Community Empowerment to Support

Malnutrition Programme

Noriah B1, Nik Nur Eliza M1, Mohd Idris O1, Eliana M1, Rahimi H2, Faris A3,

Hakimin MK4, Norhashimah A5

1 Institute for Health Management

2 Pejabat Kesihatan Daerah Kuala Lipis

3 Pejabat Kesihatan Daerah Gua Musang

4 Pejabat Kesihatan Daerah Hulu Perak

5 Pejabat Kesihatan Daerah Hulu Selangor

PRESENTATION LAYOUT

INTRODUCTION

METHODOLOGY

FINDINGS

CONCLUSION

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INTRODUCTION

• Orang Asli (OA) women in Negeri Sembilan in2009, the maternal mortality rate was reportedto be 35.7 per 100,000 live births which wasabout 30% higher than the national rate.

• Based on the National Obstetrics RegistryPreliminary Report of National ObstetricsRegistry (July-Dec 2009), the prevalence ofanaemia in pregnancy among the OA womenwas 32.7%3. This is probably attributed by thelower socio-economic background leading topoor dietary intake and resulting in poor bodyiron stores.

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Rationale of the study:

• Knowledge and practice of balanced diet

play an important part in the well being of the

pregnant mothers especially in the

marginalised OA population.

• One of the objectives of this study is to

compare the knowledge and practice of

balanced diet intake among the rural and

fringe OA women in Peninsular Malaysia

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High Maternal Mortality among OA mothers

60% of Maternal Mortality in 2006-2008 Caused by Post Partum Haemorrhage

Possibility of Underlying Anaemia in Pregnancy

Importance in Addressing Malnutrition Among OA expectant mothers

Link between MM and Malnutrition

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Study design & Sample Size

• Cross-sectional study

• Sample size aiming for 1100 Orang Asli women with 20%

non-response rate (450: Rural, 450: Fringe)

Inclusion Criteria

• Women respondents

• Reproductive age group of 15-49 years old.

Sampling

• Four states were selected: Pahang, Kelantan, Perak and

Selangor. (Table 1)

METHODOLOGY

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STATE Fringe Rural

Pahang Pos Kuala Koyan

Pos Lenjang

Pos Pantos Pos Sinderut

Perak RPS Kemar

Kelantan Pos Kuala Betis

Selangor Kg Tun Razak

Kg Gerachi

Kg Pertak

Table 1: STUDY SITE

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Data Collection

The study is divided into two phases:

Phase 1 (Aug -Nov 2014)

Guided administered face-to-face

questionnaire. The framework of the

questionnaire is mainly based on the KAP

(Knowledge, Attitude, Practices) survey

questionnaire.

Phase 2 (Jan-Nov 2015)

Training and implementation of the identified

intervention and post-evaluation study will be

conducted on the intervention group

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Phase 1 Data Collection

RPS KEMAR

POS LENJANG

POS SINDERUT

KG GERACHI

KUALA KOYAN

PANTOS

KUALA BETIS

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FINDINGS: PHASE 1

The findings of Phase 1 were presented in theNational Steering Committee in December 2014

Response rate 80.2% with 441 respondentseach for rural and fringe community.

The knowledge of protein-based food e.g.meat/chicken for both the fringe and ruralrespondents were not significantly different(70.5%, 71.1%; p=0.881).

Awareness on anaemia in pregnancy is48.5% (rural) and 40.3% (fringe) (p=0.019)

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The actual practice of protein-based food e.g.meat/chicken intake was significantly different withthe rural respondents (31.1%) take less ofprotein-based food on daily basis as compared tothe fringe (62%) respondents (p<0.001).

Seafood intake for the rural respondents was low(4.1%) whilst fringe respondents’ intake wasmuch higher (18.2%)

The knowledge of fruit as part of balanced diet forboth fringe and rural respondents wererespectively at 73.5% and 62.7% (p<0.01). Thepractice of fruit intake on daily basis in rural wassignificantly lower as compared to fringe group(25.9%, 42.4%, p<0.001).

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• Even though both groups of knowledge

levels are similar, less rural respondents

take meat/chicken and fruits as compared

to the fringe respondents. This might be due

to scarcity of both food groups at the rural

setting.

• Lack of financial means may contribute to

lower consumption of balance diet food as

they can be considered as quite pricey

especially in the interior/remote setting.

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The food sourcepattern for the ruralcommunity ischanging as theyare now lessdependent onhunting and theysell agriculturalproduce e.g.banana topurchase rice forconsumption.

To improve thenutritional intakeamong the OAwomen, it isimperative to tacklethe root problemof poverty amongthe community withinter-agency effortfrom thegovernment andnon-governmentalbodies.

Increasing financialmeans of thecommunity willleads to biggerpurchasing powerfor the OA and thus,their ability topurchase morehealthy andbalanced- food forthe family members.

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Table 2: Daily food intake and Knowledge on Balance Diet

Pratice (Daily Intake) Knowledge on Balance

Diet

Diet Rural Fringe Rural Fringe

n % n % n % n %

Vegetables 401 91.1 417 94.8 311 73.3 376 86.6

Tapioca 392 89.3 264 60.0

Egg 168 38.2 252 57.3

Fish 279 63.4 328 74.5

Meat/Chicken 137 31.1 273 62.0 302 71.1 306 70.5

Dairy Product 109 24.8 113 25.7

Rice 360 81.8 428 97.3 374 88.2 389 89.6

Fruits 114 25.9 200 45.4 266 62.7 319 73.5

Seafood 18 4.1 80 18.2

Dry/ Preservative

Food* 322 75.9 358 82.5

Sweet/ Salty Food* 331 78.1 384 88.5

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Sources Of Food Rural Fringe

n % n %

Small Scale Farming

(Tapioca/ Banana/

Kangkung etc)

347 86.5 245 94.8

Fishing 183 45.6 173 49.1

Hunting 46 11.5 25 7.1

Livestock 42 10.5 33 9.4

Jungle Produce 133 33.2 138 39.2

Purchase 228 56.9 307 87.2

Table 3: Sources of Food Supply

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INCOME (RM) RURAL FRINGE

n % n %

520* and less 376 93.1 238 59.5

521-830 16 4.0 66 16.5

831-999 1 0.2 34 8.5

1000-1499 7 1.7 37 9.3

1500-1999 2 0.5 17 4.3

2000 and above 2 0.5 8 2.0

Table 4: Household income per month

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The stakeholders involved were:

- UNDP officers

- UNFPA representative

- Kuala Lipis, Hulu Perak, Gua Musang, Hulu Selangor

Health District officers

- Hospital Orang Asli Gombak

- Family Health Development Division

- Jabatan Kemajuan Orang Asli (JAKOA)

- Orang Asli Health Unit under the Public Health

Division

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TRAINING MODULE DEVELOPMENT

WORKSHOP, 10-11 FEB 2015 at IHM

Presentations to the stakeholders.

Intervention strategies identified based on findings

Kuala Lipis was chosen due to high rate of unsafe

deliveries

Kemar, Hulu Perak was chosen due to low protein

intake

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TRAINING PROGRAM

35 selected Orang Asli volunteers participated in a

training program in March 2015

• Volunteers from HuluPerak20

• Volunteers from Kuala Lipis15

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TRAINING MODULES DURING

THE PROGRAM

Antenatal and postnatal care

Safe delivery

Maternal balanced diet

Maternal related diseases

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OA VOLUNTEER TRAINING PROGRAM,24-26 MAR 2015, IHM BANGSAR

Maternal health and safe delivery training by Dr

Rahimi and Matron Asiah from PKD Kuala Lipis

“Pemakanan sihat dan Piramid makanan”

training by PKD Hulu Perak team (En Amirrul,

Matron Ruslina and Sister Nortah21

INTERVENTIONS IN PHASE 2

PASKOAs preparing the food and drink for the children

Multivitamin were given to the children by PASKOAs

Nail grooming session

Children eating food prepared by the PASKOAs

Talk on food pyramid, maternal health and safe delivery by PASKOA (Puan Hamidah and Puan Zainirah)

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INTERVENTIONS IN PHASE 2

Talk on food pyramid by Ms Siti

Talk on maternal health and safe delivery by Ms Rusmainie

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INTERVENTIONS IN PHASE 2

Maternal Health Education by local

OA Community Nurse

Healthy Eating Education by local OA

Assistant Medical Officer Samples of leaflets in Semai and Temiar dialects 24

ACCESS ROADS TO POS

LENJANG, KUALA LIPIS

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THANK YOU

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