihatan Primer
Cawangan Kesihatan
Keluarga
Keluarga
Perancangan& Pentadbiran
Kesihatan Ibu Pembangunan Polisi
Kesihatan Ibu
dan Neonatal Perkhidmatan
dan Neonatal Penjagaan Perubatan
Kesihatan Penjagaan
Kesihatan Perubatan
Primer
Kesihatan Kesihatan Primer Kewangan
Kanak-kanak
Kanak-kanak
Sokongan Teknikal
Kesihatan
Kesihatan
Remaja
Remaja Informatik Kesihatan
Kesihatan Warga
Kesihatan Warga
Emas
Emas
Kesihatan Orang Kesihatan Kesihatan
Kesihatan Orang Kesihatan Kesihatan
Kurang Upaya Wanita Sekolah
Kurang Upaya Wanita Sekolah
 The Objectives of
Basic Family Health Program
 To provide comprehensive health care
services for the prevention of morbidity and
mortality, promotion and maintenance of the
health of the population especially pregnant
mothers and newborns, infants and toddlers
school children and adolescents, men and
women, elderly and children with special
needs.
 The Objectives of
Basic Family Health Program
 To promote and maintain the community
mental health status.
 To promote healthy diet and nutrition
practices and maintain the nutrition status of
the community.
 To provide PHC services to the population and
promote wellness and facilitate maximum
recovery from illness.
 MATERNAL
HEALTH
 Scope of Maternal Health
 It includes:
i. to promote the health of young potential
parents
ii. helping them to develop the proper
approach to family life and community
welfare
iii. giving guidance in mother craft and
problem related to family planning
 Aim of Maternal Healthcare

“ to ensure that every expectant and nursing

mother maintains a good health, learn the
art of childcare, has a normal delivery and
bears healthy children”
(WHO technical report series 1966)
What is Safe Motherhood?

Safe motherhood is the

strategy to reduce
maternal death in the
country.
Maternal Health Coverage in Malaysia, 1990-
2012
Maternal Mortality Ratio in Malaysia, in
Selected Years, 1991-2011

Main causes of death

• Associated medical conditions
• PPH
• Obstetric embolism
• Hypertensive disease of pregnancy
Components of Safe Motherhood
Antenatal
care

Clean &
Family
safe
planning
delivery

Essential
Essential
obstetric
fatherhood
care
 Essential Services for Safe Motherhood
Before and During During Delivery After Delivery of Newborns
Pregnancy
 Family planning  Clean and safe delivery  Resuscitation when indicated

 TT immunization  Early detection & mx of:  Prevention of hypothermia

1. eclampsia
2. hemorrhage
3. prolonged labor

 Screening for medical Early and exclusive breast-

conditions feeding
 Iron and folate  Prevention of infection
supplementation
 Nutrition and dietary
advice
 STD/HIV prevention and
management
 Essential Services for Safe Motherhood
Interventions of Delivery on the Mother
 Detection and early management of PP complications e.g. hemorrhage, sepsis and
eclampsia

 PP care (promotion and support for breast feeding

 information and services for family planning
 STD/HIV prevention and management
 Tetanus toxoid immunization

Care of the Newborns and Infants

 Registration of newborns  Immunization as per the NIS
 Assessment of growth and  Dietary supplements if indicated
development
 G6PD and T4 screening  Management of infection
 Vitamin K for all newborns
 Health education to parents
Frequency and Percentage of G6PD
Deficiency, 2008-2012
Congenital Hypothyroidism Screening
by Type of Facilities, 20-2012
 About Breastfeeding?
 Natural method of infant feeding
 Time of initiation: within 30 minutes because
early initiation promotes lactation and infant
bonding
 Milk production: frequent prolonged suckling
enhances breast milk production
 Frequency of feeding: on demand
 Rooming in: essential to promote bonding and
breastfeeding
 Promotion of Breastfeeding
Antenatal visit Labor Room Postnatal visit
 motivate mother on  initiate early  support
exclusive breastfeeding, breastfeeding
breastfeeding

 discuss advantage of  discourage pre-lacteal  discourage all forms

breastfeeding feeds of artificial feeding

 counsel mothers on
the dangers of
artificial feeding

 correct retracted
nipples

 increase food intake

 Breastfeeding: advantages !!!
1. Nutrition and growth
2. Immunity: ‘Colostrum is the first natural immunisation a baby receives’.
3. Anti-allergic properties
4. Psychosocial: mother-infant bonding
5. Dental: prevention of tooth decay and malalignment
6. Necrotizing enterocolitis
7. Sudden infant death syndrome (SID)
8. Maternal benefits
9. Availability
10.Economic benefits
The Baby-Friendly Hospital Initiatives
 A global program sponsored by WHO and
UNICEF
 To encourage and recognize hospitals and
birthing centers that offer an optimal level of
care for infant feeding
 Assists hospitals in giving mothers the
information, confidence and skills needed to
skillfully initiate and continue breastfeeding
their babies
Exclusive Breastfeeding
 Risk Approach in Maternal and Child
Health (MCH)
 A process of identifying mothers at risk due to
pregnancy and referring them to higher levels
of care to prevent complications such as
morbidity and mortality of the pregnant
women. It is a method of measuring the needs
of individuals and groups for health care, and it
is a tool for the reappraisal and reorganization
of health and other services to meet that
need.
 Steps in Implementing Risk Approach
 Identify risk factors (e.g. hypertension, diabetes
mellitus, anemia etc.)
 Identify the cut-off point for each risk factor (e.g.
Hb<9g/dl for diagnosis of anemia)
 Identify the pregnant women with high risk
factors
 Refer the high risk women for higher level of care
 Reorganize the health services according to the
level of needs.
 Benefits of Risk Approach

 Introduction of the color  Development of policies,

coding* system guidelines for management of
anemia, PPH,eclampsia etc.

 Improving the referral system  Reallocate resources in health

centers accordance to needs

 Upgrading the health centers  Training of the traditional

with ABCs etc. birth attendants (TBSs)

 Close rapport between  Midwife training to put up

hospitals and health centers intra-venous infusion
 What is Color Coding ?
 Introduced in 1989 as a risk approach strategy
 Four color codes used to indicate different risk
levels of pregnancy
 Empower staff at primary care level to refer
high risk pregnant mothers to higher levels of
care
 A guide to health personnel to make decisions
at the first point of contact with patient
 Color Coding in Risk Approach

WHITE CODE GREEN CODE YELLOW CODE RED CODE

Patient is at Patient may The patient Life
no or low risk develop requires threatening
and can be complications antenatal condition and
monitored by hence monitoring by a requires
a community requires doctor immediate
nurse or monitoring hospital
midwife by a senior referral and
nurse admission

ABC Hospital Delivery

What is Alternative Birthing Centre (ABC)?
 Delivery rooms are built in certain health
centers or residential area
 Selection criteria for patients is important
using the high risk approach or the color
coding system
 Deliveries conducted by trained personnel
 Management and referral of cases with
complications available during and
immediately after delivery
 Benefits of Maternal Home-Based Card

 Continuity of  Improve quality of

information for better documentation
patient management  Seamless health care
 Individual health  Reduce waiting time
monitoring  Less storage space
 Responsibility and needed.
accountability for own
record
 Active member of care
team
Maternal Health Coverage in Malaysia, 1990-
2012
Institutional and Domiciliary Deliveries in
Malaysia, 1990-2012
 Confidential Enquiry into Maternal Death
(CEMD)
 An audit of every maternal death
 Its anonymous nature encourages accurate
reporting of the cases.
 It is multidisciplinary involving the public and
private sectors
 It uses the ‘road to death’ approach
 It is not punitive or finger-pointing
 It allows all personnel involved in the care of the
mother to justify their management.
Maternal Mortality and Ratios in Malaysia, by
states, 2007-2010
 SCHOOL
HEALTH
School Coverage by Health Services 2013
 School Health Services
Target population  Std.1, Std. 6 and Form 3 students

Services  Health and dental check-up

 Health screening
 Health education
 Immunization
 Hearing and visual acuity test

Environmental health  Compound check for mosquito

breeding
 Cleanliness of canteen food and
premises
 Detection Rate of Common Morbidities
Among School Children for Every 1000 School
Children in 2012
 ADOLESCENT
HEALTH
 Adolescence
 Representing the age span of 10-19 years
 It is an transition phase whereby adolescents
pass through an intensive period of physical,
mental, social and psychological development.

 These lead to changes and life challenges due

to pubertal changes, adolescent identity,
cultural adaptation and economic
independence
 Adolescent Health
 Adolescents form one fifth or 20% of the
Malaysian population totaling 5 million (2009)
 Specific morbidities are high especially
psychosocial problems:
i. Accidental injuries
ii. Unprotected sexual intercourse Undetected And
Not Willing To
iii. Smoking Reveal

iv. Alcohol & substance abuse

 Morbidities Among Adolescents
NHMS 2 (1996)
 Sexual activity was 1.8%
(majority heterosexual
63.2%; homosexual 19.9%;
and 9.4% used CSWs
 Prevalence of smoking was
16.7%
 Alcohol consumption was
9%
 Drugs used was 2.2%
 Psychiatric morbidity 13.0%
NHMS 3 (2006)
 Sexual activity was 2.1%
(2004)
 Problems of teen
pregnancies, unwanted
babies, child abandonment
and abortion are of great
concern
 Psychiatric morbidity was
19.4%
 Psychiatric Morbidity Among Children and
Adolescents
The NHMS 1 NHMS 2 NHMS 3
National (1996) (2006) (2011)
Health
Morbidity
Survey

Psychiatric 13% 19.4% 20.3%

health
problems
Adolescent Health Service Screening
Trend,2008-2012
Adolescents Screened (n=305,399) with
Associated Health Problems (2012)

1.0%
1.4% Nutritional problem

Physical problem
2.8%
8.6% Risk behavior

Mental problem

4.1% Sex health problem

Adolescent Health Screening (2012)

305,399 screened

49,187 counseled

29,041 referred to hospitals

 WOMEN’S
HEALTH
 Introduction

 Health care for women includes the entire

spectrum of a woman’s life, not just
pregnancy and childbirth
 At each stage of a women’s life there are
important preventive health care steps to
follow in order to provide early detection
of medical problems, or to prevent them
entirely.
 Women and Men are Different
 Men and women have the same health issues
but their symptoms may be completely
different e.g. a ‘silent' heart attacks in women
 Some medical problems are more common
in women than in men:
Women Men
Depression Alcoholism
Obesity Attention deficit/ hyperactivity
Osteoarthritis Parkinson disease.
 Special Concerns for Women
1. Good prenatal care increases the chance of healthy infant
and decreasing pregnancy-related maternal complication.

2. Obesity contributes to developing heart disease, type 2

diabetes, some cancers, osteoarthritis and sleep apnea.

3. Heart disease is number one cause of death for women in

developed countries.

4. Women often focus on the health of their spouse and

children, often neglecting their own health. Taking time to
maintain good health is crucial, for women and their family
members.
Ten Most Frequent Cancers, Female 2009
 Women Health Program
The main activities are;
i. Cervical cancer screening
ii. Family planning
iii. Breast cancer prevention
iv. Activities relating to reproductive health
and gender
No. of Pap Smear Slides Taken Selected Years,
1995-2012
No. of New Family Planning Acceptors by Type of
Methods, 2008-2012
 Women Health
Family Planning Clinical Breast
Services (2012) Examination
A total of 112,572 new  A national training
FP acceptors were module on clinical
registered breast examination was
the most popular developed as a move to
methods was pill(61%), adopt clinical breast
progesterone-only examination as a
injection (25.3%),male screening tool for down
staging breast cancer
condoms (8.9%) and
detection.
IUD (2.3%).
Percentage of Clinical Breast Examination
Coverage by Age Group, 2010-2012
High Risk Women Registered and Referred for
Mammography in 2012
 HEALTH OF THE
ELDERLY
( GERIATRIC HEALTH)
 What is Ageing?
 A progressive state beginning from conception
and ending with death. Associated with it are
certain physical, social and psychological
changes
 Elderly
 WHO defines old age as those who are ≥ 60
years (developing countries) or ≥ 65 years
(developed countries)
 Terminology used include:
▪ the aged
▪ older people
▪ senior citizen
▪ warga emas
▪ warga tua
 Why Older People?
 Ageing population is:
▫ Global phenomenon
▫ A phenomenon occurring both in developed
and developing countries
▫ Challenge of increased longevity but
compressed morbidity
▫ major cause of population ageing include
▪ declining fertility and mortality rate
▪ improved health and life expectancy
 Proportion of Population Aged 65+, 60+,
50+ and 0 -14, Malaysia, 1970-2050

50

45
65+ 60+ 50+ 0-14
40

35
Pe rc e n t (% )

30

25

20

15

10

0
1970* 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Ye ar
Tengku Aizan et al
2005
Media Seminar on Active and Productive Ageing 17-18 December, 2005 Reinassance Hotel, Kota Bharu
 Illness and Old People
 A study by the Public Health Institute (IKU) in
1995 showed:
▪ 81.4% suffered from at least one chronic
medical illness
▪ 12.7% had 3 or more chronic diseases i.e.
 Joint pain 50.1%  Hypertension 26%
 Eyesight problem 40%  Heart diseases 16.3%
 Hearing problem 21%  Diabetes 11.6%
 Socio-economic Implications
 Social security
▪ In Malaysia, the social security covers only
employees in the formal sector
▫ Pension scheme for public servants while EPF for private
sector employees
▪ Only 61.8% of total employed persons covered
by these two schemes leaving the remaining
38.2% without known source of coverage
(Labor Force Survey Report, 1998)
Elderly Attendance at Health Clinics (New
and Repeat Cases by Sex),2008-2012
Top 10 New Diagnoses among Elderly Detected in
Health Clinics, Jan-Dec 2012
Trend of Hospital Admission of Elderly People
in MOH Hospitals, 2005-2008
Year Number of Percentage
Admission of Hospital
for Elderly Admission
People
2005 338,469 18.57
2006 358,828 19.10
2008 418,181 20.37

Source: Health Informatics Center, MOH (2008)

NUTRITION
 Introduction
 The impact of different lifestyles on health is
well recognized
 One of the important lifestyle choices is
related to diet: the health implications of an
unhealthy diet are severe and of growing
public health concerns worldwide.
 Appropriate nutrition is essential for health.
 Key Facts Regarding Obesity
 Worldwide obesity has  Most of the world’s
doubled since 1980 population live in
 In 2014, more than 1.9 countries where
billion adults (> 18 years overweight and obesity
and older) were kill more people than
overweight. Of these over underweight
600 million were obese  42 million children
 39% of adults aged 18 under the age of 5 were
years and over were
overweight or obese in
overweight in 2014, and
2013
13% were obese
 Obesity is preventable
Prevalence of Obesity by Ethnic Groups and
Sex in Malaysia,1992-2004
What Causes Obesity and Overweight?
 Increased intake of
energy-dense food high in
fat
 Increased physical
inactivity due to
sedentary nature of many
forms of work, changing
mode of transportation
and increasing
urbanization
 Common Health Consequences of
Overweight and Obesity
 Cardiovascular diseases (mainly heart disease
and stroke)
 Diabetes
 Musculoskeletal disorders (osteoarthritis)
 Cancers (endometrial, breast, and colon)
Note: The risk of these NCDs increases with an
increase in BMI
 Three Levels of Response to Obesity
Individual Level Societal Level Industry Level
 Increased consumption  Support individuals in  Reducing fat, sugar and
of fruit and vegetables, following salt content in
whole grains and nuts recommendations processed food
 Regular physical activity through sustained  Ensuring healthy and
(150 minutes/week for political commitment nutritious choices
adults and 60 and collaboration with available and affordable
minutes /day for stakeholders  Practicing responsible
children)  Make regular physical marketing
activity and healthier  Ensuring availability of
diet choices available, healthy food choices
affordable and and supporting regular
accessible physical activity at
workplace
 Micronutrient Deficiency
• Deficiency in iodine, vitamin A and iron are
responsible for high global burden of disease.
Vulnerable group Nutritional deficiency
1. Strict vegetarians 1. Vitamin B12 deficiency and iron
deficiency
2. Immigrants 2. Vitamin D deficiency
3. People with alcohol dependency 3. Vitamin B12 and folate deficiency

4. Very young and very elderly people 4. General deficiencies.

pregnant and lactating women.
 What is Food Pyramid?
 The food pyramid tells people the proper
amount of what type of thing to eat.
 They are grains,vegetables,meat and beans,
fruits, and milk.
 The bigger the area of each category, the
more
of it one should eat.
 The steps on the food pyramid is a reminder
that
one need also to exercise for good health.
Thank you,
Damia