THE MALAYSIAN PAEDIATRIC ASSOCIATION FEBRUARY 2019 FOR MEMBERS ONLY

Editorial Board World Prematurity Day Datuk Dr Zulkifli Ismail Dr Selva Kumar Sivapunniam 16 November 2018,

MPA 2017 – 2019 EXECUTIVE COMMITTEE President AP Dr Muhammad Yazid Jalaludin Immediate Past President Dr Thiyagar Nadarajaw Vice-President Dr Hung Liang Choo Secretary AP Dr Tang Swee Fong Asst Secretary Dr Selva Kumar Sivapunniam Treasurer Dato’ Dr Musa Mohd Nordin Group picture Committee Members Datuk Dr Zulkifli Ismail Datuk Dr Soo Thian Lian Dr Noor Khatijah Nurani In conjunction with World Dr Khoo Teik Beng Prematurity Day, Hospital Sultanah Dr Mohamad Ikram Ilias Bahiyah and Malaysian Paediatric Dr Ong Eng-Joe Association organised an event in Honorary Auditors Hospital Sultanah Bahiyah on 16 Prof Wan Ariffin Abdullah November 2018. Prof Dr Thong Meow Keong The objectives were to raise public Affiliated to: awareness regarding prematurity Dr Eric(neonatologist) with the ladies • Malaysian Council For Child Welfare and the challenges, and serve to • ASEAN Pediatric Federation provide a platform for families to • Asia Pacific Pediatric Association – APPA (Previously Association of share their experience in caring of care to celebrate this meaningful Pediatric Societies of the South East premature babies. It was also an and memorable event. Asian Region – APSSEAR) opportunity for medical staffs to show • International Pediatric Association their continuous support to premature The events of the day included an (IPA) babies and their families post- introductory video to our Neonatal

The Berita MPA is published for members to discharge from NICU. Intensive Care Unit of Hospital keep them informed of the activities of the Sultanah Bahiyah. This video helped Association and to keep up with developments in paediatrics and child health. This event was enthusiastically the parents involved to reminisce participated by 20 ex-prematurite kids their experiences in NICU during those who were born in Hospital Sultanah difficult days. The views and opinions in all the articles Bahiyah between the year 2014 are entirely those of the authors unless otherwise specified. and 2017. The highlight of the event was We invite articles and feedback from our Prince and Princess Dressing readers – Editor We invited our NICU and paediatric Competition. This event included clinic staffs who were involved in their an introductory video of each of

continued on page 3…

Unit 16-07, 16th Floor, Menara Arina Uniti, 97, Jalan Raja Muda Abdul Aziz, 50300 . Tel: 03-2202 7099 Fax: 03-2602 0997 Email: [email protected] Website: https://mpaeds.my

BERITA MPA – FEB 2019 • 1 FromReport The President

Looking Ahead!

Assalamualaikum and Salam Examples include Immunise4Life childhood malnutrition among Sejahtera, campaign throughout the year, the under-5 children. It was a very Preparation of Health Education fruitful meeting and hope this kind Happy New Year 2019! Material and Immunisation of collaboration would continue Counselling Guidebook for to grow. Esteemed members of MPA, a fresh Healthcare Providers Workshop new year is once again upon us 1/9/2019 The Star ePaper - The Star - 8 Jan 2019 - Page #17 organised by the Family and another year of success and Development Unit, MOH together happiness has passed. It’s time for with World Health Organization, us to reflect on what we have done Food-Environment Policy Index in the past year and be thankful for Expert Rating Workshop to the blessings and achievements, Benchmark Food Environment despite all the challenges and Policies for Malaysia organised by obstacles. UKM; Workshop on Addressing the Looking back at 2018, I would say Global Health Challenge of Obesity that I am very honoured to be in Malaysia and Beyond organised given the opportunity to work with by Academy of Sciences Malaysia the esteemed council members and The Academy of Medical and to lead MPA to the next level. Sciences Britain; Health and I am also very proud to have you, Living Forum by BFM; Counselling MPA members, who had given Kit Harmonisation Meeting for relentless support towards all MPA Childhood Obesity Prevention activities, in particular the 40th MPA Among Children Under 5 by Ministry Annual Congress in . Without of Health. Not to forget the two nd Published in The Star, 8 January 2019 your participation, the congress workshops held in IMU i.e. 2 Public http://mystar.newspaperdirect.com/epaper/viewer.aspx 1/1 would not have achieved the Health Roundtable Discussion on 26 As mentioned in the recent highest number of attendance of a September 2018 entitled “Control of Star newspaper, MPA is also national meeting to date. I am as Sugar Sweetened Beverage (SSB): holding discussions with multiple nd well proud to understand that the Regulation or Taxation?” and the 2 stakeholders including government paediatricians would undoubtedly Institute of Research, Development ministries, state governments, go above and beyond when it and Innovation (IRDI) Public Health related expert bodies and potential comes to child’s right. Policy Dialogue incorporating the private sector partners, to develop rd 3 MPHPA Public Health Policy a new childhood obesity prevention 2018 witnessed the MPA’s strong Roundtable Discussion on 22 programme. It will integrate and continuous involvement November 2018 titled “Inclusion of screening, face-to-face counselling in immunisation to childhood Pneumococcal Conjugate Vaccine and customised online intervention, malnutrition (stunting and obesity) (PCV) in National Immunisation targeting parents during the pre- and not to forget marginalised Program (NIP): What’s more and conception, antenatal, newborn children. A number of council what’s next?” both organised and infancy, and 2 to 6 years old members and I have been by The Malaysian Public Health stages. Impact assessment will be attending meetings held by the Physicians’ Association (MPHPA) incorporated to enable continuous government agencies as well as and the Institute for Research, improvement. Stay tune to this new the NGOs, providing ideas and Development and Innovation, initiative! comments, as we believe that International Medical University everyone should work together (IRDI, IMU). My New Year message would not for the betterment of child’s life. be complete without highlighting Our commitment in providing a A hectic year indeed but that our annual highlight; MPA Annual better future for Malaysian children put the smiles on the councils’ Congress. This year, the 41st MPA is evidenced by MPA active faces as we move to 2019. On Annual Congress would be held participation in programmes, 7 January 2019, myself and the in conjunction with the 15th Asian training workshops, dialogues team from Ultraworks had a solid Oceanian Congress of Child and campaigns organised by 3-hour meeting with Dr Faridah Abu Neurology (AOCCN) on 19 – 22 the Ministry of Health, Ministry Bakar, the Director of Family Health September 2019 at Shangri- of Education, academia and Development Unit, MOH, discussing La Hotel, Kuala Lumpur. The the media. on strategies on how to combat theme “Synergy to Challenge

2 • BERITA MPA – FEB 2019 Update

… from page 1

our ex-preemies, their details, including information on their gestation and birthweight. As their names were being shown, they presented themselves in an appealing manner in the fashion walk on stage.

Besides entertainment, we also had Healthcare Education for parents, including CPR and hand washing techniques. Boundaries in Child Neurology” augurs well with MPA’s vision of providing a As part of the event, the was bathed in highly stimulating and cutting edge purple light on 17 and 18 November 2018. scientific programme to our members; the seasoned clinicians, trainees and We are looking forward to celebrate a similar event in allied health professionals that are 2019 and provide continuous support for our ex- preemies involved in the care of children with and families. 2 neurological disorders. I believe Dr Khoo Teik Beng as the Congress President and Dr Tan Wee Nee his team would do their best to present us [email protected] with the latest updates in Child Neurology and not forgetting the social events which is dear to our heart, where we all meet and greet. To all members, do mark the date and try your very best to attend this year’s congress.

As for research, allocation for grants has been increased to a maximum of RM10,000 for five grants per year. I would like to encourage all members to submit their applications and grab this grant opportunities offered under the MPA banner. Information about grant application would be constantly updated through our MPA website.

Dear members, every end marks a Dr Ng Yun Yun(Neonatologist) new beginning. Keep your spirits and pacifying an ex-preemie determination unshaken. With courage, faith and great effort, you shall achieve everything you desire. No one can go back in time to change what has happened, so let us work on our present to make a wonderful future for our children.

Gong Xi Fa Cai!

Fashion show winners

Muhammad Yazid Jalaludin President 2017-2019 Teaching basic CPR to parents [email protected]

BERITA MPA – FEB 2019 • 3 UpdateReport The Rabies Outbreak in Rabies outbreak was thus the shorter the incubation declared in Sarawak on 1 July period. 2017 by our director general of health. Since then, there is no What are the signs sign that we have gained an upper hand on this dreaded and symptoms of disease. At that point of time, no rabies? clinician thought about rabies Patients will develop as a differential diagnosis, as we prodromal symptoms which strongly believed that Sarawak are non-specific (somewhat is “Rabies Free” as far as we akin to a flu-like illness). They know. The diagnosis of possible will experience tingling pain rabies was made after the followed by limb weakness parent of the third patient gave Dog captured, suspected of rabies. (pic: The Star) at the bite site a few days a very clear history of his clinical later. Subsequently, the presentation and also history weakness will progress to of dog bite prior to it. The other by dogs), contamination of fresh, the confusion and coma stage. clue was that the 3 patients were open bleeding wounds and Then death will usually ensue in from nearby villages in Serian, of less effectively through mucosal about 14 days. which 2 of them were siblings. contact with saliva or secretions which harbour RABV. There are 2 forms of rabies – the As of 10 December 2018, there were furious (encephalitis) or dumb 16 confirmed cases (7 paediatrics The risk of developing rabies (paralytic) type. The furious is more and 9 adults) of human rabies in depends on the anatomical site common, representing 75% of rabies Malaysia. There is only one survivor of the bite, the severity of the bite, infection encountered so far. who is a paediatric patient but with the species inflicting the wound severe neurological deficit. These and presumably the rabies virus Once neurological symptoms have confirmed human rabies cases only variant. The transmission rate developed in a patient, the rabies represent the tip of an iceberg of following multiple and severe bites infection is almost always fatal as people who have been exposed over the head was highest at there is no effective treatment yet. to rabid animal bites. Therefore, 50–80%, followed by the finger, hand we are anticipating there may or arm bites at 15–40%; and leg bites What is the appropriate be more human rabies cases that at 3–10%. may emerge as some bite victims management for such did not come for treatment. It is a What is the a dreaded disease? devastating disease to treat as the The best measure is the prevention mortality is 99.9% once the patient pathogenesis of rabies of dog and cat bites. developed signs and symptoms infection following an of rabies. animal bite/scratch? If in the unfortunate event that one is bitten/scratched by dogs/cats, Once bitten/scratched, the What is rabies? the following should be done: RABV will stay at the bite/scratch Rabies is a neglected emerging site and find its way through the 1. Wash the wound under running zoonotic disease caused by neuromuscular junction at the water and soap for at least 15 rabies virus (RABV). Rabies virus motor end-plate. Once it gets minutes immediately. It can be is the prototype virus of the past the neuromuscular junction, life-saving and good wound genus Lyssavirus in the family it will make its way to the central care has been shown in clinical Rhabdoviridae of the order nervous system (CNS) through nerve studies to reduce the risk of Mononegavirales (MNV). axons at a rate of around 3mm an rabies infection by 40 to 90%. It is hour (50-100mm per day ). Once important for parents to wash the RABV causes rabies infection in the virus reaches the CNS, rapid children’s wound properly even animals and humans. It is a highly dissemination occurs. if it is painful. This is important neurotropic virus, invariably causing to ensure that the saliva that a fatal encephalomyelitis once The incubation period from the contains the virus is removed as the infection is established and has time of being bitten to the clinical much as possible. reached the brain. manifestation of rabies is usually 2. After washing the wound, please between 4 to 8 weeks on average. go immediately to the nearest In rare fulminant cases where there How is rabies government healthcare facility is a direct bite on the cervical transmitted? to get another round of wound nerve plexus, rabies can occur as washing and assessment. The RABV is transmitted through quickly as 5 to 6 days. The nearer assessment is to determine animal bites/scratches (mainly the distance of bite from the CNS,

4 • BERITA MPA – FEB 2019 Update

whether rabies vaccination and HIV patients (children CD4 of < A timely availability of the animal rabies immunoglobulin (RIG) is/ 25%, adult with CD4 count of < rabies status is very important are indicated. 200 copies/ml), solid organ or for immediate control measures 3. Please do not do toilet and hematological malignancy patients by the veterinary department suturing (T&S) immediately for the who are on chemotherapy or and rationalising the scarce wounds as the patient needs to receiving immunosuppressive resources of rabies vaccine and be assessed for RIG before this agents, they should receive immunoglobulin. similar doses of rabies vaccination procedure. Any suturing may We need a dedicated “dog bite cause direct introduction of virus [regardless of whether they have received previous PEP or pre- clinic” to better manage animal into the motor end-plates or bites of such scale to ensure these nerve roots. exposure prophylaxis (PrEP)] plus rabies immunoglobulin. cases are managed properly and resources are used in a more cost Rabies Vaccines: Rabies immunoglobulin (human or effective manner. We can have all WHO Position Paper equine depending on availability) the money in the world but sourcing is to be given for category risk 3 for “WHO prequalified” vaccine or (April 2018 Update) bites whereby the dogs or cats that immunoglobulin supply is always a recommends the bite the patient are clearly rabid or challenge to the health system. cannot be monitored for the next 14 following for post days. The immunoglobulin should be Health awareness in regards to exposure prophylaxis instituted as much as possible at the rabies is still poor and need to be bite side and the maximum dose enhanced to prevent more human (PEP): of immunoglobulin should not be rabies cases. Even though the 2 doses of intradermal (ID) rabies exceeded. (Human RIG – 20IU/kg, outbreak has been for more than vaccine at Day 0, 3 and 7 for Equine RIG – 40IU/kg) a year now, some victims still treat category risk 2 and 3 wounds. Each animal bites very lightly and are dose of 0.1ml rabies vaccine is to (For more details, please refer to very ignorant about rabies. be given at each deltoid or antero- afore mentioned WHO Position lateral thigh region by a trained Paper) Law enforcement to encourage personnel. good pet ownership is important to What did we learn from prevent more animals from being Intradermal method of rabies infected with rabies. 2 vaccine institution is recommended a rabies outbreak of for its dose and cost effectiveness this scale? especially in situation like Sarawak Chua Hock Hin We need a good animal bite that is facing an outbreak of such Infectious Disease Consultant surveillance system in place in extent. Sarawak General Hospital which all animals that bite a victim [email protected] For individuals who are will need to be accounted for and immunocompromised like untreated tested for rabies.

New NRP VITALS © App Bridges NRP Simulation and Your Smart Device NRP VITALS © is a newly released app developed by the NRP Steering Committee to fill the need for a convenient neonatal patient monitor simulator. NRP VITALS allows users to enhance their simulation events by displaying those vital signs most important for newborn resuscitation. Users can perform timed simulation controlling heart rate, SpO2, skin temperature, and ECG waveforms without additional computer systems or costly third-party apps. NRP VITALS can be used with a smartphone as a stand-alone monitor or be paired with another device via Bluetooth or Wi-Fi, allowing the smartphone to be used as a remote control for conveying vital signs to a tablet.

This application is available at for free on the App Store and Google Play by searching for the keyword “NRP VITALS”.

This application was developed in part through an unrestricted educational grant from Johnson & Johnson.

BERITA MPA – FEB 2019 • 5

Report

Dato’ Dr Musa giving Group photo his facts

Dato’ Dr Rus Anida Awang explaining on asthma Dr Jessie Anne De Bruyne as one of the exacerbation The large crowd of attendees panelists, flanked by Dato’ Dr Aziz (L) and Dato’ Dr Ahmad Fadzil (R) Paediatric Respiratory Summit 2018 5 August 2018, Putrajaya

In Malaysia, it is estimated that there Dato’ Dr Rus Anida Awang, Guidelines mentioned nebulizer as are 2 million people who suffer from Consultant Paediatrician and an alternative technique, especially asthma. Out of this number, 40% of Paediatric Respiratory Physician when the patient is required to them have uncontrolled asthma; at Hospital Pulau Pinang, talked have higher doses of inhaled with remaining 60% divided to about the management of asthma bronchodilator medication, or the partially controlled asthma (58%) exacerbation and explained the patient usage of devices may be and controlled asthma (2%). While efficacy of nebulized budesonide problematic. the statistics are indeed worrying, compared to oral prednisolone what is even more concerning in acute bronchial asthma in her Hot debate is that 66% of asthmatic patients opening remarks. She referred to One of the most interesting reported missing work or school due some clinical evidences which agendas that took place towards to asthma. More needs to be done mention that high dose inhaled the end of the day was the hot to enable asthmatic patients to corticosteroids had been proven to topic debate: “Do premature have better control of their disease reduce admission rate when given babies have a higher risk of management. Seeing there was in the Emergency Department contracting asthma?” between a need to address asthma control during the first hour, to reduce the Dr Anna Marie d/o Nathan, amongst children, AstraZeneca length of hospital stay and reduce an Associate Professor at the collaborated with the Malaysian the relapse rate. Department of Paediatrics, Faculty Thoracic Society (MTS) in hosting of Medicine in University of Malaya, the Paediatric Respiratory Summit Guidelines vs Evidence and Dato’ Dr Musa Mohd Nordin, 2018, aimed at the healthcare A panel discussion also took Consultant Paediatrician and community through continuing place during the event on the Neonatologist at KPJ Damansara sharing of medical knowledge. Conundrum of paediatric asthma: Specialist Hospital. Their unique ‘Guidelines vs. Current Evidence different stands and professional The summit included 13 speakers in Asthma Management’. The mannerism peaked as they speak from various hospitals in the lecture was presented by Dr Jessie on respective evidences firmly. paediatric respiratory unit, providing Anne De Bruyne, former head an avenue for meaningful of the Paediatric Respiratory and AstraZeneca was delighted to discussion amongst experts to Allergy Unit in the Department of host this event in collaboration increase the awareness of asthma Paediatrics, Faculty of Medicine with MTS and looking forward for for a more accurate diagnosis of in University of Malaya. In her more scientific partnerships with the disease and discuss suitable talk, she emphasised that there the Paediatric and Respiratory recommendations regarding the was an equivalent effect in using Paediatric experts in future. 2 management of chronic childhood the spacer device as compared asthma amongst medical to a nebulizer in managing mild Rethina Gunaseelan practitioners. and moderate asthma. The GINA [email protected] guidelines and the European

6 • BERITA MPA – FEB 2019 Report

“Inclusion of Pneumococcal Conjugate Vaccine (PCV) in National Immunisation Program (NIP): What’s more and what’s next?”

NCD MALAYSIA ROUNDTABLE 3/2018 22 November 2018, Kuala Lumpur

Malaysian Public Health 6. Implement a structured Physicians’ Association and coordinated effort in collaboration with to improve and enhance IRDI-IMU held the 3rd pneumococcal diagnostic NCD Roundtable laboratory capacity Discussion on 22 which is critical not only November 2018 at for optimal patient care International Medical but also for surveillance, University. All 28 vaccination monitoring stakeholders from and impact assessment various associations, as well to support good professionals, quality research and academicians and development (R&D); Various stakeholders present at the discussion consumers discussed and agreed to come 7. Under the 2019 budget out with a resolution to 3. Consider implementing mass for the medical and health recommend to the Government immunisation at a pilot scale of protection scheme of the B40, of Malaysia about “Inclusion the size of a reasonable state it is recommended that the of Pneumococcal Conjugate population in order to assess pneumococcal vaccination for Vaccine (PCV) in National feasibility of including PCV into children be considered as one Immunisation Program (NIP)”. the NIP in relation to human of the benefits under this health resource, cold chain and logistic protection plan; We support the idea to include needs, surveillance system and PCV as compulsory vaccination impact measurement and 8. The government to also consider in NIP for kids below 2 years old as address any other uncertainties in incorporating vaccination for vaccinating the children shows policy decision process; elderly in the NIP. Considering the positive impact on adults and that pneumonia is a significant helps to reduce pneumonia cases 4. Encourage and support cause of morbidity and mortality in Malaysia. We also urge the pneumococcal surveillance and among Haj pilgrims especially Government to: carriage studies, pneumococcal among the elderly, government disease burden and other and Tabung Haji to consider 1. Review and have clearer target related socio-economic, pneumococcal vaccination on efforts to reduce morbidity clinical and epidemiological as part of the health package and mortality related to studies which could provide required for potential pilgrims. pneumonia instead of targeting base-line information relevant on reducing the overall under-5 for the implementation of the 9. Awareness campaigns about mortality among children with vaccination program; pneumococcal infections this vaccination proposal. should be regularly organised Pneumococcal vaccination 5. In order to address the issue of and enhanced amongst the is not expected to make any the high price of pneumococcal community as well as healthcare significant impact on the overall vaccine, the government may professionals to increase mortality rate of under-5 children; want to consider collaborating pneumococcal vaccine uptakes. with other ASEAN member 2 2. Design, develop and implement states toward regional vaccine a system of notification or registry procurement approach. The of pneumococcal infections Senior Officers Meeting for Health Muhammad Yazid Jalaludin to better capture and record Development (SOMHD) and [email protected] the cases of pneumococcal ASEAN Health Ministers Meeting infection for the purpose (AHMM) platforms could be used of surveillance and impact for this purpose. measurement;

BERITA MPA – FEB 2019 • 7 Update Child Violence and Maltreatment in Malaysia

Locally a child is defined as “a person HSS 1996, Kamaruddin 2000, Choo detention camps. These children are under the age of 18 years” in the 2011). Data from community studies denied their basic rights for identity, Child Act 2001 (revised 2016) and on maltreatment of 15-17yr olds in education, healthcare and adequate UNCRC (Convention on the Rights of 2006 and 10-12yr olds in 2011 showed shelter. Here violence is imposed by the Child). Children and adolescents that at least half have some form of the authorities by neglect. comprise a third of the population physical or emotional abuse and live of Malaysia (see Table 1). Despite in uncertain home environments. ‘Big Picture’ Reasons for many advances in human rights and Violence against Children medicine, children remain fragile and More damaging are thousands of ‘run away’ or missing children, some open to abuse and violence. As such Children experience violence and forced into prostitution locally or the United Nations commemorates maltreatment primarily due to th overseas. The International Bureau 4 June as the ‘International Day parental and societal failure. There for Children’s Rights in 2006 stated of Innocent Children Victims of has been a decay in parenting that “Malaysia is a source, transit & Aggression’ (http://www.un.org/en/ abilities over time and the changing destination country for women and events/childvictimday/). This brief social structure, urbanisation and girls trafficked for the purpose of article is to outline major areas where stressful focus on academics has sexual exploitation”. To our shame we children in Malaysia still face violence. placed pressure on families and also support child marriages, often children. The failure of authorities to deal with the poverty that affects Table 1: Population Data on Children in Malaysia, 2017 20-30% of Malaysian families, the rising cost of living and lack of provision % of Total Age (years) Male Female Total of good child care means that Population societal safety nets have not been 0-4 1,354.4 1,266.5 2,620.9 8.2% put in place. Both the Department of Social Welfare and Royal Malaysian 5-9 1,307.2 1,225.4 2,532.6 7.9% Police are grossly under staffed and 10-14 1,324.2 1,255.2 2,579.4 8.0% have limited training to deal with the epidemic of child maltreatment. 15-19 1,488.9 1,384.1 2,873.0 9.0% Hence we have poor outcomes in Population of 5,474.7 5,131.2 10,605.9 33.1% children and families which result in Children (Sub-Total) abuse, drugs, suicide, crime, etc. 20-24* 1,711.5 1,539.6 3,251.1 10.1% How do we Move Forwards Total (all ages including 16,561.1 15,488.6 32,049.7 100% as a Profession and adults) Society? Source: Department of Statistics, Malaysia 2018; Numbers in 1,000s. *The World Health Organization has recently increased the age of adolescence to encompass We have to develop both ‘Protection’ those aged 10-24 years. and ‘Prevention’ services. As medical pro fessionals we have traditionally Local Data on Violence to older men, and have a very high been better at offering support to a number of teenage pregnancies. We damaged child than at preventing against Children have many “looked after children” violence from occurring. Very (i.e. children in residential care) and few have ventured out into the Little progress has been made to deal still place adolescents in prison rather community to engage the issues and with violence against children locally. than remand or rehabilitation centres. we tend to wait in our hospitals and While we thankfully do not suffer from Some of these children suffer from clinics for problems to be identified wars or armed conflict, we have an chronic institutional abuse. It is also and brought to us. Some doctors even endemic maltreatment of children. important to remember that children fail in their duties to protect children Table 2 shows selected local data involved in crime, drugs, bullying, and under the Child Act. Those in private on violence against children. Child suicide are a sign of violence at home have a statutory duty to immediately abuse reports to the Department or in society. Our data on these areas report children in need of care and of Social Welfare in 2016 comprised is weak and grossly incomplete. The protection, while those in government 4,962 children. However data is grossly Global Youth Online Behaviour Survey, or university have to also act as incomplete due to underreporting Microsoft Corp. in 2012 showed that temporary protectors and take these and lack of cohesive data sharing 84% of all Malaysian students had children in custody. Failure to do so between agencies. Classifying child experienced bullying. constitutes an offence and a possible and adolescent sexual abuse as fine of up to RM 5,000 or imprisonment rape confuses the issue and limits While we would like to focus on for up to two years or both. Medical support. Three local published Malaysian children and families, I professionals should be more community prevalence studies would urge us to also remember proactive in working with Welfare on child sexual abuse shows rates stateless children, street children, and Police in offering protection to between 8-26% of all children (Amar children of immigrants and those in children when identified.

8 • BERITA MPA – FEB 2019 Update

Table 2: Local Data on Violence against Children

Issue Year Number Source & Notes Child Abuse Reports 2016 4,962 Department of Social Welfare 2016: 978 sexual, 565 physical, 1,314 neglect Rape reports to Police 2016 2,124 Royal Malaysian Police 2016: 0-12yrs 145, 13-15yrs 962, 16-18yrs 512, >18yrs 505 Data from community study on 2006 Physical 19% Choo et al, 2011 Society for Adolescent Health Adolescent Maltreatment 15-17yr Neglect 21% and Medicine olds (45% at least one maltreatment) Emotional 20% n = 1,870, , domestic violence 10%, Sexual 22% parental mental illness 2%, parental drug use 2% Data from community study on 2011 Physical 53% Ahmed et al 2015 PLoS ONE Adolescent Maltreatment 10-12yr Neglect 37% n = 3509 students, Selangor, 56% urban, 99.5% olds (67% at least one maltreatment) Emotional 21% living at home, unemployed fathers 4.7%, Teacher 29% parental conflict 13.5%, parental drug abuse 1.7% Run-Away/Missing Children 2013- 3,959 13-15yrs Parliamentary response 2017 (often sold into prostitution) 2016 3,333 16-18yrs Child Prostitution & Trafficking of Estimate 150 Tenaganita Report 2015 Children children forced into prostitution yearly Teenage Pregnancies 2015 18,847 Ministry of Health 2016 Child Marriages (girls <15 yrs) 2010 15,000 Department of Statistics Malaysia Looked After Children (Registered 2016 5,013 centres Department of Statistics Malaysia Care Centres; Govt, NGO, Private) 35,491 children Child in Prison 2008 9,000 Malaysia Prison Department report 2015 & UNICEF/Royal Malaysia Police 2013 Juveniles detained by police for 2016 4,886 Department of Social Welfare & Royal Malaysian involvement in crimes Police 2016 (31% related to drugs) Disciplinary cases with criminal 2017 6,917 Ministry of Education elements in schools Stateless Children (Street Children & 290,437 residing in Save the Children Australia 2017 Immigrants, Immigrant Camps) Malaysia (647 in detention camps in 2016)

Prevention is the way forwards but Evaluations of the KOSPEN and 1. Restricting ourselves to only harder to achieve. It has to involve ‘Doktor Muda’ programmes have meaningful work and set limits on an improvement in parenting abilities, shown almost no risk reduction and our work times (for those that work societal safety-nets for families and outcomes remain unchanged. There long hours). children in crisis, affirmative action is much work to be done to develop 2. Reduce children’s school work for the poor and immigrants, a effective programmes that involve pressures and volume. significant rise in basic wage, etc. This not just children but families. No single 3. Institute weekly screen-free-family- requires a strong and people focused agency or NGO can be effective times. government; perhaps now possible and all of civil society needs to get with a major change in the nation. involved. 4. Invest in relationship time and listen more to our children and spouse The Department of Social Welfare A Personal Way Forwards should be the lead agency to deal Finally as we work to support our with prevention programme but is On a personal note a real way nation’s children let us keep Article 12 unable due to major manpower, forwards must involve personal from the Convention on the Rights of professional expertise and resource change. We should not speak about the Child (UNCRC 1989) as our central limitations. This organisation requires saving the nation’s children when we guiding principle: a major revamp. Hence the Ministry are losing our own selves. Society has “In all actions considering of Heath has been the most active become increasingly immersed and children … agency in attempting to deal trapped in activities or work that is less with child maltreatment. MOH has than meaningful, at the expense of the best interest of the child shall excellent plans and I recommend a neglect of families and relationships. be a primary consideration.” 2 read of the 2015: National Adolescent Time to listen to each other is minimal Health Plan of Action 2015-2020 and the real bonds between families (available online). There are clear are poor even for the medical Amar-Singh HSS strategies to deal with sexual, mental professional. Key measures we could [email protected] health and risky taking behaviour. take include: However there is limited execution.

BERITA MPA – FEB 2019 • 9 Report

1ST Malaysia Marfan Syndrome Symposium 22 November 2018, Kuala Lumpur

This date marked a very quality of life. Dato’ Dr Fazir meaningful day for patients Bin Mohamad, the head of with Marfan syndrome (MS), Orthopedics Department as the very first Malaysian HKL, gave an astonishing talk Marfan syndrome support on skeletal abnormalities, network meeting was scoliosis, particularly on the successfully held in care and management of Paediatric Institute, Hospital these abnormalities. Kuala Lumpur (HKL). Participants present at the symposium Participants were back to The event was jointly the hall again after lunch organised by Paediatric break. Patients and family Cardiology Unit HKL and members of the Marfan the Malaysian Paediatric Association. syndrome network meeting As the organising committee, we joined the symposium, hope that this is a first baby step too, with queries in mind towards regular educational updates regarding the disease. on MS to both healthcare providers The challenge of the and the communities, and the Some of the many speakers for the day day after a heavy meal formation and establishment of a started by Dr Keng Wee formal Marfan syndrome support Teik, who is the Head of network or foundation. In keeping cardiac, eye and musculoskeletal Genetic Department HKL, with the with our main goal, we hope that this systems. topic on other issues in MS. He leads symposium would increase awareness an excellent team of doctors, who and improve further the knowledge Ophthalmological work closely with cardiology team, of healthcare providers in the in co-managing patient with MS. He understanding of MS, more in depth complications successfully captured the audience’s knowledge regarding the spectrum of We then moved on to our next attention with his talk. disease, thus enabling them to provide speaker, Dr Sunder Ramasamy, better services and management to who gave an eye-opening talk on the Subsequent talk by Prof Dr Thong their patients. Therefore, on this special ophthalmological manifestations and Meow Keong, who established and occasion, we are proud to be the host management of Marfan syndrome. headed the Genetics & Metabolism for the 1st Malaysia Marfan Syndrome He is the Consultant Paediatric Unit at the Department of Pediatrics, Symposium, too. Ophthalmologist at Tropicana Hospital, Faculty of Medicine, University of and HKL visiting consultant, with many Malaya since year 2000. He is also the A total of 57 medical personnel years of experience in managing current Vice-President of the Medical from various centres attended the MS patients. Genetics Society of Malaysia. He symposium. Distinguished speakers shared an impressive talk on genetic who are well known in managing MS The day continued after a short counseling issues in Marfan syndrome. patients were invited to give a talk on break with another talk by Dr Hung their respective specialty, including Liang Choo, with over 20 years of Lastly, we invited Ms Ng Yi Ming, a genetic, paediatric cardiology, experience in managing children and patient with Marfan syndrome, who is ophthalmology, cardiac surgery, as adolescents of Marfan syndrome with currently pursuing her PhD in Clinical well as orthopaedics. cardiac involvement. Psychology, to share her own life experience. She went through a roller- Not to miss the following figurative Event highlights coaster experience since diagnosed speaker, Dr Pau Kiew Kong, the Senior as Marfan syndrome, yet she is a Dr Hung Liang Choo, the Senior Consultant Cardiothoracic Surgeon in cheerful person. She gave a very Consultant Pediatrician and Pediatric National Heart Institute. He has done motivating speech to the audience. Cardiologist HKL, as well as the numerous cardiac surgeries. He has A great applause to her for being symposium Chairperson, welcomed many encounters with MS patients the speaker! all participants. with cardiac manifestations who needed surgeries. This turned out to be a fruitful We were honored to have Dr Chew symposium and we thank all speakers. Hui Bein, the Consultant Paediatrician Musculoskeletal system We look forward to more in the future. and Clinical Geneticist HKL, to start 2 the talk with a good introduction As Marfan syndrome is often associated with the musculoskeletal on Marfan syndrome, its genetics system, it is crucial to know its Thay Wee Ying and diagnostic Ghent criteria. The 3 [email protected] main complications in MS involve the management and hence improve the

10 • BERITA MPA – FEB 2019 Report 1st Malaysian Marfan Support Network Meeting 22 November 2018, Kuala Lumpur

The First Malaysian Marfan Support The meeting was chaired by Dr a Marfan Support Group using social Network Meeting was held Hung Liang Choo and Dr Chew media in order to keep each other concurrently with the 1st Malaysia Hui Bein. It began with icebreaking updated from time to time. Marfan Syndrome Symposium on 22 and getting to know each other, November 2018 at Institut Pediatrik, followed by sharing of experience This network meeting brought many Hospital Kuala Lumpur (IPHKL). It was as a patient or family who are families with Marfan syndrome jointly organised by the Paediatric living with Marfan syndrome. together, created more awareness Cardiology Unit IPHKL, with the Consultants from other department among the practitioners and the Malaysian Paediatric Association. such as Dr Sunder Ramasamy communities regarding Marfan (Ophthalmologist), Dato’ Dr Fazir syndrome. This marks the end of the A total of 33 participants from (Orthopaedic Surgeon), Dr Pau year 2018, we wish that there will be 7 families with at least a family Kiew Kong (Cardiothoracic more to come in the coming years. member with Marfan syndrome, Surgeon), Prof Dr Thong Meow 2 attended the meeting. They came Keong (Paediatric Geneticist) from various institutes such as IPHKL, were invited to answer parents’ or Lee Jia Ni IJN, PPUM, and Prince Court Medical patients’ questions. [email protected] Centre. Some of the family members even travelled from , Tears & laughter Kelantan, and Singapore There were tears and laughter during in order to know more about their the sharing session. By the end of inheritable illness and provide the session, they were motivated to support to their affected family support each other to overcome members. their fears. They decided to organise

A 31-year-old lady, pursuing her PhD in Psychology shared her touching experience on her journey as a patient with Marfan Syndrome Dr Hung and Dr Chew leading the ice breaking session

Group photo Dato Dr Fazir sharing on spine care for patients with scoliosis Parent sharing on the care of family with Marfan syndrome

BERITA MPA – FEB 2019 • 11 Report YDSG PPUKM Diabetes Camp 2018 10 December 2018, Kuantan

10 December 2018 marked the sessions focused on food Talentime too beginning of most Malaysian groups, carbohydrate counting, The camp ended with the children’s favourite time of the year – hypoglycaemia management, sick participants showing off their school holidays! For a special group day management, and diabetic various talents during talentime. The of children and adolescents, there ketoacidosis. The sessions were audience were treated to four very was something extra to look forward facilitated by doctors, diabetic creative performances, including to. It was time once again, for the educators and nutritionists. Two parodies of the fairy tale Hansel Young Diabetic Support Group clinical psychologists from PPUKM and Gretel, and the movie Frozen. (YDSG) of PPUKM (Pusat Perubatan – Ms Melia and Dr Yang Wai Wai There was also a Korean pop dance UKM) to organise their annual – led the adolescents in sessions and a creative sketch showcasing diabetes camp. with a slightly different focus. They some surprising acting talents. Being worked on psychological issues judged the best act, the youngest This year, the camp was held at Bukit faced by these adolescents who group comprising of 7 to 10-year-olds Gambang Resort City, Kuantan, are living with diabetes. There walked away with first prize. Pahang. A total of 35 children were also sessions facilitated by with Type 1 and Type 2 diabetes diabetes educators and nutritionists, It is always endearing to see how mellitus, aged between 7 and 19 whereby participants fine-tuned the children and adolescents years, attended the camp. They their knowledge of carbohydrate interact during the camp, how the were accompanied by 26 adult counting and reading labels with older ones would watch over the facilitators including endocrinologists, hands-on activities. younger ones and cheer them on in paediatricians, nurses, educators, various activities. Old friendships are nutritionists, clinical psychologists Prizes for best glucose renewed, and new friendships are and helpers from the medical formed. Everyone went home with industries. The excitement was heavy levels invaluable experiences and priceless in the air as participants and their Each meal time was preceded by memories, already looking forward parents mingled with each other on a mini clinic and all blood glucose to the next camp. registration morning. readings were recorded. The participants learnt to adjust their The PPUKM Diabetes Camp 2018 was insulin doses according to their Blood glucose before held with the support of Malaysian blood glucose readings and food Paediatric Association (MPA), lunch! portions. It was not all teaching Malaysian Endocrine and Metabolic The 3-day 2-night camp kicked off and learning for these children and Society (MEMS), Rahmat Lim & with an ice-breaking session upon adolescents. They had allocated Partners, McDonald’s Malaysia, arrival at the resort. This gave the time at the swimming pool, by far Nestle Sdn Bhd, UKM Kesihatan Sdn participants the opportunity to the favourite physical activity of Bhd, Abbott Diabetes Care (M) Sdn get to know each other through the younger children. Mornings Bhd, Johnson & Johnson Medical laughter and fun. After a mini clinic began with exercise sessions. There Malaysia, Medtronic International session whereby all participants had was also a telematch session. The Limited, Roche (M) Sdn Bhd, and their blood glucose checked and participants learned how their blood Sanofi (M) Sdn Bhd. 2 recorded, they adjourned for lunch. glucose changed with the different There was a flurry of activity as the activities they took part in, and older participants confidently did most importantly how to manage Joyce Hong Soo Synn & their carbohydrate counting and them to prevent wide fluctuations in Wu Loo Ling tucked in after their insulin injections, blood glucose levels and nocturnal [email protected] while the facilitators went round hypoglycaemia. Needless to say, [email protected] helping the younger ones. prizes were given out for these events and to individuals with the The participants were divided best glucose control throughout the into groups according to age duration of the camp. for teaching sessions. These

Arriving at Bukit Gambang Resort City

Group photo Group discussion

12 • BERITA MPA – FEB 2019

Report

Opening remarks by Dato’ Dr Siti Sabzah Group photo of committee members with parents and Hear Me members

Parents’ session with NGO Hear Me Attentive audience Paediatric Hearing Loss Course 18 December 2018, Alor Setar The Otorhinolaryngology Hear Me Pathologist); and last session of Department of Hospital Sultanah case discussion moderated by We were very pleased that the Bahiyah (HSB) in collaboration with Dr Izny Hafiz (Otologist) and course also was joined by an NGO, Malaysian Paediatric Association Dr Abdul Hadi. Hear Me. Hear Me is an organisation (MPA) and Kedah State Health formed by a group of parents with Department has successfully Overall all participants showed hearing disabled children. This organised the Paediatric Hearing good participation and enthusiasm. NGO mainly helps in approaching Loss: Intervening Issue of Early They were actively involved during parents by providing information, detection – Hearing and Speech the case discussion session. Parents sharing experiences, and guiding Intervention Course which was held also participated in the discussion parents in managing their hearing at Auditorium Hospital Sultanah support group session with Hear Me. impaired children. Bahiyah. The session also managed to set up parents support group (Hear Me) The course started with opening Objectives of the course are to with representative from parents of remarks by Dr N Thiyagar (Head create awareness regarding the northern region. We are thankful to Department of Pediatric, HSB) and importance of early intervention in our organising committee especially Dato’ Dr Siti Sabzah Hashim (Head paediatric population with regard the Audiology Unit, ORL Department of Service ORL, Ministry of Health). to speech and hearing and also to for their hard work to make The topics covered included, emphasise the role of educators this course possible. This course Anatomy and Physiology of Hearing: and parents in early rehabilitation concluded the continuous medical What can be done at primary care and intervention. This course also education of ORL Department by Dr Hafizah Husna (Specialist aims to address practical approach HSB for 2018 and we hope this ORL); Transdisciplinary Approach on issue of hearing aid usage and last course in collaboration with in Early Intervention by Dato’ Dr home based programme (HBP). Malaysian Paediatric Association Siti Sabzah; Newborn hearing was of benefit to all parties involved screening: Who and How to Start The course was successfully in management of paediatric by Madam Norasuzi (Audiologist attended by total number of 125 hearing loss in the northern region HSB); Early Hearing: Detection & participants including 58 Medical with the objective of achieving Intervention The Role of Primary Officers and House Officer, 46 early detection and intervention for Care by Madam Alia Nadiha Alias paramedics from Hospital Sultanah these children. 2 (Audiologist HSB); Impact of Hearing Bahiyah, Klinik Kesihatan, other Loss for Speech and Language government hospitals and also Development by Madam Norbaiti 21 parents. Thiyagar Nadarajaw Mohamad Adli (Speech Language [email protected]

BERITA MPA – FEB 2019 • 13 Announcements

Local Venues

8th ASEAPS Congress 2019 7th Annual Elite Pediatric GI Congress Organised by Malaysian Association for the Date : 3-4 April 2019 Study of Pain Venue : Abu Dhabi, UAE Date : 11-14 April 2019 Email : [email protected], george@ Venue : Pullman , Sarawak promedme.com Tel : 03 2276 0555 Website : https://www.elitepeds.com/ Fax : 03 6207 6795 Email : [email protected] Website : http://www.aseaps2019.com World Congress on Paediatric and Neonatology 2019

th Date : 25-26 April 2019 15 Asian Oceanian Congress of Child Venue : Valencia, Spain Neurology (AOCCN) in conjunction with Email : pediatricscongree@ the 41st Malaysian Paediatric Association ologymavensmeeting.com Annual Congress 2019 [email protected] ‘Synergy to Challenge Boundaries in [email protected] Child Neurology’ Website : http://www.ologymavens.com/cme/ Date : September 19-22, 2019 pediatrics/pediatrics-neonatology- Venue : Shangri-La Hotel, Kuala Lumpur conferences Tel : 603- 7931 2131 Fax : 603- 7932 2132 Website : www.aoccn2019.com 27th Inter-American Congress of Cardiology Email : [email protected] Date : 15-18 May 2019 Venue : Punta Cana Convention Centre, 2019 - International Paediatric Events Dominican Republic Website : http://congresosiacrd2019.org/ 29th International Pediatric Association (IPA) Email : [email protected] Congress 2019 Date : 17-21 March 2019 2nd International Congress of Hypertension Venue : Atlapa Convention Centre, Panama in Children & Adolescents (ICHCA) City, Central America Date : 24-26 May 2019 Email : [email protected] Venue : Warsaw, Poland Website : https://www.ipa2019congress.com/ Email : [email protected] Website : http://htpaediatrics.com/ 2019 First Steps in Neonatal Brain Ultrasound: An Amazing, 52nd Annual Meeting of the European Adventurous Journey Society for Pediatric, Gastroenterology, Date : 18 March 2019 Hepatology and Nutrition (ESPGHAN) 2019 Venue : Palazzo Ricasoli Polihotels, Florence, Italy Date : 5-8 June 2019 Email : [email protected] Venue : Scottish Event Campus, Glasgow, UK Website : https://www.bapm.org/events/ Email : [email protected] Website : https://www.espghancongress.org 2019 Neonatal Ultrasound Course Why, How and When an Ultrasound Image? European Society of Paediatrics and Date : 19-22 March 2019 Venue : Palazzo Ricasoli Polihotels, Florence, Neonatal Intensive Care (ESPNIC) Dates : 18-21 June 2019 Italy Venue : Salzburg, Austria Email : [email protected] Email : [email protected] Website : aimgroupinternational.com/2019/ Website : https://espnic2019.kenes.com/ ultrasound

28th World Neonatal Pediatrics and Family New Life Members New Ordinary Members Medicine Conference Khoo Chai Soon (1148) Nurul Zamil Mohd Muzzamil Date : 21-22 March 2019 Khoo Hui Lynn (1151) Chin Sheau Yin Lee Wai Quen (1153) Norashikin Mohd Ranai Venue : Dubai, UAE Teng Lip Yuen (1154) Mohd Azri Zainal Abidin Email : [email protected] Thong Siew Peng (1155) Website : http://neonatal.pediatricsconferences. com

14 • BERITA MPA – FEB 2019 BERITA MPA – FEB 2019 • 15