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Friday, July 20, 2012

Prevalence of Hypertension, Diabetes Mellitus and Metabolic Syndrome among Orang Asli : Comparison Between Rural and Urban Orang Asli


The Orang Asli (OA) is the indigenous people of Peninsular Malaysia. Majority of the OA still lived in remote and rural areas but over the past three decades, many had to undergo relocation programs when their inhabited land and the land where they hunt and grow their crops were acquired by the state authority for new development. They are given new houses with amenities, special schools for the children, free health care services and various programs implemented to ensure employment and improvement in their quality life. The Department of OA Affairs (JHEOA) was established to look after the socioeconomic well-being of these indigenous populations.

There have been many health survey and studies conducted on the OA but the focus has been mainly on communicable disease and nutritional status. While problems such as intestinal parasitic infections, anaemia, and malnutrition still persist, adoption of urbanized lifestyle and unhealthy dietary habits have resulted in increasing number of OA affected with lifestyle-associated chronic diseases such as hypertension, diabetes mellitus and metabolic syndromes. A study conducted in 1993 reported the crude prevalence rate of diabetes mellitus and impaired glucose tolerance among the OA in resettlement areas (10.7%) compared to those who stayed in rural areas (3.3%) are significantly higher. In another study, it was also shown that overweight and obesity were also prevalent especially among the female OA.

Therefore, the objective of this study is to determine the current status of diabetes mellitus, hypertension and metabolic syndrome among these two different indigenous population areas.

Literature Review

Demographic shows Orang Asli (OA) are the indigenous inhabitants of Peninsular Malaysia. They constitute a minority group making up approximately 0.6% of the total population (22.2 million In 2000).In 2000 according to department of statistic census recorded 132,486 Orang Asli population while from department of Orang Asli Affair , JHEOA recorded in 2004 the population are 149,723.[3]

Basically Orang Asli officially classified into 3 main ethno-linguistic group, and each group have their own sub group and usually found in certain area only. The three major groups are Senoi, Proto Malay (Aboroginal Malay), Negrito. While under all these major group there are 19 sub group for example semai, temiar, jakun, Temuan,Bateq,and Jahai.

In the era of globalisation, Orang Asli are not left behind and affected through these changes especially in their rural-urban distribution, socio-economic, and health care. There are gradual shifts in the rural-urban distribution of Orang Asli in Peninsular Malaysia since 1970. The 1991 census showed that the majority of Orang Asli lived in rural area (88.7%), small towns (2.4%) and small percentage in urban areas [9] but by 2000, 11.3% of Orang Asli had settled in urban areas.[10]

The socio-economic status of the Orang Asli is addressed here with respect to poverty, education achievement, employment status, housing, and basic amenities (electricity, toilet facility, and water supply). It was a benchmark to measure the progress of development on the livelihood and living conditions of the Orang Asli.[5]

In health care the policies of JHEOA towards Orang Asli are “To create an individual, family and community of Orang Asli who are healthy and productive by health system that is fair, easily accessible, disciplined and adaptive to change in response to environment and customer is expectation with every level besides encouraging individual responsibility and social participation towards improving the quality of life”. So this make us called to see how far this health care system meet the objective.[10]

Diabetes mellitus been a major global public health problem, and the incidence are keep increasing year by year. In Malaysia, the prevalence of diabetes mellitus among adults of age ≥30 years increase from 8.2% in 1996 to 14.9% in the 2006 National Health Morbidity Survey (NHMS). All these survey shows higher among people in urban and socioeconomically disadvantaged.[2]

World Health organization (WHO) quotes that hypertension is where the blood pressure is the force of blood against the artery walls as it circulates through the body. High blood pressure or hypertension is the constant pumping of blood through blood vessels with excessive force. To determine hypertension one should be measured with systolic ≥140 mmHg and diastolic ≥90mmHg in three time taken about two hours apart.[8]

Metabolic Syndrome is the name for a group of risk factors that raises the risk for heart disease , and other health problem such diabetes and stroke. The international diabetes Federation (IDF) consensus definition for metabolic syndrome identified central adiposity (waist circumferential) as as essential component for the diagnosis. A south asian would be diagnosed with metabolic syndrome if the waist circumferential is ≥85.0 cm for male and ≥80.0cm for female.[4]


1. Report of WHO and IDF (International Diabetes Federation) consultation. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia

2. Institute of Public Health, Ministry of Health, Malaysia. The Third National Health survey of Morbidity Survey (NHMS III), Diabetes Mellitus 1996 and 2006.

3. Department of Sustainable Development and Healthy Environment, WHO. Hypertension fact sheet, September 2011.

4. Wan Nazaimoon, Wan Mohamud, and M Suraimi; Cardiovascular, Diabetes and Nutrition Research Centre, Institute for Medical Research (IMR). Prevalence of diabetes, impaired fasting glucose and metabolic syndrome among female Orang Asli community in Peninsular Malaysia, October 2010.

5. Geok Lin Khor and Zalilah Mohd Shariff; Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, UPM. The ecology of Health and Nutrition of Orang Asli (Indigenous People) Women and children in Peninsular Malaysia

6. Lim YAL, Romano, Colin N, Chow SC and Smith HV; Department of parasitology, Faculty of Medicine UM. Intestinal parasitic infections amongst Orang Asli (indigenous) in Malaysia. Has socioeconomic development alleviated the problem?

7. NM AMal, R Paramesaravathy, GH Tee, K Gurpeet, C Karuthan; Medical Resource Centre, Institute for Medical Research, Malaysia. Prevalence of Chronic Illness and Health Seeking Behaviour in Malaysian population : Results from Third National Health Morbidity Survey (NHMSIII) 2006.

8. TO Lim, Z Morad ; Clinical Research Centre, Kuala Lumpur Hospital. Prevalence, Awareness, Treatment and Control of Hypertension in the Malaysian adult population : Results from the National Health and Morbidity Survey 1996.

9. Department of Statistic

10. Department of Orang Asli Affairs (JAKOA)

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