Cardiovascular Disease Among Urban Malaysians HEALTH INSURANCE AND Social Care Essay

Cardiovascular Disease Among Urban Malaysians Health And Social Care Essay

Results from INTERHEART global case-control review (Yusuf et al. 2004, Anand et al. 2008) concluded that the following nine potentially modifiable risk factors account for over 90% of the risk of an acute myocardial infarction (to be able of highest to cheapest people attributable risk for Southeast Asian and Japanese subgroup): dyslipidemia, abdominal obesity, hypertension, smoking, frequent physical activity, regular alcohol consumption, psychosocial elements, diabetes mellitus, daily fruit and veggie consumption. There are six set up key risk factors for cardiovascular system disease: adverse diet plan, above-optimal degrees of serum total cholesterol and blood pressure, overweight/obesity, diabetes mellitus and using tobacco (Stamler 2005).


Urban areas are defined as gazetted areas and their adjoining built-up areas with a merged population of 10 000 people or more during the consensus (Mahari et al. 2009). The fraction of rural people in Malaysia was 40.4 % in 2000 and around 38.4 % in 2007, compared to Switzerland with 26.6 % in 2007 (UN Demographic Yearbook 2009).

The fast urbanization of the globe brings significant alterations to lifestyles. Nowadays more than 50% of the world’s population has already been living in cities, and and estimated 70% by 2050 (WHO 2010).

Epidemiology of coronary disease risk factors

A major trend in developing countries may be the epidemiological changeover from communicable causes of death to non-communicable causes. Projections by Mathers et Loncar (2006) estimate that globally the proportions of deaths due to non-communicable illnesses will rise from 59% in 2002 to 69% in 2030. Regarding to Malaysia’s statistics of death, ischaemic cardiovascular disease and cerebrovascular disease already are considered the leading causes of death in 2007 (Section of Statistics Malaysia 2009).

Malaysia is strongly damaged by the above mentioned health-transition. The National Health and Morbidity Survey (NHMS) III (2006) confirmed that the prevalence of obesity has more than tripled in a decade (from 4.4% in 1996 to 14.0% in 2006), the prevalence of hypertension has got increased by about one third in 10 years (from 33% to 43%) and the prevalence of newly diagnosed and referred to diabetes has practically doubled in the same period. The prevalence of diabetes is significantly higher in cities, whereas the rural human population is significantly more influenced by hypertension and tobacco make use of.

Studies from the areas of the developing environment show divergent results. A study from Vietnam (Pham et al. 2009) confirmed the higher prevalence of hypertension in the rural populace of the Mekong Delta (rural male 27%, female 16%). On the other hand a higher prevalence of hypertension in urban subjects was within the National Nutrition and Health Survey 2002 in China (Wu et al. 2008) and a systematic analysis in Sub-Saharan Africa (Addo et al. 2007). Regarding smoking a recent analysis from China (Ho et al. 2010) revealed an increased prevalence of ever-smokers among urban adolescent women.

In a semi-rural network, Chia and Srinivas (2009) found a higher mean predicted cardiovascular system disease risk: 20-25% for men and 11-13% for ladies (mean era of the subjects 65.4 years(±8)). Studies from Vietnam (Pham et al. 2009), Brazil and Mexico (Ford et Mokdad 2008) revealed a higher prevalence of obesity in cities than in rural areas.

With a value of 11.6 % Malaysia has the second highest estimated comparative prevalence of diabetes mellitus in South East Asia in 2010 2010 (with Singapore representing the best prevalence), which is more than double of highly created Japan (Sicree et al. 2006). Dietary imbalances in South-Asian populations are common: there is often a low absorption of n-3 polyunsaturated fatty acids and fibre, and high intake of saturated fatty acids, carbohydrates and trans-isomer essential fatty acids (Isharwal et al. 2009, Misra et al. 2009).

Preventive programmes in Malaysia

In 2007 Malaysia’s Ministry of Wellbeing started a pilot study to check run a chronic care model called Network Based Multiple Risk Factors Intervention Technique to Prevent Cardiovascular and Chronic Kidney Disorders (CORFIS) to assess how effective a multidisciplinary care crew could take care of hypertension, hyperlipidaemia and diabetes mellitus in comparison to routine care by a general practitioner. The CORFIS Stage I Report (2009) stated that CORFIS care and attention demonstrated significant improvement in the supervision of above-mentioned chronic disorders. In taking care of diabetes mellitus CORFIS demonstrated significant improvement of HbA1c, blood sugar and medication adherence, in handling hypertension a significant decrease in systolic and diastolic blood circulation pressure and achieving target blood circulation pressure control and in general management of hyperlipidaemia a significant improvement in both serum LDL-C reduction and attaining target LDL-C control.

Cognitive aspects of cardiovascular risk factors

A national research of 16440 subjects in the whole of Malaysia (Rampal et al. 2007) figured the prevalence of hypertension in Malaysia can be high, but there are low levels of consciousness and treatment, and poor control of hypertension. In main care people in Kelantan, a mainly rural place of northeastern Peninsular Malaysia, knowledge about obesity was found low since a substantial minority of the subjects does not regard obesity as unhealthy and doesn’t associate it with diet or lack of workout (Jackson et al. 1996). Two analyses from Penang (Yun et al. 2007) and Seremban (Ding et al. 2006) concluded that people with diabetes mellitus were significantly more proficient in their disease than healthy topics and education and profits had been the predominant predictive elements of understanding of diabetes. The International Tobacco Control-South-East Asia survey (Siapush et al. 2008) exposed that male Malaysian smokers with a higher income had a higher self-efficacy to give up smoking. It had been also stated that working was associated with higher cigarette consumption (which differs from results found in high-income countries). In a report among Malaysians age 18 and above Lim et al. (2009) found that smokers were less knowledgeable about the dangers of smoking and had more positive attitudes towards smoking cigarettes. Another result of this analysis was that education and female gender were associated with a negative attitude. Jackson et al. (2004) asked people in Kelantan (Northeast Malaysia) about safe ways to smoke: Common beliefs were that drinking water or spending sour fruit can “clean away” the effect of smoking cigarettes. Manaf et Shamsuddin (2008) studied smoking among small urban Malaysian girls (university learners) and located associations with individual (slim image, monthly allowance, car ownership), friends and family (smoking cigarettes brothers, parental marital position) and environmental elements (having more smoker close friends, perceiving female cigarette smoking as normal).

Data from rural parts of Turkey demonstrated that there seems to become a low level of understanding of heart disease, cardiovascular risk factors and the value of coverage from those risk elements (Metintas et al. 2009). Goldman et al. (2006) confirmed inadequate understanding and awareness about cholesterol and the associated CVD risk in New England. A report by Kalra et al. (2004) executed in Asian Indian communities in Northern California exposed that awareness for a number of risk factors for CVD was present, and knowing of risk elements increased when somebody, that the individuals knew, was suffering from the disease.

Problem statement and justification

In concern of the world’s fast speed of urbanization with involved changes of lifestyles, the developing importance of cardiovascular disorders as leading causes of death in middle-profit countries and the speedy surge of cardiovascular disease risk elements in Malaysia during the last decade, a better knowledge of the underlying health beliefs, attitudes and perceptions of probably preventable coronary disease risk factors is essential. The results gained from studying expertise, attitudes and perception of the risk factors may help to formulate far better cardiovascular prevention plans and programmes. To my expertise, few qualitative analyses in Malaysia contain examined the cognitive areas of cardiovascular risk elements: Ching et al. (2009) showed that many overweight and obese individuals perceived themselves as ugly and feeled ashamed and frustrated, were less effective at work and had harmful attitudes towards themselves due to unwanted weight; Jackson et al. (2004) reported about lay beliefs about smoking that included safe ways of smoking, e.g. choosing sour fruit, smoking after foodstuff, exercising and by using a filter.

General Objective

Understand health beliefs, expertise and perception of – specifically preventable and modifiable – cardiovascular risk factors to help in the look of prevention programmes of coronary disease.

Specific Objectives

Evaluate knowledge, perception and attitudes of coronary disease and associated major modifiable risk elements in urban Malaysians attending an outpatient clinic.

Understand what are the key sources of details about cardiovascular disease and risk factors for the study population.

Understand how cultural elements could effect perception of cardiovascular risk.

Help to identify cardiovascular prevention courses’ priorities.

Help to understand what kind of barriers limit the adaptation of preventive methods.

Understand personal health priorities in the analysis setting.

Research methods

Study design

This study uses quantitative and qualitative methods (in-depth open-ended interviews and rank-order methods).

Study location and population

It is prepared to randomly select from the outpatient clinic of University of Malaya Medical Center, Kuala Lumpur, 20 clients suffering from cardiovascular disease and 20 patients not really suffering from this condition. To be contained in the study, participants need to have a minimum age of 18 years and should be able to speak Bahasa Malaysia, Mandarin or English.

Data collection

In-depth open-ended interviews with individuals will be utilized to collect the key data. In addition to the interviews, the topics will end up being asked to rank-buy cardiovascular risk elements and common factors behind loss of life in Malaysia. Interview inquiries will be pilot-examined before some of the research is being performed. Written consent will end up being obtained before starting the interview. The interviews will need place at the outpatient clinic of University of Malaya Medical Centre. A local research associate fluent in English, Malay and Mandarin will learn to aid in the interviews. During interview notes will be taken and the interviews will come to be audio recorded. Transcriptions of the interviews based on audio recordings will end up being performed and down the road translated into English. The study duration is approximately 3 months, from Can to Juli 2010 and data collection planned to start in May 2010. Ethical clearance will be attained from the ethical committee of University of Malaya, Kuala Lumpur.

Data analysis

For qualitative data content material analysis will be used to categorize textual info from the transcripts of the interviews. Evaluation of the data pieces produces codes that in the future result in themes (Given 2008).

For the quantitative component of data analysis, rate of recurrence distribution will come to be calculated to summarize relevant data obtained from the interviews and Pearson’s Chi-squared evaluation to test for statistical significance in the comparison of proportions of different categories (e.g. patients with coronary disease (CVD) vs. sufferers without CVD; male vs. female).


Since smokers appear to be less proficient in smoking (Lim et al. 2009), our study is expected to confirm limited understanding of the dangers of smoking cigarettes in our subjects. Like the review by Jackson et al. (2004) additional understanding can be gained from asking the participants about safe ways to smoke. Jackson et al. (1996) described the low knowledge of clients from a rural area about the complexities and health effects of obesity and we anticipate our leads to be alike. Research from the western portion of the world revealed a minimal level of knowledge

about heart disease, cardiovascular risk factors and the importance of safeguard from those risk factors (Metintas et al. 2009) and inadequate expertise and awareness about cholesterol and the associated CVD risk (Goldman et al. 2006). Little is well known about knowledge, perception and attitudes of additional risk factors, e.g. physical inactivity, hypertension, adverse diet and psychosocial pressure in Malaysians. Thus benefits from our proposed thesis should support complete the gaps.

Key literature

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Open-ended Interview guide

Getting ready

Establish rapport, give explanations of study, describe anonymity/confidentiality, describe note-taking/recording, obtain written consent. Hand out patient information leaflet.

Sources of information

“I’d like to begin off by asking you about information about health topics.”

“What kinds of info on health do you like to have?”

“Where carry out you get info on health matters from?”

“Which source of data carry out you trust the most?”

Understanding of health risks and understanding of cardiovascular risk factors

“I’d like to start off by requesting about what is named ‘health risks’.”

“When you hear the word ‘health risk’, what do you consider of?”

“What are a few examples of everything you consider being a risky for your health?”

“Do you ever speak to your family or friends about risks to wellbeing? What kinds of factors do you discuss?”

“When you hear the word ‘heart disease’ or ‘cardiovascular disease’, what do you think of?”

“What do you think makes people more likely to get a heart attack?”

Understanding of high blood circulation pressure and effect of high blood pressure

“What do you think of when you notice the term ‘high blood pressure’?”

“Do you take into account high blood pressure being a disease?”

“What types of things can occur to your wellbeing if your blood pressure is too high?”

“Do you know your blood circulation pressure?”

“Can you think about any reasons why people suffer from high blood circulation pressure?”

“What do you think people can do to avoid getting high blood circulation pressure?”

Understanding of cholesterol and aftereffect of cholesterol

“What do you consider of when you hear the term ‘cholesterol’?”

Probe for understanding of different sorts of cholesterol, e.g. LDL and HDL, or ‘good and bad cholesterol’.

“What sort of food do you consider containing a lot of cholesterol?”

“Do you consider high cholesterol being truly a disease?”

“Are you aware your cholesterol level?”

Understanding of diabetes mellitus and aftereffect of diabetes mellitus

“What do you consider of when you notice the word ‘diabetes’?”

“Do you take into account high blood sugar being a disease?”

“What types of things can happen to your wellbeing if your blood sugars is too much?”

“Can you think about any reasons why people suffer from high blood sugar?”

“Have you any idea your blood sugar level?”

“What could you do to keep your blood vessels sugar low?”

Understanding of obesity, over weight and healthy diet

“What do you consider of when you hear the word ‘obesity’?

“How would you know whether somebody is overweight?”

“Do you consider obesity an illness?”

“What varieties of things can happen to your body for anyone who is obese”?

“In your opinion, what is the reason for overweight and obesity?”

“Is it possible to give me a few examples of food that is healthy for your center?

“Do you take in fruits and/or vegetables each day?”

Understanding of the importance of physical activity

“Can you think about any reasons why physical activity/work out is important for your health?”

“What kinds of things can happen to your body when you have a lack of exercise?”

“Carry out you do moderate (e.g. walking, cycling and gardening) or strenuous training (e.g. running, soccer and swimming) for 4 h or even more a week?”

Understanding of the consequences of smoking

“Do you take into account smoking a danger for your wellbeing?”

“What types of things can happen to your health if you smoke?”

“Are you aware any safe methods to smoke?”

“Do you smoke?”

Understanding of psychosocial stress

“What do you consider of, if you hear the term ‘stress’?”

“What types of things can happen to your health in case you have an excessive amount of stress?”

“Do you frequently feel stressed?”


“Among everything you do in your life, how important could it be to you to accomplish things to stay healthy?”

“What kinds of issues do you do to stay in good health?”

Rank purchasing cardiovascular risk factors

“On these cards happen to be written 10 factors that may be a well being risk for your heart and soul and blood vessels. Please order the factors to be able of highest to lowest risk.”

10 cards of cardiovascular risk factors are shown to the topics for case study template rank-ordering.

“On these cards are written 10 illnesses that cause loss of life in Malaysia. Please buy the death causes to be able of most common to least common.”

10 cards with common factors behind death in Malaysia are offered to the topics for rank-ordering.

Socidemographic information

Write down: get older, gender, ethnicity, career and education level.