Prevalence Trend and Clinical Profile of Leprosy Among the Indigenous Penan Community in Rural Baram, Sarawak, Malaysia: A Retrospective Study

In Malaysia, despite achieving leprosy-elimination status in 1994, leprosy remains a public health issue among the indigenous Penan community in Sarawak. This study aimed to determine the prevalence trend and clinical profile of leprosy among the Penans in rural Baram, Sarawak, Malaysia. A retrospective records review was conducted on 10-year (2008-2018) time trend of annual prevalence rate and 5-year (2013-2018) Penan leprosy patient clinical profile. Out of the 257 new cases of leprosy reported in Sarawak, 42.8% were Penans, and 72.7% were from Baram. The annual Penan ethnic-specific prevalence rate ranged from 2.08 to 35.5/10 000. Forty-six cases were analyzed for clinical profile: There were more males, active case detection, and multibacillary leprosy. The prevalence trend of leprosy among the Penans in rural Baram exceeded recommended elimination targets. Majority of the cases were detected through active case detection, but cases were detected late. Interventions are needed to improve early diagnosis and detection to achieve elimination of leprosy.

Effectiveness of a brief intervention for smoking cessation using the 5A model with self-help materials and using self-help materials alone: A randomised controlled trial

INTRODUCTION

The '5A' model for smoking cessation was introduced in 2000 by the US Department of Health and Services. This brief intervention was recommended worldwide for smoking cessation. However, little is known about its effectiveness for smoking cessation in a primary care setting in Malaysia.

OBJECTIVE

To determine the effectiveness of a brief intervention for smoking cessation using the '5A' model with self-help materials compared to using self-help materials alone.

METHODS

This randomised controlled trial was conducted at the Primary Care Clinic at the University Malaya Medical Centre (UMMC) between June and October 2009. Subjects were all current smokers aged 18 years and above. A total of 208 subjects were recruited and randomised into two groups. Subjects in the intervention group were given a brief intervention based on the '5A' model with selfhelp materials, while the control group received self-help materials alone. Subjects were later followed up at one and four months via telephone calls. The outcome measure was a self-reported attempt to quit smoking.

RESULTS

At one-month follow-up, 15/77 (19.5%) of the participants in the intervention group had attempted to quit smoking compared to 8/80 (10.0%) in the control group. There was no significant difference between the two groups (p=0.09). At the four-month follow-up, 13/58 (22.4%) participants in the intervention group had attempted to quit smoking compared to 9/57 (15.8%) in the control group. Once more, there was no significant difference between the two groups (p=0.37).

CONCLUSION

This study showed that there was no significant difference between a brief intervention using the '5A' model with self-help materials and using self-help materials alone for smoking cessation in a Malaysian primary care setting. However, these results do need to be treated with caution when taking into consideration the high dropout rate and bias in the study design.

Anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) in rural Sarawak, Malaysian Borneo

Nycticebus spp, commonly known as the slow lorus, is a small nocturnal primate found mainly in Asia. The adult slow loris weighs between 265 g and 1150 g depending on the type of species. It has a characteristic round head with large, forward-facing eyes. Slow lorises are known for their poisonous bite and are the only venomous primates. To date, there have been two published cases of slow loris bite in humans. This case report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) to a young man at Mulu District, in a remote area of Sarawak, Malaysian Borneo. The patient developed dyspnoea, a feeling of suffocation, swollen lips and cramp-like sensations over both hands. He subsequently developed syncope and hypotension. The patient was clinically stable following intramuscular injection of adrenaline 0.5 mg stat dose.