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马来西亚霹雳州本土儿童成长管理面临的挑战:一项定性研究。

The challenges in managing the growth of indigenous children in Perak State, Malaysia: A qualitative study.

机构信息

Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia.

Institute for Health Systems Research, Ministry of Health, Ipoh, Malaysia.

出版信息

PLoS One. 2022 Mar 23;17(3):e0265917. doi: 10.1371/journal.pone.0265917. eCollection 2022.

Abstract

Indigenous peoples in Peninsular Malaysia, known as Orang Asli, have been associated with the problem of malnutrition. Approximately 40% of their children are underweight. Indigenous peoples' distinct social, cultural, and economic traits, which differ from those of the dominant communities in which they live, may pose significant challenges for health care providers (HCPs) in addressing the malnutrition issue. This study explores challenges encountered by HCPs, with at least six months of experience in monitoring the growth parameters of Orang Asli children residing in Perak State in Peninsular Malaysia. A cross-sectional study was conducted between December 2020 and June 2021, involving three focus group discussions and three in-depth interviews. Thematic analysis was used. A total of 19 participants (6 nurses, 5 nursing managers, 4 medical officers, 2 nutritionists, a family medicine specialist, and a paediatrician) took part in this study. The challenges were summarized into four themes: (I) accessibility to nutrition, (II) accessibility to healthcare services, (II) skills of HCPs, and (IV) challenges of implementing nutrition programs. The inability of the Orang Asli children to access nutritious food was due to poverty, different perceptions of life priorities, and the practice of food taboos among the communities. Inadequate infrastructure and transportation discourage parents from bringing their children to healthcare facilities. The belief in and preference for traditional healing, the practice of semi-nomadic lifestyles, and fear of HCPs and their timid nature were factors that prevented Orang Asli children from accessing healthcare services. HCPs need to equip themselves with cross-cultural communication and interaction skills and adapt their skills to environmental challenges to overcome unexpected encounters in mobile clinics. The non-exposed food items, the risk of food basket sharing with other family members, and community feeding programs' coordination were the challenges to be addressed when implementing nutrition programmes for Orang Asli children. The challenges of HCPs are multifactorial and require a multifaceted approach. There is a need for joint efforts of stakeholders, from communities and non-governmental organisations (NGOs) to the health authorities, to address the challenges of HCPs.

摘要

马来西亚半岛的原著民,被称为 Orang Asli,一直与营养不良问题有关。他们大约有 40%的儿童体重不足。原著民独特的社会、文化和经济特征与他们所居住的主流社区不同,这可能给医疗保健提供者(HCP)在解决营养不良问题方面带来重大挑战。本研究探讨了 HCP 在监测居住在马来西亚半岛霹雳州的 Orang Asli 儿童生长参数方面至少有六个月经验时所遇到的挑战。这是一项在 2020 年 12 月至 2021 年 6 月期间进行的横断面研究,涉及三个焦点小组讨论和三个深入访谈。使用了主题分析。共有 19 名参与者(6 名护士、5 名护理经理、4 名医生、2 名营养师、1 名家庭医学专家和 1 名儿科医生)参加了这项研究。这些挑战总结为四个主题:(一)获取营养的机会;(二)获取医疗保健服务的机会;(三)HCP 的技能;以及(四)实施营养计划的挑战。Orang Asli 儿童无法获得营养食品是由于贫困、对生活优先事项的不同看法以及社区中的食物禁忌实践。基础设施和交通不足阻碍了父母带孩子去医疗机构。对传统治疗的信仰和偏好、半游牧生活方式的实践以及对 HCP 的恐惧和他们的胆怯性格是阻止 Orang Asli 儿童获得医疗服务的因素。HCP 需要具备跨文化沟通和互动技能,并根据环境挑战调整技能,以克服流动诊所中的意外情况。在为 Orang Asli 儿童实施营养计划时,需要解决非暴露食品项目、与其他家庭成员分享食物篮子的风险以及社区喂养计划的协调等挑战。HCP 的挑战是多方面的,需要采取多方面的方法。需要利益相关者,包括社区和非政府组织(NGO)以及卫生当局共同努力,解决 HCP 的挑战。

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