Volume 10
Number 4
April 2019
XVI
200.
Female Sex Worker Behaviour against the Risk of HIV and AIDS Transmission in Ambon City ......... 1084
Kalmia, H.M. Rusli Ngatimin, Muhammad Rachmat
201.
Relationship between Supplementary Minnesota Multiphasic Personality Inventory (MMPI) test toward
Competency and Intranatal Care Services among Midwifery Students in Tanawali Persada Health Science
School, Takalar Regency ......................................................................................................................... 1089
Lince Renden, Budu, Werna Nontji
202.
Knowledge, Awareness and Perception of Malaysian University Students on Regenerative Medicine and
Willingness to Accept and Pay for Regenerative Medicine Therapies .................................................... 1098
Ramachandren K, Tan Ess, Tan CK, Thiagarajah S
203.
Menopausal Symptoms and Menopausal Quality of Life during Transitional Period among Military
Wives ........................................................................................................................................................ 1104
Nur H.S., C.K. Tan, Normina A.B., M.S. Seghayat, F. Amini, Thiagarajah S., E.S.S. Tan
204.
Tuberculosis: A Complication after Hematopoietic Stem Cell Therapy (HSCT) and Bone Marrow
Transplant ................................................................................................................................................. 1110
Rafidah Binti Baharudin, Marjan Sadat Seghayat, Farahnaz Amini
205.
Public Perspective and Engagement in Cognitive- Stimulation Activity to Preserve Cognitive Reserve
among Seniors in Malaysia - A Pilot Study .............................................................................................. 1115
Melisa A.S., Normina A.B., E.S.S. Tan, M.S. Seghayat
206.
Quality of Life in Adults with Androgenic Alopecia ................................................................................ 1120
Lim Wan Chyi, Eugenie Sin Sing Tan, Chew Kek Lee, Navedur Rehman, Loh Wei Chao,
Tan Chung Keat
207.
Factors Associated with Beliefs and Attitudes in Organic Food Purchase among Adults in
Klang Valley ............................................................................................................................................ 1126
Lee Keat Yan, Kavita Chirara
208.
Assessment of Knowledge, Attitude and Practice of Malaysian Women towards Cervical Cancer
Vaccination .............................................................................................................................................. 1132
Mohammad Arief, LohJia Ying
209.
Body Dissatisfaction and Risk of Eating Disorder among UCSI University Non-Science
Field Students .......................................................................................................................................... 1139
Joyce Tan Xi Jie, Shashikala Sivapathy
210.
Knowledge, Awareness and Perception of Healthcare Personnel Based on Employment Level towards Stem
Cells in Pahang ......................................................................................................................................... 1144
Abu Mansor Noor Azizah, Ahmad Bustami Normina, Marjan Sadat Seghayat, Chung Keat Tan,
Eugenie Sin Sing Tan, Farahnaz Amini, Sharmanee Thiagarajah
211.
Emotional Intelligence As A Mediator Between Personality and Happiness Among Adolescents
in Malaysia ............................................................................................................................................... 1150
Sim MS, Mohtaram R
212.
Chronic Kidney Disease-Mineral and Bone Disorders Laboratory Profiles in Chronic Haemodialysis
Patients .................................................................................................................................................... 1156
Djoko Santoso, Nirapambudi Devianto, Pranawa, Moh. Yogiantoro
XVII
227.
Study on Heart Rate Visualisation Using Combination of Real Time Heart Rate Detection and Augmented
Reality ....................................................................................................................................................... 1236
Norazlin Mohammed, Junaidah Binti Idrus
228.
Protective Effect of Various Lyoprotectant on the Survival of Antineoplastic Drug Producing Serratia
Marcescens ............................................................................................................................................... 1243
Kavitha.R, Damodharan.N
229.
Comparison between Dry Needling Versus Kinesio Taping in Patients with Tennis Elbow .................... 1250
K.Guru Karthick, D.Malarvizhi, Komal Bhagat
230.
Effect of Incentive Spirometry and Balloon Exercises to Improve Pulmonary Function for
Type 2 Diabetes ........................................................................................................................................ 1254
D Malarvizhi, Geetha Anandakrishnan
231.
Design and Implementation of Health Care Video Monitoring System based on RTOS ........................ 1260
B.Raja, Ayesha Firdous, A. MohammedIshak, M. Anand
232.
Artificial Voice for Speechless .................................................................................................................. 1266
K.S.Thivya, M.Anand
233.
Comparative Analysis of Automated Applications using Fetal Ultrasound Images ................................ 1271
Bahbibi Rahmatullah
234.
An Analysis on Social Support and Community Commitment in the Investigation of New Cases of Smear
Positive Pulmonary TB in the Work Area of Donggala Health Centre, Donggala Regency,
Central Sulawesi ....................................................................................................................................... 1277
Miradiantri Tule, Muh. Syafar, Alimin Maidin
235.
Healthy Life Pattern Behind Related To the Movement ProgramFirst 1000 Days of Life in Gowa Regency
of South Sulawesi Province ..................................................................................................................... 1284
Muh Zaifullah, Ridwan M. Thaha, Suriah
236.
Awareness, Knowledge and Attitude towards Nutrigenomics among Health Care Workers in Indonesia: A
Preliminary Exploration ............................................................................................................................ 1289
Widyawaty N, Tan C.K, Tan E.S.S, Seghayat M.S, Normina A.B
237.
Consumption of Malay Herbal Medicine (MHMs) During Pregnancy and Postpartum ......................... 1296
Normina A.B., Noradhiah T., Y.B. Ho, C.K. Tan1, M.S. Seghayat, Mirnalini Kandiah,
A.Z. Aris, E.S.S. Tan1
238.
Social Demand and Future Prospective of ‘Anti –Aging Medicine among Malaysians .......................... 1302
Ng CY, Seghayat MS, Tan ESS, Tan CK Amini F, Thiagarajah S, Sharma D, Normina AB
239.
Predicts the Successfulness of a Trial Voiding without Catheter (TWOC) through Urine Retention Volume,
Detrusor Wall Thickness (DWT) and Intravesical Protrusion of Prostate (IPP) on Acute Urinary Retention
(AUR) Patients Due to Benign Prosotatic Hyperplasia (BPH) ................................................................ 1308
Dian Kurniasari, Budiono, Tarmono, Hardjowijoto, Soetojo
240.
Effectiveness of Virtual Reality Using PS4 Gaming Technology in Stroke Rehabilitation for Improving
Upper Limb Function- A Pilot Study ....................................................................................................... 1315
Suresh J, Harish C
DOI Number: 10.5958/0976-5506.2019.00856.8
Knowledge, Awareness and Perception of Malaysian University
Students on Regenerative Medicine and Willingness to Accept
and Pay for Regenerative Medicine Therapies
Ramachandren K1, Tan Ess1, Tan CK1, Thiagarajah S1
School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, Faculty of Medicine and Health Science,
UCSI University, 56000 Cheras, Kuala Lumpur, Malaysia
1,
Abstract
Regenerative Medicine (RM) is an interdisciplinary field with countless potentials and serves as a solution
for the growing rate chronic diseases, communicable and non-communicable diseases in developing
countries. For the past 23 years, Malaysia has been exploring this field for the boon RM holds.This study
aimed to determine the level of knowledge, awareness and perception of Malaysian university students on
Regenerative Medicine. A cross sectional, quantitative pilot study was conducted among 390 Malaysian
university students above 18-year-old from government and private universities with science background
through convenient sampling. Key results showed that Medical and health science students had more
awareness and higher knowledge on RM than engineering and physical science students (p<0.001).
Significant association between the types of course enrolled and awareness/knowledge on RM observed
(p<0.05).There were significant associations between the level of knowledge and the awareness, willingness
to accept and pay for RM therapies/courses (p<0.05). Other demographics did not influence their level of
knowledge. Significant association seen between WTP and acceptability of Embryonic stem cell research
(ESCR) p<0.05.Students with moderate to good level of knowledge have more awareness, more supportive
and showed positive perception towards RM.
Keywords: Regenerative medicine; awareness; knowledge; perception
Introduction
Regenerative Medicine (RM) has been evolving
gradually in Malaysia for the past 23 years. This is
evident from the established centres for Haematopoietic
Stem Cell Transplant (HSCT) in a number of
government and private hospitals such as Institute of
Paediatrics in Hospital Kuala Lumpur in 1994, Subang
Jaya Medical Centre in 1994, Hospital University
Kebangsaan Malaysia in 1999. Stem cell therapy
one of the major component in RM is considered as
a great breakthrough in the paradigm of medicine1,2.
Exploration of RM holds the key to solve many growing
chronic diseases, infectious diseases and other noncommunicable diseases in developing countries3.
Corresponding author:
Tan Ess
E-mail: eugenietan@ucsiuniversity.edu.my
University Kebangsaan Malaysia has come out with My
Derm, an autologous skin product4. Tissue-engineered
autologous bladder is been used for patients needing
cystoplasty5. Numerous RM clinical trials going on
which have successfully produced successful therapies
that have benefited the developed countries6-8 countries
like Japan, Korea and United States the advancement
in RM is astounding9.There are substantial evidence
supporting the benefits of RM in health and wealth of
a nation10. In line to this, Malaysia should explore more
in RM and by evaluating the knowledge, awareness and
perception among the Malaysian university students
will contribute to this exploration. Approximately 3%
of the Malaysia’s population are students pursuing
tertiary education according to National Education
Statistic Ministry of Higher Education 2015. However,
lack of awareness among the Malaysian students on the
potential of RM therapies this will impact the health
management in future. Hence, interest in RM need to
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
be instilled among Malaysian youngsters. Besides,
education being significant in economic growth and
national development, it can be an ideal and powerful
tool to create awareness and knowledge related to
RM among Malaysian tertiary students. As science
and technology is expanding in all fields especially in
medicine, our students need to be equally aligned with
the growth and aware of global development. In order
to assist the growth of RM in Malaysia, a pilot study
has been conducted to assess the students’ knowledge,
awareness and perception in RM.
Methodology
Regenerative Medicine (RM) has been evolving
gradually in Malaysia for the past 23 years. This is
evident from the established centres for Haematopoietic
Stem Cell Transplant (HSCT) in a number of government
and private hospitals such as Institute of Paediatrics in
Hospital Kuala Lumpur.
Study Design
This study was designed as a questionnaire based
quantitative study. It was calculated that 384 candidates
were required to achieve 95% confidence level and
confidence interval of 5% based on SPSS. Informed
consents were obtained prior to the distribution of
questionnaire. The researcher designed the questionnaire
by sourcing from indexed journals, books and reports
on RM and vetted by subject supervisor and lecturers
from Faculty of Medicine Health and Science (FMHS)
in UCSI.
Study Population
A sample size of 390 respondents from Klang Valley
with science background were targeted. Only Malaysian
undergraduate and postgraduate students from both
private and government universities with age range of
18-55-year-old were recruited. Both gender whom were
English literate were accepted for the study. Students
from within and outside the premise recruited with the
permission of the Deans of the universities.
Questionnaires
The self-administered instrumentation tool used
1099
in this survey was formulated based on the literature,
journals, reference book, report from reliable sources
reviewed on various topics related to regenerative
medicine’s components including stem cells, tissue
engineering and molecular and genetics with their
current therapies and future directions of RM11-13.
The questionnaire comprises 5 sections: Section ADemographics- 12 questions, Section B-Awareness on
RM-10 questions, Section C- Knowledge on RM -10
questions, Section D- Perception on RM-12 questions and
Section E- Willingness to accept, pay and contribute for
RM based therapies, courses and research-8 questions.
A combination of dichotomized and trichotomized
responses, Likert scale were used to collect data from
participants.
Ethical Clearance: Ethical approval was granted
from the UCSI ethical committee (Proj-FMHSEC-2016-519). Written informed consent was obtained
from each recruited respondent.
Data Analysis
All data collected via this study was analysed
using the Statistical Package for the Social Sciences
(SPSS) version 20. Content validity of the questionnaire
was done by conducting a pre-test of the instrument
in a small group of university students. Descriptive
analysis was used to describe the levels of awareness,
knowledge, and perception of the participant groups.
Comparison between groups according to their answers
and socio-demographics characteristics. Significance for
all statistical measures was determined at the p value <
0.05 level.
Result and Discussion
Knowledge among
Regenerative Medicine
University
Students
on
Level of knowledge on RM was determined
through participants’ familiarity with the definition
of regenerative medicine, the branches of RM, the
disciplines that consider RM application as important as
shown in Table 1.
1100
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Table 1. Analysis on knowledge Questions
Questions
Yes
n (%)
No
n (%)
Not sure
n (%)
Types of stem cells (ESC, ASC, iPs)
98 (32.7)
111 (37.0)
91 (30.3)
Role of adult stem cells in the body
171 (57.0)
59 (19.7)
70 (23.3)
Formation of iPs
84 (28.0)
117(39.0)
99(33.0)
Potentials of stem cells in myocardial infarction
84 (28.0)
111(37.0)
105(35.0)
Stem cells as a mode of treatment for diabetes and leukaemia
122 (40.7)
44(14.7)
134(44.7)
Collecting umbilical cord blood stem cells is pain-free and
has no side effects
133 (44.3)
68(22.7)
99(33.0)
Awareness among
Regenerative Medicine
University
Students
on
Only 38.3% of respondents have heard of the
term ‘Regenerative Medicine’ and 61.7% have not
heard of this before. Among the 38.3%, students from
health science were (n=66, 38.6%), Engineering and
physical science students (n=25, 30.9%) and medical
(n=24, 50%). Besides that, (n=88, 44.4%) government
university students were more familiar with RM
term than private university students (n=27, 26.5%)
(p<0.05). This could be because of active involvement
of government universities in stem cell research which
is evident through higher number of scientific papers
published14,15. However, there is limited information
available on the knowledge, awareness and perception
on stem cells among Malaysian medical students16.
Participants in general, obtained this awareness from a
variety of source. It is not surprising that majority of the
respondents heard of RM through mass media as this is
the easiest and fastest route to disseminate information.
The public are able to obtain information easily through
the media and internet17.
Perception among
Regenerative Medicine
University
Students
on
A total of n=229 (76.3%) of respondents agreed to
support regenerative medicine, n=66 (22%) were ‘not
sure’ whether they would support and only n=5(1.7%)
denied to support RM in Malaysia . Total of 70%
male and female respondents agreed to support RM
in Malaysia. Respondents in the age range of 18-31
years showed better support than middle age group
because most of the respondents in this age group are
in health-related courses. Based on the data analysis,
undergraduate (n=182 ,73.1%) and postgraduate (n=47,
92.2%)(p<0.01). Students from government universities,
79.8% and 69.6% private university students supported
RM. Higher support received from health-based
students (81.3%) than engineering-based students
(63.0%) (p<0.01).When the respondents’ perception
on the estimated duration needed for RM to grow
in Malaysia explored, 65% respondents commented
that RM would be successful in 10 years and 26% of
them felt the growth would take about 20 years. RM is
growing exponentially in Asia-Pacific region especially
in India and China9. Moreover, one third respondents
chose Government Funding and Support, Research,
Regulatory environment, Legislative constraints,
Investors and Public awareness as determinant of RM’s
success. Public awareness is one of the influencing
factors which would influence the growth of any field18.
Willingness to Accept and Pay for Regenerative
Medicine Therapies/Seminars
Based Table 2, the study conducted, 62% respondents
were willing to accept RM therapies but only 56%
were willing to pay for therapies. The remaining 38%
respondents who were not willing to accept the therapies
also answered that their religion would influence their
perception RM. Respondents whose perception on
embryonic stem cell research has the influence of
religion and who were not sure if the religion would
influence have not accepted nor pay for RM therapies
(p<0.01) . This shows there is strong religious affiliation
among the respondents in Malaysia19. Product/ therapy
specification and information ‘halal’ would contribute to
increase the acceptability among the public especially
for Muslim residents. Apart from this, respondents who
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1101
felt RM has numerous potentials to improve wellbeing agreed to pay whereas those who did not have confidence on
the benefits disagree to pay (p<0.01).
Table 2. Association Between WTA and WTP with Demographic, Knowledge Level and Support
Characteristics
WTA RM Therapies
(n=300)
Yes
n (%)
No
n (%)
Male
60 (75.0%)
20
(25.0%)
Female
126 (57.3%)
94
(42.7%)
WTP RM therapies
p value
Yes
n (%)
No
n (%)
42
(52.5%)
38
(47.5%)
89
(40.5%)
131
(59.5%)
92
(42.0%)
127
(58.0%)
39
(48.1%)
42
(51.9%)
p value
Gender
0.007**
0.06
Course category
Medical and
Health Science
125 (57.1%)
94
(42.9%)
Engineering and
Physical Science
61 (75.3%)
20
(24.7%)
0.005**
0.361
Monthly household income
<RM2,000
50 (58.8%)
35
(41.2%)
34
(40.0%)
51
(60.0%)
RM2,001 to
RM5,000
67 (56.8%)
51
(43.2%)
44
(37.3%)
74
(62.7%)
RM5,001 to
RM7,500
29 (65.9%)
15
(34.1%)
24
(54.5%)
20
(45.5%)
RM7,501 to
RM10,000
20 (80.0%)
5
(20.0%)
13
(52.0%)
12
(48.0%)
16
(57.1%)
12
(42.9%)
>RM10,000
20 (71.4%)
8
(28.6%)
0.16
0.12
Level of knowledge
Poor
43 (51.2%)
41
(48.8%)
25
(29.8%)
59
(70.2%)
Moderate
107 (65.2%)
57
(34.8%)
72
(43.9%)
92
(56.1%)
Good
36 (69.2%)
16
(30.8%)
34
(65.4%)
18
(34.6%)
19
(26.8%)
52
(73.2%)
112
(48.9%)
117
(51.1%)
0.04*
0.000**
Support for RM
No
34 (47.9%)
37
(52.1%)
Yes
152 (66.4%)
77
(33.6%)
0.008**
Factors associated with Students Level of Knowledge on Regenerative Medicine
0.001**
1102
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Based on this study, there is statistically very
significant difference between the knowledge of students
from Medical and Health Science with students from
Engineering and Physical Science categories on RM
components (p<0.05). It is clearly evident that students
from Medical and Health Science have better knowledge
than the students from the other category. More than
70% of them knew the components better compared to
the other group.
Result showed that n=41 female participants have
good level of knowledge than male n=11 (p<0.01). As for
those who have moderate level of knowledge, the female
respondents are more in percentage (58.2%) than male
(45.0%). However, there is no significant association
between level of knowledge, age range and level of
education. (p>0.05) Apart from this, more government
university students n=38 have good level of knowledge
than private university students n=14 p<0.01). Medical
and Health Science students have higher percentage of
moderate to good level of knowledge than Engineering
and Physical Science (p<0.01). The existing background
on healthcare and life science knowledge could have
influence their knowledge level on RM. This is proven
among students with life science knowledge whom
have better acceptability on genetic testing12. Students
with poor level of knowledge (81.0%) still chose mass
media as their main source of information compared to
exhibition, education or medical professional. (p<0.01).
There is a very significant association between source of
information and level of knowledge among the students.
Students with moderate to good knowledge have more
than one resources on RM.
Factors associated with students awareness on
Regenerative Medicine
There is no association between the level of
education and the awareness among them as the
p-value is 0.09. Association between awareness on the
exploitation of ‘stem cell’ words in health products
and university students’ demographic factors showed
that 85.4% medical students, 74.9% of health sciences
students and 48.1% of students from physical science
and engineering were aware of the misuse of ‘stem cell’
word in healthcare products. There is a very significant
association between this awareness and the categories of
courses (p<0.01). More than 66% of undergraduate and
post graduate from all 3 categories of courses seemed
to be aware of this exploitation (p<0.05). Even though,
majority of the students had not heard of regenerative
medicine, they were familiar with stem cell related
questions. According to14 study, most of the Malaysian
medical students were aware of stem cells and the
characteristics but limited awareness noted. Medical
students 85.4% (n=41) and 53.2% (n=91) health science
students have heard of ill effects of unproven stem cell
therapy. Only (30.9%) physical science and engineering
students seemed to be aware of this statement. This
shows that there is awareness among students across the
courses but more awareness is seen in medical and health
science students than physical science and engineering
students(p<0.01) Students at both level of study and
from science background have some awareness on
unproven stem cell therapy. Medical and health related
students were more aware about potentials of gene
therapy than engineering and physical science students
(p<0.01). However, there is no association between
the level of study and awareness on potential of gene
therapy (p>0.05).
Factors Associated with Students’ Perception on
Regenerative Medicine
Strong association seen between support received
and level of knowledge. Respondents with moderate to
good level of knowledge agreed to support than those
with poor knowledge. (p<0.01) . Students with moderate
to good level of knowledge agreed with RM’s potentials
and thus became more supportive towards RM. Besides
that, any misperception should be carefully handled.
Respondents of 40% were neutral about medical tourism
leading to misconception because of lack of familiarity
about the risks it carries. While 60% of online stem
cell clinic use internet as their marketing tool for
business13. The management of public discourse and
their misperceptions should be overcome by adequate
public education and discussion to see progress in stem
cell research20. There is no significant association among
the level of study but medical and health students agreed
more than engineering students that television can be the
source of exploitation (p<0.01).
conclusion
This study has yielded positive feedback about RM
among students in higher learning. Overall the awareness
on RM is low but medical and health science students
seemed to have more awareness than engineering and
physical science students. Students with moderate to
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1103
good level of knowledge have better awareness on
RM. Majority were aware of the potentials of stem
cells and the risks of unproven therapy compared to
potentials of genetic therapy. Significant association
has been seen between respondents with moderate to
good level knowledge and awareness. Even though
there are students with poor knowledge whom were
willing to know more about RM, the proportion seemed
higher among the students with moderate-good level
of knowledge. Students used more than one source of
information have moderate to good level of knowledge.
Through such knowledge, there was some awareness on
RM but inadequate.
5. A. Atala, S.B. Bauer, S. Soker, J.J. Yoo, A.B. Retik.
Lancet. 2006;367(1241).
Acknowledgment: This work was supported by
UCSI University Ethical Committee {Proj-FMHSEC-2016-519} and the UCSI Trust Fund [UCSI
University Trust Graduate Scholarship].
11. A.S. Mao, D.J. Mooney. Proc. Natl. Acad. Sci.
2015;112(14452).
Ethical Clearance: Taken from the committee
13. L.Y.E. Jee Leng, S. Lean Keng, W.A.N. Wan Amir
Nizam, T.A.N. Suat Cheng. Malaysian J. Med. Sci.
MJMS. 2015;22(23).
Source of Funding: Nil
Conflict of Interest: Nil
References
1. K. Harding, M. Sumner, M. Cardinal. Int. Wound J.
2013;10(132).
6. H.L. Greenwood, P.A. Singer, G.P. Downey, D.K.
Martin, H. Thorsteinsdottir, A.S. Daar. PLoS Med.
2006;3(e381).
7. E. Folch, I. Hernandez, M. Barragan, C. FrancoParedes, Am. J. Med. Sci. 2003;326(66).
8. V. Falanga, M. Sabolinski, Wound Repair Regen.
1999;7(201).
9. D. Sipp, Regen. Med. 2009;4(911).
10. R.L. Buckler, Bio Process Int. 9 (Suppl. 1).
2011;14(19).
12. R. Connolly, T. O’Brien, G. Flaherty. Travel Med.
Infect. Dis. 2014;12(695).
14. G. Steinhoff, Regenerative Medicine (Springer,
2011).
15. N.M. Bahri, E. Suryawati, K. Osman. Eurasia J.
Math. Sci. Technol. Educ. 2014;10(195).
16. N. Ariffin, (2009).
2. A.R. Hayati, M.M.N. Fariha, G.-C. Tan, A.E. Tan,
K. Chua. Arch. Med. Res. 2011;42(291).
17. M. Boles, A. Adams, A. Gredler, S. Manhas. Prev.
Med. (Baltim). 2014;67(S40).
3. C.M. Zelen, D.P. Orgill, T. Serena, R. Galiano, M.J.
Carter, L.A. DiDomenico, J. Keller, J. Kaufman,
W.W. Li. Int. Wound J. 2017;14(307).
18. D.T. Harris, I. Rogers. Curr. Stem Cell Res. Ther.
2007;2(301).
4. W.T. Seet, M. Maarof, K.K. Anuar, K.-H. Chua,
A.W.A. Irfan, M.H. Ng, B.S. Aminuddin, B.H.I.
Ruszymah. PLoS One 2012;7(e40978).
20. J.B. McCormick, H.A. Huso. J. Cardiovasc. Transl.
Res. 2010;3(122).
19. P. Foong, Asian Bioeth. Rev. 2011;3(182).
DOI Number: 10.5958/0976-5506.2019.00857.X
Menopausal Symptoms and Menopausal Quality of Life during
Transitional Period among Military Wives
Nur H.S.1, C.K. Tan1, Normina A.B.1, M.S. Seghayat1, F. Amini1, Thiagarajah S.1, E.S.S. Tan1
Faculty of Medicine and Health Sciences, UCSI University, No.1, Jalan Menara Gading,
UCSI Heights, Cheras, 56000 Kuala Lumpur
1
Abstract
Menopause is a physiologic phase in women life involving hormonal changes that could lead to severe
menopausal symptoms and thereafter affecting one’s quality of life. Moreover, army wives lead stressful
lives. In this study, we aimed to determine quality of life among army wives during menopausal transition
as well as to investigate possible association between socio-demographics and their quality of life. Seventyfive army wives were recruited. Mean age of menopause reported was 51.7 (± 2.5 SD). Physical domain
was the most reported menopausal symptoms followed by psychosocial, sexual and vasomotor. Most army
wives reported having lack of energy (78.7%), feeling worn out (77.3%) and decreased in physical energy
(76%). Least reported symptom was change in facial hair (25.3%). Menopausal stages were significantly
associated with MENQOL domains changes except sexual domain (p<0.05). Army wives in the early
perimenopausal stage was most affected in psychological and physical domain. Overall MENQOL scores
were associated with household income, spouse’s division and rank (p<0.05). Spouse support is crucial
during the menopausal transition. As such, intervention such as awareness, education and counselling can
help these army wives to improve their QoL.
Keywords: Menopause; women; hormonal; symptoms; quality
Introduction
Menopause is defined as cessation of menstrual
cycle due to decrease secretion of progesterone and
estrogen from ovarian1. The age of menopause is
between 45 and 55 years. Menopausal symptoms which
are associated with the physiological and hormonal
changes include hot flushes, night sweats, mood swings,
vaginal dryness and much more. The symptoms broadly
divided into vasomotor, physical, pyschological and
sexual components2.
Perimenopause is defined as by World Health
Organization as the period of time before the final
episode of menstruation3. It extend over 2 to 8 years prior
to menopause and 1 year after the last menstruation.
During this transition time, women experience different
physical, psychological and even social changes that
Corresponding author:
M.S. Seghayat
E-mail: marjansadat@ucsiuniversity.edu.my
may affect their quality of life in a great degree depend
on verities of sociodemographic factors. The cultural,
social, economic, religious and educational status might
be determinant of impact of these changes in quality of
life in perimenopause women.
Besides disturbance due to bothersome menopause
symptoms, family environment often influence
managing the life during these years resulting in chronic
stress in premenopausal women. Military wives have
been identified to have a higher level of stress, and
depression compare to the nonmilitary wives4. There are
many studies in association of menopausal symptoms
and quality of life in women, but no study had been
conducted in this specific population in order to see
the degree of menopausal symptoms impacting their
life. Thus, this research aimed to determine incidences
of menopausal symptoms among the military wives in
Malaysia and identifying their impact on the healthrelated quality of life.
Methodology
Study Design and Subjects and Sample Size
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
A cross sectional survey was conducted from
November 2015 to March 2017 in an Army Camp
situated within vicinity of Kuala Lumpur. Sample were
army wives whose husband are serving or had previously
served the country. Inclusion criteria were women aged
45 to 85 years old and was experiencing symptoms
of menopause. Calculated sample size was 73. Other
parameters include 95 percent power at significant level
of 5% with assumption of design effect of 2.5.
Sampling Measurement
The questionnaire consisted three sections; sociodemographics, history of menstrual cycle and Menopause
Specific Quality of Life (MENQOL).
MENQOL was developed and established by5 and
had since been widely used in clinical settings to assess
health-related quality of life in the menopausal stage. It
is also validated in many populations globally. There are
29 items in the self-administered instrument; vasomotor
(3 items), psychosocial (7 items), physical (16 items) and
sexual (3 items). Initially, each system is qualitatively
evaluated as present or nor present. If the symptom is
present, then it is scored from 0 as not bothered to 6 as
extremely bothered. Score for MENQOL is the mean
total of each domain.
Ethical Approval
Permission for conduct of study was granted by the
Officer in Command of 712 Pusat Perubatan Angkatan
Tentera, Kuala Lumpur. Ethical approval was granted
by Faculty of Medicine and Health Sciences, UCSI
University via approval code Proj-FMHS-EC-2016-516.
Statistical Analysis
Statistical analysis was done using the statistical
package for the social sciences software (SPSS Software,
Chicago, IL) version 23.0 and statistical significant was
deemed at p<0.05.
Result and Discussion
Socio Demographic
Eighty army wives were approached to participate
in this study. Five respondents were rejected due to
surgical menopause and history of cancer. Range age of
respondents is 45 to 58 years old with median age of 52.
Range age for attainment of menarche is 11 to 15 years
old with median age of 13. Most respondents received
1105
education lower than O-level and were from low income
group with 74.7% and 56.0% respectively. Only 22.7%
of respondents have husbands who are actively serving.
Table 1 shows socio-demographic for this study.
Table 1. Socio-demographics and History of
Menopause
Characteristic
n
Percentage (%)
Age Categories (Years)
45 to 49
50 to 54
55 to 59
25
30
20
33.3
40.0
26.7
Ethnic
Malay
Non-Malay
62
13
82.7
17.3
Religion
Muslim
Non-Muslim
62
13
82.7
17.3
Occupation
Working
Non-Working
32
43
42.7
57.3
Level of education
Lower than O-level
O-level & above
56
19
74.7
25.3
Household Income
Less than MYR 3500
More than MYR 3501
42
33
56.0
44.0
Spouse
Army
Veteran
17
58
22.7
77.3
Rank
Lower rank
Officer
51
24
68.0
32.0
Age attained menarche
10
11
12
13
14
15
16
1
3
25
27
10
8
1
1.3
4.0
33.3
36.0
13.3
10.7
1.3
28
37.3
34
11
2
45.3
14.7
2.7
46
29
61.3
38.7
Regular menstrual cycle
Yes
No
Postmenopausal
Late perimenopausal
Early perimenopausal
Pap smear
Yes
No
Menopausal Age
45 to 49
50 to 54
55 to 59
5
26
2
15.2
78.8
6.1
1106
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Menstrual Specific Quality of Life (MENQOL) and
Domain Scores
The most affected MENQOL domain is psychical
with median score of and range from 1.00 to 6.94; which
three most commonly reported symptoms were lack
of energy (78.7%), worn-out (77.3%) and decreased
in physical strength (76%). Psychosocial is the second
most affected domain with median of 2.43; which more
than half reported experiencing memory loss (62.7%),
having anxiety (58.7%) and feeling less accomplished
(54.7%). Vasomotor and sexual domains were equally
affected with median of 2.33. In sexual domain, more
than half experienced changes in sexual desire (62.7%).
The least reported symptom was changes in facial hair
(25.3%). Scores for each menopausal symptom is listed
in Table 2.
Table 2. Frequency of menopausal symptoms
No Experience
Yes
n
%
n
%
Hot flushes
47
62.7
28
37.3
Night sweats
45
60.0
30
40.0
Sweating
39
52.0
36
48.0
Dissatisfied with personal life
49
65.3
26
34.7
Feeling anxious or nervous
31
41.3
44
58.7
Experiencing poor memory
28
37.3
47
62.7
Accomplishing less than I used to
34
45.3
41
54.7
Feeling depressed, down or blue
40
53.3
35
46.7
Impatient with other people
47
62.7
28
37.3
Wiling to be alone
43
57.3
32
42.7
Flatulence (wind) or gas pain
36
48.0
39
52.0
Aching in muscle and joints
20
26.7
55
73.3
Feeling tired or worn out
17
22.7
58
77.3
Difficulty in sleeping
43
57.3
32
42.7
Aches in back of neck or head
28
37.3
47
62.7
Decrease in physical strength
18
24.0
57
76.0
Decrease in stamina
19
25.3
56
74.7
Feeling a lack of energy
16
21.3
59
78.7
Drying skin
29
38.7
46
61.3
Weight gain
41
54.7
34
45.3
Facial hair
56
74.7
19
25.3
Changes in skin
36
48.0
39
52.0
Feeling bloated
41
54.7
34
45.3
Low backache
27
36.0
48
64.0
Infrequent urination
38
50.7
37
49.3
Involuntary urination
46
61.3
29
38.7
Sexual Desire
28
37.3
47
62.7
Vaginal dryness
37
49.3
38
50.7
Avoiding intimacy
46
61.3
29
38.7
Median (Range)
Vasomotor
2.33 (1.00 – 7.33)
Psychosocial
2.43 (1.00-7.29)
Physical
3.00 (1.00 – 6.94)
Sexual
2.33 (1.00 – 6.66)
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Menstrual Specific Quality of Life (MENQOL) and
Menstrual Stages
Table 3 demonstrates associations between
MENQOL and menstrual stages. Respondents in late
perimenopausal stage experienced more vasomotor
1107
disorders; median score was 3. Postmenopausal stage
was least affected and better quality of life. Vasomotor
(p=0.021), psychosocial (p=0.030) and physical domains
(p=0.026) were significantly affected by menopausal
stages except for the sexual domain (p=0.502).
Table 3. Menstrual Quality of Life at varied menstrual stages
Domains Scoring
Menopausal stage categories
Median
p-valuea
Range
Vasomotor
Regular cycle
Postmenopause
Late Perimenopause
Early Perimenopause
1.00
2.67
3.00
2.33
1.00 – 7.33
1.00 – 7.33
1.00 – 7.33
1.00 – 3.67
0.021*
Psychosocial
Regular cycle
Postmenopause
Late Perimenopause
Early Perimenopause
2.29
2.29
3.57
6.00
1.00 – 5.43
1.00 – 6.29
1.43 – 5.57
4.71 – 7.29
0.030*
Physical
Regular cycle
Postmenopause
Late Perimenopause
Early Perimenopause
2.44
3.41
4.06
4.75
1.00 – 5.06
1.00 – 5.75
2.25 – 6.94
3.56 – 5.94
0.026*
Sexual
Regular cycle
Postmenopause
Late Perimenopause
Early Perimenopause
2.00
2.67
3.00
2.33
1.00 – 5.00
1.00 – 6.33
1.00 – 6.67
1.00 – 3.67
0.502a
2.20
2.82
3.23
3.85
1.00 – 4.06
1.07 – 5.41
1.91 – 5.13
3.24 – 4.47
0.007*
MENQOL
Regular cycle
Postmenopause
Late Perimenopause
Early Perimenopause
Menstrual Specific Quality of Life (MENQOL) and Menstrual Stages
Age category was strongly associated with
vasomotor domain. Women within the age of 50 to
54 years old experienced more vasomotor symptoms
compared to women at the age of 45 to 49 and 55 to
59. Psychological and physical domain was associated
with spouse division; which median scores were higher
among wives whose husbands were actively serving
versus veteran. Sexual domain was associated with
household income. No associations were reported for
MENQOL domains with ethnicity, religion, occupation
and education. Overall, MENQOL score was associated
with household income, spouse division and rank.
Overall Discussion
Mean of menopausal age in this study is 51.7
(± 2.5 SD). This result is found to be almost similar
to a study conducted in Kuching, involving 356
Sarawakians which mean age of menopause was 51.28
±2.3 years old6. However, other studies in Malaysia
reported earlier menopausal age. Mean menopausal
age reported in Kelantan and Ipoh was 49.4 ± 3.4 and
47.96 ± 2.5 years old respectively7. Indonesia also had
an earlier menopausal age. Indonesians were reported to
experience menopause at 49.98 old respectively8.
A larger study involving seven countries in SouthEast Asia reported median age of menopause at 51.09.
This study encompassed Malaysia, Singapore, Taiwan,
Philipines, Indonesia, Korea and Hong Kong9. The
SWAN (Study of Women’s Health Across the Nation)
proposed natural age of menopause to be 51.4 years
1108
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
old10. Thus, the mean menopause age for army wives in
this study are within proposed normal range.
urination due to poor bladder control was found to be
higher almost two folds compared to Melbourne study18.
Variation in menopausal age across different
countries can be attributed to several intrinsic factors
such as body mass index, educational status, physical
activity, smoking habit, alcohol consumptions, better
self-rated health and reproductive history11-14.
In this study, early perimenopausal stage experienced
impairment in psychosocial and physical domain; while
late perimenopausal stage were affected in vasomotor
domain. These findings were in agreement with several
other studies6,7,9,16,19,20 In contrary, several studies found
that postmenopausal women experienced more sexual
symptoms; but such association was not established in
this study6,7,18.
In this study, physical domain was the most affected
domain with majority of army wives experiencing lack
of energy (78.8%), tiredness and worn out (77.3%)
and decreased physical strength (76%). Similarly, East
Malaysians were also more affected in the physical
domain with the highest reported symptoms were
muscular skeletal discomfort (80.1%); followed by
physical and mental exhaustion (67.1%) and sleeping
difficulties (52.2%)6. Meanwhile, highest reported
symptoms were tiredness (79.1%), reduced level of
concentration (77.5%) and musculoskeletal aches
(70.6%) in Kelantan7.These findings are different
than those commonly reported in western countries;
where vasomotor symptoms like hot flushes were
more prominent. In Netherland, 85% women reported
having vasomotor symptoms; while less than half were
reported in this study15. Lower incidences vasomotor
symptoms were also found in few other studies in Asian
countries6,9,16
Table 4 compares menopause symptoms in this
study with those in other countries within the Asia Pacific
region. Generally, physical domain was most affected
with complains on musculoskeletal and tiredness. On the
contrary, study conducted in Taipei reported difficulty
in sleeping as their highest symptom17. Incidences
of several menopausal symptoms were found to be
higher in this study compared to other studies. Frequent
Our results found no association between household
income and menopausal quality of life; which better
income actually lead to poorer QoL. Most studies reported
the opposite and the norm that menopause women with
better economic status were less affected14,21. Army wives
seemed to be more influenced by their spouse. Women
whose spouse had retired or was serving in the lower
rank had better QoL. Vice versa, army wives had higher
anxiety and were more depressed. Spouse support is
crucial during the menopausal transition. An educational
program which comprised of management and health
of menopausal transition was conducted for spouse was
in Iran; such intervention evidenced significantly lower
psychological and physical domains22.
As for other domain, women at the age of 50 to 54
were significantly affected the vasomotor menopausal
symptoms compared to those at the age of 45-49 and
55-60 years old. It could be explained by the fluctuation
of estrogen levels and it reaches the peak during
the perimenopausal stage. These findings were in
agreement with other studies in the country as well as
studies conducted among Caucasian and Australians.
Vasomotor symptoms can be as high as 75% during the
perimenopausal6,18,20,23,24,25
Table 4. Comparison of Menopausal Symptoms in this Study and Other Studies in the Asia Pacific Region
No
Symptoms
Lembah
Klang
2017,(This
Kelantan
2003,[7]
work)
Singapore
2002,[16]
Taipei
2001,[17]
Melbourne
2000,[18]
Bangkok
1997,[26]
1
Feeling tired or worn out
77.3
79.1
38.8
33.8
43
63
2
Reduced concentration
-
77.5
45.1
-
20
-
3
Musculoskeletal aches
73.3
70.6
51.7
37.4
57
71
4
Backache
64.0
67.7
Included
with muscle
ache
41.5
32
27
5
Night Sweat
40.0
53.0
8.9
11.8
24
-
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1109
Cont... Table 4. Comparison of Menopausal Symptoms in this Study and Other Studies in the Asia Pacific
Region
6
Mood swing/ being impatient
37.3
51.0
22.4
-
-
43
7
Vaginal dryness /discomfort
50.7
45.7
20.7
24.2
32
8
8
Difficulty sleeping
42.7
45.1
23.4
57.4
45
52
9
Hot Flushes
37.3
44.8
17.6
16.4
41
33
Conclusion
Results showed decreased QoL particularly in
physical and psychosocial domains. It was associated
with spouse division. Army wives of actively serving
spouse were most affected. Therefore, it is necessary
to develop effective intervention program such as
awareness, education and counselling for these army
wives.
Acknowledgment: The research team are grateful
for support of medical committee in Pusat Perubatan
Angkatan Tentera Sungai Besi, Kuala Lumpur, Malaysia
Ethical Clearance: Taken from the committee
Source of Funding: Nil
Conflict of Interest: Nil
References
1. H.D. Nelson, E.M. Haney, L. Humphrey, J. Miller,
A. Nedrow, C. Nicolaidis, K.K. Vesco, M. Walker,
C. Bougatsos, P. Nygren, (2005).
2. M. Hunter, Qual. Life Res. 2000;9(733).
3. H. Burger, J. Sex. Med. 2008;5(2266).
4. E.E. Dimiceli, M.A. Steinhardt, S.E. Smith. Armed
Forces Soc, 2010;36(351).
5. J.R. Hilditch, J. Lewis, A. Peter, B. van Maris, A.
Ross, E. Franssen, G.H. Guyatt, P.G. Norton, E.
Dunn, Maturitas, 1996;24(161).
6. S.A.S.A. Rahman, S.R. Zainudin, V.L.K. Mun. Asia
Pac. Fam. Med, 2010;9(5).
7. H.K. Dhillon, H.J. Singh, R. Shuib, A.M. Hamid,
N.M.Z.N. Mahmood. Maturitas, 2006;54(213).
8. M. Yohanis, Indones. J. Obstet. Gynecol. Vol. 37,
No. 2, April 2013 (2016).
9. M.J. Boulet, B.J. Oddens, P. Lehert, H.M. Vemer, A.
Visser, Maturitas. 1994;19(157).
10. E.B. Gold, A. Colvin, N. Avis, J. Bromberger, G.A.
Greendale, L. Powell, B. Sternfeld, K. Matthews.
Am. J. Public Health, 2006;96(1226).
11. M. Akahoshi, M. Soda, E. Nakashima, T. Tominaga,
S. Ichimaru, S. Seto, K. Yano, Int. J. Obes.
2002;26(961).
12. M.D. Sammel, E.W. Freeman, Z. Liu, H. Lin, W.
Guo. Menopause, 2009;16(1218).
13. E.B. Gold, S.L. Crawford, N.E. Avis, C.J. Crandall,
K.A. Matthews, L.E. Waetjen, J.S. Lee, R.
Thurston, M. Vuga, S.D. Harlow. Am. J. Epidemiol,
2013;178(70).
14. L. Li, J. Wu, D. Pu, Y. Zhao, C. Wan, L. Sun, C.
Shen, W. Sun, Z. Yuan, Q. Shen, X. He, J. Jiang, N.
Luo, Y. He, Q. Qian, P. Cai, M. Zhang. Maturitas,
2012;73(354).
15. A. Oldenhave, L.J.B. Jaszmann, A.A. Haspels,
W.T.A.M. Everaerd. Am. J. Obstet. Gynecol,
1993;168(772).
16. H. Chim, B.H.I. Tan, C.C. Ang, E.M.D. Chew, Y.S.
Chong, S.M. Saw. Maturitas, 2002;41(275).
17. J.-L. Fuh, S.-J. Wang, S.-J. Lee, S.-R. Lu, K.-D.
Juang. Qual. Life Res, 2003;12(53).
18. L. Dennerstein, E.C. Dudley, J.L. Hopper, J.R.
Guthrie, H.G. Burger Obstet. Gynecol, 2000;96
(351).
19. M. Porter, G.C. Penney, D. Russell, E. Russell,
A. Templeton. BJOG An Int. J. Obstet. Gynaecol,
1996;103(1025).
20. F.H. Loh, L.W. Khin, S.M. Saw, J.J.M. Lee, K. Gu.
Maturitas, 2005;52(169).
21. R.E. Williams, K.B. Levine, L. Kalilani, J. Lewis,
R. V Clark. Maturitas, 2009;62(153).
22. N. Bahri, N. Yoshany, M.A. Morowatisharifabad,
A.D.
Noghabi,
M.
Sajjadi.
Menopause,
2016;23(183).
23. S.M. McKinlay, D.J. Brambilla, J.G. Posner. Am. J.
Hum. Biol, 1992;4(37).
24. D.J. Brambilla, S.M. Mckinlay, C.B. Johannes. Am.
J. Epidemiol, 1994;140(1091).
25. J.R. Guthrie, L. Dennerstein, J.R. Taffe, P. Lehert,
H.G. Burger. Climacteric, 2004;7(375).
26. S. Punyahotra, L. Dennerstein, P. Lehert. Maturitas,
1997;26(1).
DOI Number: 10.5958/0976-5506.2019.00864.7
Knowledge, Awareness and Perception of Healthcare Personnel
Based on Employment Level towards Stem Cells in Pahang
Abu Mansor Noor Azizah1, Ahmad Bustami Normina1, Marjan Sadat Seghayat1, Chung Keat Tan1,
Eugenie Sin Sing Tan1, Farahnaz Amini1, Sharmanee Thiagarajah1
1
Faculty of Medicine and Health Science, UCSI University, 56000 Cheras, Kuala Lumpur, Malaysia
Abstract
Stem cell research and treatment hold much promise and expectation both globally and locally to date with
a lot of interest garnered. The aim of this survey was to assess their knowledge, awareness and perception
towards stem cells based on their employement level, as well as insight on healthcare personnel‘s acceptance
of stem cells from religious and moral point of views and the support on the treatment and research. A
cross-sectional tool was used on 307 healthcare personnel in Pahang, Malaysia was conducted by using
cluster random sampling from six primary healthcare clinics. Ethical approval (NMRR-14-1052-21256)
was granted from Malaysian Research & Ethics Committee, Ministry of Health, Malaysia and UCSI Ethics
Committee. Based on the result, knowledge on the stem cell among respondents associated with education
(p=0.000).Recognizing the low learning in foundational microorganism, the members demonstrated
enthusiasm for undifferentiated cell data extremely significant with p < 0.01. The association of awareness
on impact of religious and ethical belief over storing and using stem cells for research or therapy among
respondents by both education and employment status have very significant p value < 0.01. Overall, the
perception of the healthcare personnel based on education to support on stem cell research, in willingness
to use medical treatments from embryonic stem cells, using excess embryo during IVF, tax contribution for
stem cell research in Malaysia were very significant with p value < 0.01.Taking everything into account, this
investigation reflects low level of information, mindfulness and impression of social insurance work force
dependent on their business status on the of perspectives relating to undeveloped cells in Malaysia.
Keywords: Stem cell; awareness; knowledge; perception; healthcare.
Introduction
Cells, have been once a study and research mainly
in biological and pharmaceutical field. The remarkable
evolution embarked the creation of paradigm shift in
medical field since the first bone marrow transplants in
the 1960s and the isolation of embryonic stem cells from
mice in the 1980s followed by many other cell based
therapies exclusively stem cell treatment and research
has taken place last few decades1.
Organ and tissue donors has always been
critically insufficient to supply and replace damaged
Corresponding author:
Chung Keat Tan
sharmanee@ucsiuniversity.edu.my
or dysfunctional part and even then, the compatibility
with recipient in another challenge2. The rise of number
mortality and morbidity in terminal diseases and
degenerative body parts due to the loss or failure of
specific cell types function also have been the key for
the stem cell field expansion.
Stem cells is one of the main component in
regenerative medicine, apparently provide a renewable
source for transplantation, and alternative therapies
for a multitude of damaged organs as well as many
other medical conditions. Accumulated evidences in
clinical trials shown there are realistic possibilities with
technologies stretching to optimization of stem cells
therapies to improve life quality and solve age related
factors in near future3.
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Stem cells have the ability to self-renew and
potential to give rise as specialized cell types. Based on
their degree of plasticity, versatility and tissue origin,
stem cells have been classified into diverse specialized
cell types. The stemness can be categorised in the degree
of plasticity from the highest of totipotent, pluripotent,
multipotent, oligopotent and unipotent which relatively
expressed potential to generate the variety of cell
lineages to the lowest4. Generally, stem cells come from
two main sources whereby embryos formed during the
blastocyst phase have encompass embryonic stem cells;
ESC and adult tissue have adult stem cells, while induced
pluripotent stem cell known as iPSCs are synthetically
stimulated to ‘induce’ pluripotency from the somatic
cells, besides all these resources able to give rise to
cancer stem cells too.
Despite its great potential and high demands, stem
cells are surrounded by various social, ethical and
legal issues which are shared by stem cell scientists’
globally5,6.
Future impact of stem cells is inevitable, right
knowledge especially among healthcare personnel
is important as they act as pivotal in educating and
disseminating reliable health information where public
are confident in the validity. Widespread of information
to the public could aid informed decision making
and eases comfort with the new technology so as to
overcome public misperceptions about stem cell and the
research and its social implications7. As such, this study
aims to determine the level of knowledge, awareness
and perception of stem cell among health care personnel
in Malaysia based on their employment level. This was
done to evaluate the views of each health personnel
based on their work experience and employment status.
1145
Kuantan District Medical Officer. In addition, ethical
approval (NMRR-14-1052-21256) was granted from
Malaysian Research & Ethics Committee, Ministry
of Health, Malaysia and UCSI Ethics CommitteeThe
questionnaire composed of four sections; demographics
(9 items), awareness (11 items), knowledge (17 items)
and perception (7 items). All documentations were
available in English and Bahasa Melayu (Malaysia’s
national language). Translation were verified by
professional linguisitic of postgraduate qualification.
The data collected were analyzed using SPSS
(Statistical Package for Social Studies) version 21. The
main statistical analysis was descriptive. The level of
significance was set at p < 0.05 and confidence interval
= 95% and Chi-square test was used for statistical tests.
Result and Discussion
Knowledge of Healthcare Personnel towards Stem
Cells
Level of knowledge regarding stem cell in general,
and their source of information were evaluated. Figure
1 showed none had level of knowledge at the scale of 5
while nearly 40% comprised in scale 3 and 4 while the
rest 60% of participants were in scale of 1-2.
Methodology
Figure 1. Level of knowledge on stem cells (n=307)(Scale of
1=poor to 5=excellent)
A cross-sectional questionnaire was conducted
at five major medical clinics in Pahang, Malaysia.
Location of sampling are: 3o51’22.8”N, 103o21’57.1”E,
3o49’11.8”N,
103o19’24.6”E,
3o47’20.6”N,
o
o
o
103 14’19.0”E, 3 49’28.6”N, 103 17’13.8”E and
3o45’12.7”N, 103o12’15.2”E. A total of 307 healthcare
personnel comprising of doctors, nurses, medical
assistants, pharmacists, assistant pharmacists, laboratory
technicians, radiographers, dieticians, physiotherapists,
occupational therapists and attendants were recruited.
Written permission for sampling was obtained from
However based on the association of respondents
who have heard information on stem cells by education
level were very significant with p <0.01. Similarly, the
association of respondents knowledge on the use of adult
stem cell by education level were very significant with
p <0.01
Almost 227 (92%) female participants had claimed
that they have heard of stem cell from various sources.
Notably heard from mass media/internet with 70.7%,
followed by cosmetic products with 49.5%, while
information from medical healthcare professional and
1146
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
pharmacy which are more reliable had only 44.3%
altogether.
On the type of stem cell sources, participants were
more familiar of umbilical cord blood stem cells with
having 78.8%, followed by adult human tissue with
53.1%. Only 21.2% of participants have heard of foetal
tissue as a source of stem cell. However, based on the
Table 1 and Table 2 analysis, the interest of knowledge
on stem cell among respondents based on two criteria
which were gender, and employment status were
statistically very significant with p<0.01.
Table 1. Interest in knowledge on stem cell among
respondents by gender (n=307)
Interest in knowledge on stem cell n (%)
Gender
Yes
No
Not sure
Total
Male
42(70)
11(18.3)
7(11.7)
60
Female
180(72.9)
17(6.9)
50(20.2)
247
TOTAL
222(72.3)
28(9.1)
57(18.6)
307
Table 2. Interest in knowledge on stem cell among respondents by employment status (n=307)
Employment Status
Interest in knowledge on stem cell n (%)
Yes
No
Not Sure
Total
Doctor
39(86.7)
0
6(13.3)
45
Staff Nurses
101(80.2)
9(7.1)
16(12.7)
126
Medical Assistants
14(60.9)
4(17.4)
5(21.7)
23
Pharmacists
29(59.2)
10(20.4)
10(20.4)
49
Radiographers
6(54.5)
2(18.2)
3(27.3)
11
Dietitians
1(33.3)
1(33.3)
1(33.3)
3
Medical
14(82.4)
0
3(17.6)
17
Physiotherapists
8(72.2)
1(9.1)
2(18.2)
11
Occupational Thera
1(33.3)
0
2(66.7)
3
Attendants
9(47.4)
1(5.3)
9(47.4)
19
Total
222(72.3)
28(9.1)
57(18.6)
307
X =42.072, p= 0.001
2
Awareness of Healthcare Personnel towards Stem
Cells
banking that the participants chose were mainly from the
internet with 37.8% and medical personnel with 29.3%.
There is no significant association between potential
therapeutic applications using stem cells and education
level (p= 0.256). However, level of awareness is
significantly dependent on education level for both in
the doubt of stem cells presence in the commercialized
health or cosmetic products (p = 0.006) and stem cell
research in Malaysia (p=0.016).
There were more than two-third (67.8%) of
participants were unsure whether to choose public or
private bank for stem cell storage; 17.9 % chose public
bank and 14.3% chose private bank. It was found that
the main reasons for choosing public bank for stem
cell storage were as donation for those in need it with
32.6% followed by for research use with 24.8%. Main
reasons in choosing private bank was found with 34.5%
participants felt having own cord blood stem cell would
be safer and 22.8% participants felt that it is good
investment in case if needs.
The awareness of the presence of cord blood banking
in Malaysia was significantly higher among doctors and
medical laboratory technologist compared to others
(p=0.000), while the source of information on cord blood
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1147
The p values were very significant among the healthcare personnel’s awareness on the impact of religious and
ethical belief over storing and using stem cells for research or therapy by both education level and employment status
having p value < 0.01 as shown Table3.
Table 3. Awareness on impact of religious and ethical belief over storing and using stem cells for research
or therapy among respondents by employment status (n=307)
Employment Status
Awareness on impact of religious and ethical belief (%)
Yes
No
Not Sure
Total
Doctor
1(2.2)
23(51.1)
21(46.7)
45
Staff Nurses
20(15.9)
26(20.6)
80(63.5)
126
Medical Assistants
0
3(13)
20(87)
23
Pharmacists
6(12.2)
14(28.6)
29(59.2)
49
Radiographers
0
0
11(100)
11
Dietitians
1(33.3)
0
2(66.7)
3
Medical
2(11.8)
3(17.6)
12(63.7)
11
Physiotherapists
1(9.1)
3(27.3)
7(63.6)
11
Occupational Thera
1(3.3)
0
2(66.7)
3
Attendants
2(10.5)
3(15.8)
14(73.7)
19
Total
34(11.1)
75(24.4)
198(64.5)
307
X =39.629, p=0.002
2
Perception of Healthcare Personnel towards stem
cells
Overall, the perception of health personnel towards
stem cell in this survey have shown very significant
finding based on their education level compared to
religious level, where education acts as vital role not
only disseminating current information but also in
comprehending the stem cell in the healthcare. Support
for stem cell research among participants based on
education level had very significant value with p <
0.01. Health personnel who participated from various
level background, also gave very significant value of
perception in willing to use embryonic stem cells for
medical treatments as well as using excess embryo
during IVF for stem cell research in Malaysia based
on education level with both having p value < 0.01
However perception on using excess embryo during IVF
for stem cell research in Malaysia among respondents
based on religion had no significant value, p = 0.676.
Also, perception on need of specific legislation and tax
contribution for stem cell research in Malaysia among
the participants by education showed very significant
value with both having p value < 0.01 .
Overall Discussion
Stem cell and its immense potential soon will
revolutionize the field of science and especially
medicine. However, stem cell-based products have
yet to use as main treatment as there are many still at
clinical trials studies and FDA has approved only stem
cell-based product consist of blood-forming stem cells
derived from cord blood and bone marrow. Though
many studies have been done in other countries to assess
public attitude on stem cells, there is not many study as
yet carried out in Malaysia8-11.
Out of 307 participants, 90.9% and mostly females
(91.9%) claimed that they have heard about stem cell
which mainly from mass media/internet (70.7%) and
cosmetic products (49.5%). Marketing via online and
manipulating stem cell as seller name over the product
especially in cosmetics is a gimmick played by many
commercial industries without any or much evident
based12,13. As far as mass media and internet in the era of
4th Industrial Revolution are concerned, both contribute
to the most effective role in dissemination information.
A period which is distinct in the speed, scale and energy
at which it transforms production, distribution and
consumption. As anticipated, it followed by 38.1%
1148
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
participants received the information on stem cells from
medical health care professional. The response rate for
“yes” was more than 80% in all group of employment
status except among attendants (73.3%) and statistically
significant by education level (p=0.002). Undoubtedly,
education level as well employment status almost always
play important role in accessing the knowledge.
In the past, hardcopy scientific journals or published
articles had been the main sources for scientific
information; however, in recent years, the publics are
able to obtain the science behind stem cell research
easily through the media and internet14, 15.
Among the sources of stem cells, umbilical cord
blood was the most popularly heard by the respondents
in 78.8%; whereas foetal tissue was not much heard as a
source of stem cell (21.1%). The popularity of umbilical
cord is much expected as its preservation has been
widely promoted especially in maternity hospitals and
multimedia.
In this study the participants rated themselves at level
of little (24.1%) to moderate (36.2%) level of knowledge.
However, majority of more than 75% of participants gave
positive feedback on having interest to know more about
stem cells and current status on the medical treatment
using stem cells, potential benefits and risks of adult
and embryonic stem cell research, religion and ethical
consideration of stem cells in Malaysia. Therefore this
encouraging result of the participants positively in need
for further information they are lacking of should not be
neglected. Similar outcomes by Mohammed16 and Katz,
et.al17 who found in their study that the respondents
from other countries had a similar view point thus the
respondents considered that the additional information
provided by the healthcare professionals
was
insufficient which this crucial additional information
was needed. In terms of occupation, specialists (100%),
doctors (86.7%), medical laboratory technician (82.4%)
and 80% staff nurses had greater interest in knowledge
on stem cells compared to others. Again, employment
status further suggesting that education and exposure are
the key to cultivate more interest and inquisitive in stem
cell with p<0.01.
Many profit driven companies have been
manipulating the insignificant data to sell the socalled “stem cells” in their products which claimed
to treat many medical condition. Popularly in recent
years the exploitation of stem cells in cosmetic and
healthcare products that could help to rejuvenate their
skin and make them look younger is incredible18.
Obviously, female population are easily intrigued
by the products and become the victims of their false
claim. In contrary, this survey showed that there was a
statistically significant majority of respondents who did
not have high belief in the presence of stem cells in those
products (p=0.006). The level of awareness significantly
dependent on education level for both in the doubt of
stem cells presence in the commercialized health or
cosmetic products and stem cell research in Malaysia
with p value < 0.01.
Conclusion
As a summary of the key findings, the results showed
that overall the employment status significantly plays a
major role in knowledge, awareness and perception on
stem cells of health care personal at Kuantan, Pahang.
Be that as it may, the key findings likewise demonstrated
low level of information, mindfulness and recognition on
stem cells among healthcare personnel. Thus, the health
care personals have to be well equipped with awareness
and knowledge on stem cell by regular exposure to key
updates in their field of work. Thus it can be concluded
that regardless on the level of education, the knowledge
and exposure on stem cell among health personal has to
be improved significantly.
Ethical Clearance: Taken from the committee
Source of Funding: Nil Conflict of Interest: Nil
References
1. G. Orlando, K.J. Wood, R.J. Stratta, J.J. Yoo, A.
Atala, S. Soker. Transplantation. 2011;91.
2. K. Kalra, P.C. Tomar. Am. J. Phytomedicine Clin.
Ther. 2014;2(913).
3. M.Z. Ratajczak, T. Jadczyk, D. Pędziwiatr, W.
Wojakowski. 2014;417.
4. U. Bissels, D. Eckardt, A. Bosio. In edited by
G. Steinhoff (Springer Netherlands, Dordrecht).
2013;155–176.
5. C. Marwick. JNCI
2001;93(1192).
J.
Natl.
Cancer
6. M.C. Nisbet. Public Opin. Q. 2004;68(131).
Inst.
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1149
7. S.J. Olshansky, L. Hayflick, B.A. Carnes. Journals
Gerontol. Ser. 2002;A 57(B292).
16. A. Mohammed, S. Mohammed, S. Mohammad, E.
Sayed. 2016;5(88).
8. D. Dhar, J.H.E. Ho. Yale J. Biol. Med. 2009;82(113).
Res.
17. G. Katz, A. Mills, J. Garcia, K. Hooper, C. McGuckin,
A. Platz, P. Rebulla, E. Salvaterra, A.H. Schmidt, M.
Torrabadella. Transfusion. 2011;51(578).
10. A. Mohr, S. Raman. PLOS Biol. 2012;10(e1001418).
18. C.M. Rachul, I. Percec, T. Caulfield. Aesthetic Surg.
J. 2015;35(730).
9. S.C. Schwarz,
2010;156(155).
J.
Schwarz.
Transl.
11. J.L. Lye, L.K. Soon, W.A.N. Wan Ahmad, S.C. Tan.
Malays. J. Med. Sci. 2015;22(23).
12. D. Sipp. Stem Cells Transl. Med. 2013;2(638).
13. L. Turner. Perspect. Biol. Med. 2018;61(7).
14. A. Adams, G. Lomax, A. Santarini. Regen. Med.
2011;6(121).
15. V.L. Peddie, M. Porter, C. Counsell, L. Caie,
D. Pearson, S. Bhattacharya. Hum. Reprod.
2009;24(1106).
19. P. Frati, M. Gulino, A. Pacchiarotti, S. D’Errico, L.
Sicuro, V. Fineschi. Biomed Res. Int. 2014;2014.
20. E. Einsiedel, S. Premji, R. Geransar, N.C. Orton, T.
Thavaratnam, L.K. Bennett. Stem Cell Rev. Reports.
2009;5(102).
21. M. Lako, A.O. Trounson, S. Daher. Stem Cells.
2010;28(1915).
22. M. Sadeghi,
2007;13(32).
Hum.
23. E. Commission. 2010.
Reprod.
Genet.
Ethics.
DOI Number: 10.5958/0976-5506.2019.00892.1
Social Demand and Future Prospective of ‘Anti –Aging
Medicine among Malaysians
Ng CY1, Seghayat MS1, Tan ESS1, Tan CK1 Amini F1, Thiagarajah S1, Sharma D2, Normina AB1
School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, Faculty of Medicine and Health
Sciences, UCSI University, 2Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku
Abdul Rahman, Malaysia
1
Abstract
Anti-aging medicine cultivates a target for medical intervention. However, it is still a controversial topic
which needs more research to provide a better understanding of safety and efficacy of anti-aging medicine.
This study is aimed to evaluate Malaysians’ demand and awareness of anti-aging medicine. A questionnaire
with 17 questions in four parts was developed to identify demographics profile, general health status,
awareness of anti-aging medicine and treatment. Questionnaire was randomly distributed to the patients in
a clinic in Kuala Lumpur. There were 200 consented volunteers (126 female and 74 male) who participated
in the survey. Majority of participants were 25 to 34 years old. Overall, 70% of participants were aware of
their general health status, 69 % (n=138) believed that Anti-aging medicine is a future lead in medicine.
However, 30 % of participant were worried about unexpected adverse reaction. Almost half of participants
(46.5%, n=93) acknowledged that they had no exposure to Anti-aging medicine previously. Half of the
participants (n=100) indicated age group from 25 to 34 would be the best age to start anti-aging treatment.
About 60% (n=120) believed that the ideal timing to see anti-aging effect is between 1 to 3 months. There
were a total of 84.5% (n=169) participants who expected the pricing of anti-aging medicine and treatment
to be less than RM500. A positive view and high demand toward anti-aging medicine and treatment was
observed in this study. In light with the high degree of interest upon anti-aging medicine, it is foreseeable
that the demand will increase in the future.
Keywords: Anti-aging; medicine; efficacy; safety.
Introduction
Aging is defined as a gradual changes in the structure
of any organism that occur with the passage of time,
in which it does not result from any disease of gross
accidents1 According to United Nation (UN) population
division, the number of people aged over 60 years old is
getting increasing from under 800 million to over two
billion by 2050, which means representing about 11% to
about 22% of the world population2.
In Malaysia, by 2035 it is estimated to reach the
ageing population status, with those above the age of
Corresponding author:
Normina AB
Email: normina@ucsiuniversity.edu.my,
marjansadat@ucsiuniversity.edu.my
60 constituting 15% of the population3. The elderly
population of Malaysia has shown a steady increase over
the past years, and this is expected to continue4. Life
expectancy among Malaysians has also risen to 71.51
years for men and 77.24 years for women, meanwhile
total population life expectancy is 74.28 years in 20135.
It implied that, human nation demographics is going to
shift to predominant aging nation.
With increasing numbers of aging population around
the world, health care strategies is needed to cope with
the rising numbers in order to maintain good physical
and mental health of the society6 as well as emphasis on
comprehensive health care system in the aspect of health,
social security, housing, environment that includes the
family and community7,8
Study on public perception of longevity in relation
to anti-aging medicine found supportive outlook towards
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
anti-aging research with potential to increase maximum
human lifespan by slowing aging9, particularly in older
generation10.
Anti-aging medicine consumers preferred the
results that last a long time versus immediate results
as well as gradual results which last for two years
compared to immediate results which could only last for
six months11. The cost of treatment seems to be of less
importance compared to longer lasting results. Physician
training and expertise, duration of effect, cost, and
recommendation by the physician are among the factors
affecting decisions towards anti-aging treatment use11
On the other hand, the most commonly voiced
negative personal outcome of anti-aging technologies
was that it would extend the number of years a person
spent with chronic illnesses and poor quality of life9. In
parallel, public also has their concerns about the possible
adverse side effects of anti-aging drugs9.
Evidence of human life extension is sparse and at
current time suggests that quality of life is maintained in
laboratory animals with extended lifespan12. While lifeextending effects of interventions in animal models are
invoked as arguments for supporting anti-aging research,
there is uncertainty in these interventions whether will
also extend healthy lifespan in human12.
This research aimed to establish the relation between
the public perceptions regarding anti-aging medicine in
the cultural context of aging in Malaysia. With regards
to the attitude and demand toward this related trend, the
research will establish the future prospective of the antiaging medicine in general practice setting.
Methodology
This is a cross sectional survey. The participants
selected are Malaysians aged 18 and above residing in
Kuala Lumpur. The questionnaire is set out to establish
the participant’s demographics profile such as age group,
gender, marital status, ethnicity, and monthly income
and education levels.
The questionnaire was developed in English language
and consisted of 23 questions in 5 different sections:
i.
Demographic profile (6 questions),
ii.
Respondent general health status (5 questions),
iii.
Perception of Anti-aging medicine, (3 questions)
iv.
Expectation on Anti-aging treatment (5 ques-
1303
tions)
v.
Respondent’s preference in getting Anti-aging
treatment in future (4 questions)
Likert scale was used to rate the interest in related
issue. The questionnaires were distributed randomly to
respondents who visited the clinic during consultation
from May to November 2013. Questionnaires were
handed to respondents by the researcher and they would
then be given a brief explanation regarding the intent
and purpose of research. Thereafter, informed consent
was obtained. The survey lasted for about 10 minutes.
Collected data was analyzed using SPSS 20.0
Result and Discussion
A total of 200 participants were recruited in the
survey. Majority of the participants were female (n=126,
63%). Age structure was divided in five categories: age
below 25 years (n=55, 27.5%); age 25-34 years (n=85,
42.5%), age 35-44 years (n=40, 20%); age 45-54 years
(n=15, 7.5%); and age above 55 years (n=5, 2.5%).
Different ethnic groups were involved in the study with
Malay population (n=115, 57.5%); Chinese (n=90,
45%); Indian (n=17, 8.5%); and others (n=8, 4%).
Monthly income were categorized into income lesser
than RM1000 (n=10, 5%); income RM1000-RM2999
(n=120, 60%); income RM3000-5999 (n=64, 32%);
income RM6000-9999 (n=4, 2%); and income more
than RM 10000 (n=2, 1%). Table 1 summarizes sociodemographics of participants.
Table 1. Socio-demographic of participants
Characteristics(N=200)
n
%
Gender
Female
Male
126
74
63.0
39.0
Age
<25 Years
25-34 Years
35-44 Years
45-54 Years
≥55 Years
55
85
40
15
5
27.5
42.5
20.0
7.5
2.5
Ethnic group
Malay
Chinese
Indian
Others
115
90
17
8
57.5
45.0
8.5
4.0
1304
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Monthly Income
<RM1000
RM1000-RM2999
RM3000-RM5999
RM6000-RM9999
≥RM10000
10
120
64
4
2
5.0
60.0
32.0
2.0
1.0
Out of the 200 participants, 70% of them are aware
of their apparent general health status. They have given
optimum rating upon their current health status. Most
of them have been putting effort to improve their health
status, including having regular exercise, adequate of
quality sleep, healthy organic diet with supplement,
regular health check and healthy lifestyles. This health
conscious group has their regular medical health check
in their individual preference of health center. Around
30% of the participant has been found to be less aware
of their health status at the moment with half of these
participants were within the age group of 35-44. Hustle
working lifestyle with family commitment as well as
social circle engagement may be the factors that take
up most of their time. On other aspect, most of the
participants who were less aware of their health status
are within the monthly income range of RM10002999. Table 2 outlines the awareness of participants on
their general health according to socio-demographic
characteristics.
Table 2. Awareness of participants on general
health
Socio-demographic
“Have you done anything to
improve your health?”
Yes
n (%)
No
n (%)
Gender
<RM1000
8 (4%)
2 (1%)
RM1000-RM2999
87 (43.5%)
33 (16.5%)
RM3000-RM5999
44 (22%)
20 (11%)
RM6000-RM9999
0 (0%)
4 (2%)
≥RM10000
1 (0.5%)
1 (0.5%)
Most of the participants gave similar perception
upon Anti-aging medicine. Majority of participants
(n=138, 69%) referred Anti-aging medicine as a future
lead in medicine field. However, some participants
have low confidence on the new emerging medicine
with 30% (n=60) of them anticipating unexpected
adverse reaction. Participants also believed that antiaging treatments are applicable to older people (n=30,
15%) and the treatments and consultations are too costly
(n=108, 54%). Some participants were skeptical on this
new medicine, with 36% (n=72) of them alluding the
current influences as a trend; and 45% (n=90) claimed
it as a money making business. Table 3 summarizes the
perception of participants towards anti-aging medicine.
Table 3. Participants’ perception towards antiaging medicine
“In your personal opinion, how do you see ‘Anti-aging
medicine’?
n
%
Is a future medicine
138
69
May have unexpected side effect
60
30
Is not an evidence based medicine
12
6
Only useful in old age people
30
15
Only mean for rich people
108
54
Male
50 (25%)
24 (12%)
Only a current trend
72
36
Female
90 (45%)
36 (18%)
Money making business
90
45
Age (Yrs.)
<25
45 (22.5%)
10 (5%)
25-34
73 (36.5%)
12 (6%)
35-44
10 (5%)
30 (15%)
45-54
9 (4.5%)
6 (3%)
>55
3 (1.5%)
2 (1%)
Monthly Income
More than half of the participants (n=107, 53.5%)
reported previous exposure towards anti-aging medicine
information, with health screening and medical
consultation topping the list of the most common type
of services anti-aging medicine could offer, according
to the participants. Majority showed positive acceptance
towards anti-aging medicine with 72% (n=144) indicated
possible future need for anti-aging treatment, while 28%
were not keen for the treatment at the moment. Table
4 shows the participants’ awareness towards anti-aging
medicine.
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
1305
Table 4. Awareness towards anti-aging medicine
Items
n
%
Yes
107
53.5
No
93
46.5
Yes
144
72
No
56
28
Health screening & medical consultation
186
93
Hormonal replacement therapy
105
52.5
Medically weight losing treatment
100
50
Dietician & nutritionist consultation
131
65.5
Skin & esthetic treatment
139
69.5
Image makeover consultation
133
66.5
Hypnosis & relaxation therapy
86
43
Others
7
3.5
Have you been exposed to Anti-aging information?
Do you think you need Anti-aging treatment at the
moment?
If Yes, what types of services that you think Anti-aging
clinic can offer to you?
Majority of participants reported decreased in
energy and vigor, menopause or andropause; and
decreased sexual function (n=150, 75%). as the main
concerns about aging (Table 5). In addition, participants
perceived that anti-aging medicine could results in
prevention and delay of age-related diseases (n=156,
78%), optimization of aging process (n=144, 72%) and
improvement of facial aging appearance (n=144, 72%)
(Table 6).
Table 5. Participants’ aging concerns
Aging concerns
n
%
Degenerative disease of aging
(e.g. osteoporosis, stroke, heart attack)
144
72
Changes in skin and hairs
(e.g. wrinkles, brown spot, grey hair)
126
63
Decrease in energy and vigor
150
75
Less social engagement
138
69
Loneliness &depression
138
69
Menopause / Andropause
150
75
Decreased sexual function
150
75
Decrease memory/cognitive disability
(e.g. dementia)
138
69
1306
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
Table 6. Participants’ perception on anti-aging
medicine outcome
n
%
Optimizing aging process
144
72
Longevity
102
51
Physical fitness
102
51
Improve facial aging appearance
144
72
Prevent & delay aged related disease
156
78
Improve sexual satisfaction
102
51
Improve quality of sleep
54
27
Half of the participants (n=100, 50%) indicated
age range of 25 to 34 years old as the best age to start
anti-aging treatment. On average, most of participants
reported the ideal timing to observe the therapeutics
effects at one to three months (n=120, 60%) while 19%
(n=38) of participants expected the effects within four to
six months and 15% (n=30) expected the effects within
one month .
Majority of participants were willing to pay for antiaging treatment at the cost of less than RM50 (n=74,
37%), while 25% (n=50) at the cost of RM50 to RM199,
and 22.5% (n=45) at the cost of RM200 to RM499. The
participants showed positive interest on the anti-aging
treatments, with 55% (n=110) foresee rapid increase of
demand within five years, while 41% (n=82) foresee the
demand to moderately increased (Figure 1).
Majority expressed moderate interest in anti-aging
medicine (n=122, 61%), while 35% (n=70) were very
interested to pursue anti-aging treatment modalities
(Figure 2).
Thus overall, A total of 200 respondents were
recruited in this study. Most of the respondents believed
that anti-aging medicine is the future of medicine with
majority of the respondents indicated keenness for antiaging treatment. This is similar to previous studies done
in Australia and Canada which showed overall positive
interest towards anti-aging medicine9,13
Public perception and interest seem to be positive
towards emergence of anti-aging modalities as part
of medicine. However, despite the positive outlook,
concerns on negative impact and unexpected adverse
effects of anti-aging medicine remains in mind of the
participants. One of the potential common issues in
between will be the advocates failed to persuade or
educate the public regarding the human life extension
updates. Thirty percent of respondents anticipated
possible adverse effects from Anti-aging medicine.
Figure 1. Participants’ expected demand of anti-aging
medicine within five
Figure 2. Participants’ interest in anti-aging medicine
It was reported that almost two thirds of the
American respondents had ambivalent and skeptical
view upon this new age medicine14. While most of
them see this medical advances as positive step towards
prolonging life, two thirds of their respondents foresaw
negative implications in the society. Similarly in this
study, almost half of the participants had unfavourable
view on this life extension treatment idea with many
perceiving it as a new trend of business marketing tool
for the wealthy.
Most of the time, the public merely gain knowledge
exposure from the mass media or products advertisement
with no direct medical or scientific references. Further
possible adverse reactions from this new medicine had
then hastened the public to draw their own conclusion
and self-impression.
Indian Journal of Public Health Research & Development, April 2019, Vol. 10, No. 04
However, throughout the study, some participants
had shown interest by prompting for more information
about Anti-aging medicine including availability of
Anti-aging treatment in the clinic, proven safety and
efficacy of the Anti-aging medicine, as well as price and
cost of the treatment. Excellent Willingness to Accept
for Anti-aging medicine was also reported. Only 1% of
respondent was not interested in Anti-aging medicine.
This is in line with the findings of a study in Canadian
population which elicited a strong predictor of support
toward this new emerging science13. The researchers
concluded that the population acceptance level is so
supportive that encouraged further contribution of the
life extension science in the society13.
In this study, age group of 25 to 34 was the most
indicated target group (50%) to receive anti-aging
treatment. A previous study done in University of
Toronto found that both middle age and older age groups
were more favourable towards Anti-aging treatments
compared to younger age group10. This might be due to
financial ability of older age groups.
Most of respondents indicated that Anti-aging
medicine played a role in prevention and delay of age
related diseases (78%), aging optimization (72%), facial
aging (72%), physical fitness (51%), sexual satisfaction
(51%) and sleep quality (27%). In regards of future
prospective, more than half of them (55%) anticipate
rapid increase of development in the next five years.
When comes to factors influencing patients to go
for Anti-aging treatments, the expected duration to see
effects as well as cost of the treatment were main factors
of consideration for the treatment. In addition, 60%
of participants thought that ideal timing to see effects
was between 1-3 months. Meanwhile, 84.5% of the
participants expected Anti-aging treatment to cost less
than RM500. Contrary to the first world countries, longlasting results and physician training as well as expertise
were more influential than cost of treatment11.
Conclusion
Positive views alongside high demand towards
Anti-aging medicine and treatment were observed in
this study. Although almost half of respondents had
expressed concerns regarding possible adverse effects
resulting from Anti-aging treatments; the dissemination
1307
of information and knowledge might help to enlighten
the public with both benefits and side effects. Physicians
should also look into public expectations of Anti-aging
treatment outcomes as well as pricing to ensure mutual
satisfactions following Anti-aging treatments. In light
with high degree of interests in Anti-aging medicine, it
is foreseeable that its demand will increase in the future.
Ethical Clearance: Taken from the committee
Source of Funding: Nil
Conflict of Interest: Nil
References
1. Dorland, W.A.N. Dorland. Dorland’s Illustrated
Medical Dictionary32: Dorland’s Illustrated Medical Dictionary. (Elsevier/Saunders). 2011.
2. B.S. Axel, M. Patrick, S. Atsushi. Population Aging:
Facts, Challenges, Responses (PGDA Working Paper). 2011.
3. J. Vallin, Age (Omaha). 2001;16.
4. P.S. Heller. Is Asia Prepared for An Aging Population? (INTERNATIONAL MONETARY FUND).
2006.
5. J.K. Kok, Y.N. Yap. J. Aging Stud. 2014;31(54).
6. P.C. Chen. Med. J. Malaysia. 1987;42(146).
7. D.R. Phillips, A.C.M. Chan. Ageing and Long-Term
Care: National Policies in the Asia-Pacific (Institute
of Southeast Asian Studies). 2002.
8. A. Rashid, A.A. Manan. Middle East J. Age Ageing.
2013;10.
9. B. Partridge, J. Lucke, W. Hall. EMBO Rep. LP
2010;11(735).
10. A.L. Chasteen, N.Y. Bashir, C. Gallucci, A. Visekruna. Journals Gerontol. Ser. B. 2011;66B (719).
11. S. Weinkle, M. Lupo. J. Clin. Aesthet. Dermatol.
2010;3(30).
12. R.A. Miller. Journals
2009;64A(157).
Gerontol.
Ser.
A.
13. N. Dragojlovic. J. Aging Stud. 2013;27(151).
14. L. Lugo, A. Cooperman, C. Funk, E. O’Connell, S.
Stencel. Pew Res. Center, 2013;August 6.