Malaysian Child Rearing Practices and Its Relationship to Realth by Wazir-Jahan Karim A Research Project Funded by the International Developmsnt Research Centre 1981 RC FÉB2].1983 IDRC ; rrz^i 3 - p-- 79_ o cc 58- Acknowledgaments I vould like to express my appreciation and gratitude to thé International Development Research Centre for agreeing to fund this research project in 1978. Z also wish to thank UNICEF for providing me with financial assistance for the section of the research on traditional médical practitioners and village medicines conducted I' in Yen, Kedah. The assistance and co-operation of the Ministry of Realth has been a major factor in ensuring the emooth implémentation of the research in Seberang Prai and I would specifically like to thank Dr. Chee Chin Seang, the Deputy Director of Health in Penang, Sister Kvan, Dr. Raj Karim from the Maternai and Child Health Division in the Ministry and other médical and nursing personnel in Seberang Prai for providing me with continuous assistance during the period of my fieldwork. I would also litre to thank the management of Malakoff Estate at Thsek Glugor, in particular the Manager, Mr. Jones and Mr. Shankar for allowing me to conduct my research on the estate and also for assistance provided when the census survey was conducted. My sincereat thanks also to the KEMAS teacher at Junjong, Rokiah Ahmad and the teachers at the Malakoff Estate pre- school, for help rendered to my research assistants, Muniamah Kandasamy, Tengku Zainah and Susan Oorijitham, during the intensive field work period. Ficnaliy, I can quite confidentiy say that this research would not have been possible without the commitment and enthusiasm of my research assistants and the keen interest of e nutritionist from Minnesota University, Misa Mary-Pat Selvaggio, to conduct a The study has taken approximately two and e half years to be completed between its period of inception in mid 1978 to ite period of completion in November 1981. There were considerable problems in the formulation of the research design, selection of research areas and the hiring of research assistants but despite these difficulties, it has been a valuable and worthwhile experience. The technique of participant observation has enabled me to maintain a continuing rapport with the villagers of Junjong,and the female estate vorkers et Malakoff and consequently has enabled me to expand my research activities in these areas for other projects and programmes on vomen, youth and children. These research areas nov foret one of the bases of women studies in Peninsular Malaysia and is integrated with the KANITA Research Programme on Women and Children in Development. This Research Programme based et the School of Comparative Social Sciences at Universiti Sains Malaysia is currently funded by the National Advisory Council on the Integration of Women in Development (NACIWID), within the Prime Minister's Department et Kuala Lumpur. Ultimately, it is hoped that the research findings from this study mey be integrated into a book on medical anthropology in Malaysia which may yet be another meaningful contribution to the study of vomen and children in the field of illness and health. Wasir-jahan Karim November 1981 Preface This study vas initially prompted by research findings from my earlier doctorats research on illness, traditional medicine and shamanistic cures amongst an Orang Asli (aboriginal) group, thé Ma' Betisek, of Selangor, in Peninsular Malaysia. I discovered ".that beliefs and ideas relating to illness of infants and children vers conceptually and symbolically differentated from those of adulte and expressed a deeper sense of anxiety and appréhension about the supernatural or spiritual world. It vas interesting to know to what extent the major ethnie groupa in Peninsular Malaysia expressed similar patterns of differentiation vithin the value system pertaining to illness and health. My suggestion on the need for research on the relationship between child-rearing practices and health vas taken up by Dr. J.Y. Peng and subsequently Dr. Marjone Koblinsky, from IDRC and a research design vas formulated, to conduct such a research project, using both anthropological and social statistical techniques. It vas found to be necesaary to control social variables like income, class and rural-urban différences to study the entent to which socio-cultural values played a significant role in guiding the attitudes and practices of villagers, particularly mothers towards child-care and its integration with traditional and modern health and delivery system. Toddlers and pre-school children becams the focus of this research since children of this aga group have been regularly excluded for social science research in Peninsular Malaysia, Indeed, research in the field of médical anthropology has been aadly neglected in Peninsular Malaysia, despite its tremendous potential and valuable contribution to health development and planning. V r nutritional study in the research areas chosen for this study. I vish to thank some of my colleagues from the School of Comparative Social Sciences, particularly Encik Mohd. Razha Abdul Rashid and Mise Pauline Dass for helping me interpret some of my research findings pertaining to Malay and Tamil child socializations and traditional medicine, respectively. Not for citation Without the permission from the author and IDRC Novamber 1981 Table of Contents Page Chap te r 1 INTRODUCTION 1 1.0 Problem Conceptualisation 1 2.0 Background to Haalth Developmant Problems in Psninsular Malaysia 4 2.1 The Physical and Socio-Economic Infrastructure of Psninsular Malaysia 4 2.2 Haalth Districts and Rural Haalth Units 5 2.3 Fonctions of a Rural Haalth Unit 11 2.3.1 Maternai and Child Haalth Cars 12 f 2.3.2 Enji ronmantal Sanitation 16 2.3.3 Dental He alth 16 2.3.4 Nutrition Programme 17 i 2.3.5 Family Planning Service 17 3.0 Methodology and Research Techniques 18 4.0 Salection of Villages and Village Social and Physical Infrastructure 23 5.0 Socio-Economic Characteristics of the Community Salacted 0 33 5.1 Household and Family Structure 33 5.2 Sise of the Houssholds and Number of Children 37 d 5.3 Education and Occupation of Female Spouses and Famale Heads of Household 41 5.4 Income and Expenditure Patterns 45 5.5 Household Expenditure 48 Charter 11 Page CHILD SOCIALIZATION AND ITS RF.I.ATIONSHIP TO HEALTH 60 1.0 Malay Child Socialization 60 2.0 Indian Child Socialization 76 3.0 Chinese Child Socialization 91 mater 111 ANALYSIS OF NUTRITIONAL STATUS OF MALAY, INDIAN AND CHINESE CHILDREN, BLTw N 1 TO 6 YEARS AT TASEK GLUGOR AND TASEY. JUNJONG 105 1.0 Methodolopy Adopted for the Nutritional Study 106 1.1 Stage 1: Assessrnent of Demographic and Socio-Economic Characteristice of Ilothers vit}h Toddl.ers and Pre-School Children 106 1.2 Sto.pe 2: Anthropometric and Clinicat Assessment 107 1.3 Haemoglobin Analysis 109 2.0 Technique of Detta Analysis 109 1 3.0 Anthroponetry as an Indication of Mutritional Status in Malaysian Childreni 110 3.1 Centile Distribution 111 3.2 Percent of Median Results 113 4.0 Arm Circumference as an Indicator of Nutritional Status of Malaysian Toddlers and Pre-School Children 123 4.1 Triceps Skinfold Thickness 126 5.0 Analysis of Haemoglobin and Nutritional Anaemia +- as an Indicator of Nutritional Status in Malaysien Toddlers and Pre-School Children 128 6.0 Analysis of Dental Health as an Indicator of Nutritionai Statua in '.toâllers and Pre-School Malaysian Children 130 7.0 Clinical Analysis for Protein Calorie Malnutrition, Includiiie Ribo Flavin Defiencv, 3Lia Infections and T'accination Scan 135 7.1 Ribo Flavin Deficiency 136 Page 7.2 Skin Infection 136 7.3 Vaccination Scars 137 8.0 Relating Nutritional Statua to Dietary Intake and Practices 137 8.1 Percent of Racom9nended Intake 138 8'2 Dietary Intake Associated with Biochemical and Clinical Data 141 8.3 Food Frequency Data 141 9.0 Relating Nutritional Statue to Cultural and Socio-Economic Variables 143 Chaptsr M INTÉGRATION AND CONFLICT IN TRADITIONAL AND MJDERN HEALTH CARS SYSTEMS 148 1.0 The Malay Bidan 150 2.0 The Bomoh and Other Traditional Médical Specialists 170 N Chapter V SUTARY AND CONCLUSION 188 Appendices 1 Survay Questionnaire in Bahasa Malaysia 208 2 Survey Questionnaire Translation 225 3 Survey Questionnaire Code Book 241 4 Instruction for Coding 258 5 Antbropometric and Dental Survey 264 6 Clinical Survey 267 7 Dietary Survsy 270 X Appendices Page 8 Malay-English Terminology Relating to Pregnancy and Child-Birth 277 9 Procédures for Anthropometric Measurement 279 10 Sahli's Colormatric Haemoglobin Analysis 282 11 Traditional Msdicine 283 12 Clipical Glossary Relating to Protein-Calorie Dsficiency and Malnutrition 288 13 Rules that must be observed by Registered Midwives 292 14 Bahasa Malaysia Translation for Appendit 13 293 Tables q 1 Distribution of Households Within Villages 30 2 Ethnicity and Types of Households 33 3 Ethnicity and Types of Latrines 36 4 Ethnicity and Structure of Households 39 Ethnicity and Types of Family 40 6 Ethnicity and Marital Statue 41 7 Ethnicity and Sise of Rousehold 43 8 Ethnicity and Humber of Children 44 9 Ethnicity and Levai of Education of Female Heads of Households and Female Spouses 46 10 Ethnicity and Occupation of Female Heads of Rouseholds and Female Spouses 48 11 Ethnicity and Household Incoma 51 q 12 Ethnicity and Household Expenditure 53 13 Ethaicity and Patterns of Expenditure 54 14 Standard Weekly Meal Pattern in a Malay Household et Kampung Junjung 64 15 Food Taxonomie Systems of the Malays 75 xi Tables