The Risk And Health Behaviours Towards Non-Communicable Diseases (NCDs) Among Indigenous (Orang Asli) In Negeri Sembilan, Malaysia : A Mixed Methods Study

Objectives: This study aimed to synthesise a coherent explanation risks and health behaviours on non-communicable diseases (NCDs) among the Orang Asli (OA) using three methodologies, namely 1) systematic review (SR): to systematically review the prevalence of behavioural and metabolic risks of NCDs among adults Orang Asli, 2) quantitative research: to determine the prevalence of major NCDs and its risk factors, knowledge, attitudes, practices towards NCDs and health-seeking behaviours, and 3) qualitative study: to provide a deeper explanation and understanding of the quantitative results.

Methods: A SR was conducted on four electronic databases. Eligible studies were screened, selected and reviewed and summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Then, a mixed-method sequential explanatory study was employed. In the quantitative phase, a cross-sectional survey via face to face interview was conducted among the adults Orang Asli (n = 325) in Jelebu, Negeri Sembilan. Subsequently, the qualitative phase was conducted via in-depth interviews among 16 adults Orang Asli. The study was conducted from January 2018 to April 2019. Multiple logistic regression analysis was used to analyse quantitative data. Content analysis was applied to analyse the qualitative data.

Results: Out of 1632 studies potentially relevant to behavioural risks, only 12 met the inclusion criteria. Among 170 studies that were potentially relevant to metabolic risk, only 16 were eligible for inclusion. The results from the SR revealed a high prevalence of behavioural and metabolic risk factors of NCDs among Orang Asli in Malaysia. Findings from quantitative research showed that the highest number of NCDs are self-reported hypertension (14.8%), followed by hypercholesterolemia (5.2%) and Diabetes mellitus (4.3%). Only 28.0%, 48.9% and 19.4% had good KAP category, respectively. In health-seeking behaviours, 59.3% seek modern treatment, while 40.7% use both modern and traditional treatment. Multivariate regression analysis showed that hypertension, hypercholesterolemia and Diabetes mellitus were significantly associated with the age group 40 years above. While hypertension inversely associated with non-smoker. Hypercholesterolemia had a significantly higher practices scores towards NCDs. Diabetes mellitus was significantly associated with low physical activity. Female, non-hardcore poverty group and alcohol drinker was significantly associated with abdominal obesity. The age group of 40 years and above, low vegetable intake, abdominal obesity and increased blood glucose were significantly associated with raised blood pressure group. The poorer level of knowledge of NCDs is related to lower education level, hardcore poverty group, physically inactive and inadequate vegetable intake. Low levels of attitude were also associated with alcohol consumers, physically inactive and inadequate vegetable intake group. The qualitative themes derived from this research include development and life transitions, knowledge and perception of NCDs, health effects of NCDs risk factors, barriers to preventing behavioural factors, utilisation of modern medicine and healthcare facilities, and traditional medicines. We found that low knowledge, negative attitude, obstacles towards healthy lifestyles, and barriers in accessing healthcare facilities were the main issues to tackle NCDs among Orang Asli.

Conclusion: The results of the study found that the prevalence rate of NCDs and their risk are high among the Orang Asli communities. This provides a worrying benchmark for their future health status. The implementation of the strategy should emphasize the importance of early screening, education and awareness programs as well as intervention programs aimed at reducing the behavioural and metabolic risks of NCDs, increasing the level of knowledge, attitudes and practices towards NCDs as well as addressing misconceptions and perceptions in the communities.