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Determinants of neonatal outcome in a Malaysian maternity hospital, 1980-1981

Abdul Kader H

Malays J Reprod Health, 1983 Jan;1(1):11-8.
PMID: 12279886
Matched MeSH terms: Infant Mortality*
Neonatal morbidity and mortality in Peninsular Malaysia

Abdul Kader H

Malays J Reprod Health, 1983 Dec;1(2):139-52.
PMID: 12313335
Matched MeSH terms: Infant Mortality*
Child and Adolescent Mortality Across Malaysia's Epidemiological Transition: A Systematic Analysis of Global Burden of Disease Data

Abdul-Razak S, Azzopardi PS, Patton GC, Mokdad AH, Sawyer SM

J Adolesc Health, 2017 Oct;61(4):424-433.
PMID: 28838752 DOI: 10.1016/j.jadohealth.2017.05.014

PURPOSE: A rapid epidemiological transition in developing countries in Southeast Asia has been accompanied by major shifts in the health status of children and adolescents. In this article, mortality estimates in Malaysian children and adolescents from 1990 to 2013 are used to illustrate these changes.
METHODS: All-cause and cause-specific mortality estimates were obtained from the 2013 Global Burden of Disease Study. Data were extracted from 1990 to 2013 for the developmental age range from 1 to 24 years, for both sexes. Trends in all-cause and cause-specific mortality for the major epidemiological causes were estimated.
RESULTS: From 1990 to 2013, all-cause mortality decreased in all age groups. Reduction of all-cause mortality was greatest in 1- to 4-year-olds (2.4% per year reduction) and least in 20- to 24-year-olds (.9% per year reduction). Accordingly, in 2013, all-cause mortality was highest in 20- to 24-year-old males (129 per 100,000 per year). In 1990, the principal cause of death for 1- to 9-year boys and girls was vaccine preventable diseases. By 2013, neoplasms had become the major cause of death in 1-9 year olds of both sexes. The major cause of death in 10- to 24-year-old females was typhoid in 1990 and neoplasms in 2013, whereas the major cause of death in 10- to 24-year-old males remained road traffic injuries.
CONCLUSIONS: The reduction in mortality across the epidemiological transition in Malaysia has been much less pronounced for adolescents than younger children. The contribution of injuries and noncommunicable diseases to adolescent mortality suggests where public health strategies should focus.

Matched MeSH terms: Infant Mortality/trends
Breast-feeding in some developing countries

Ahmad M

Egypt Popul Fam Plann Rev, 1979;13(1-2):168-86.
PMID: 12312263

PIP: Responses to questions relating to breastfeeding in the World Fertility Surveys of South Korea, Indonesia, Nepal, Sri Lanka, Malaysia, and Bangladesh are analyzed. Of these countries, the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%, except for Malaysia (81%) and average number of months breastfeeding took place was from 16.5-19.2, except for Malaysia (7.3). The infant mortality rate in these countries was 33/1000 live births for South Korea, 45/1000 for Malaysia, 51/1000 for Sri Lanka, 137/1000 for Indonesia, 150/1000 for Bangladesh, and 152/1000 for Nepal. Responses, however, might vary according to different interview situations. Assuming that the reporting errors are of similar magnitude and direction, the relationship between duration of breastfeeding and the birth interval can be studied. But it is possible that breastfeeding was prolonged due to other reasons for which conception was delayed; thus the regression of breastfeeding duration on the birth interval is not as logical as the regression of the birth interval on the breastfeeding is, especially when habitual breastfeeding can be avoided. The negative relationship between breastfeeding and infant mortality does exist, assuming that a woman breastfeeds all her children for similar durations. Some breastfeeding differentials are place of residence (less for rural areas), education (reduces duration), and religion (Christians have shorter duration than Muslims, Hindus, or Buddhists). In South Korea the mean length of breastfeeding of women aged 25-34 and 35-44 are 17.5 and 20.5, and women using contraceptives are 26% for 25-34 and 20% for 35-44. South Korea also has the highest level of breastfeeding, highest incidence of ever use of contraceptives, and a very low level of fertility. Nepal and Bangladesh have a high level of breastfeeding but since their contraceptive incidence is low, their fertility level remains high. Some areas of further research include influence of breastfeeding on infant and child mortality.

Matched MeSH terms: Infant Mortality
Fulltext Ending preventable newborn deaths in a generation

Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z, et al.

Int J Gynaecol Obstet, 2015 Oct;131 Suppl 1:S43-8.
PMID: 26433505 DOI: 10.1016/j.ijgo.2015.03.017

The end of the Millennium Development Goal (MDG) era was marked in 2015, and while maternal and child mortality have been halved, MGD 4 and MDG 5 are off-track at the global level. Reductions in neonatal death rates (age <1 month) lag behind those for post-neonates (age 1-59 months), and stillbirth rates (omitted from the MDGs) have been virtually unchanged. Hence, almost half of under-five deaths are newborns, yet about 80% of these are preventable using cost-effective interventions. The Every Newborn Action Plan has been endorsed by the World Health Assembly and ratified by many stakeholders and donors to reduce neonatal deaths and stillbirths to 10 per 1000 births by 2035. The plan provides an evidence-based framework for scaling up of essential interventions across the continuum of care with the potential to prevent the deaths of approximately three million newborns, mothers, and stillbirths every year. Two million stillbirths and newborns could be saved by care at birth and care of small and sick newborns, giving a triple return on investment at this key time. Commitment, investment, and intentional leadership from global and national stakeholders, including all healthcare professionals, can make these ambitious goals attainable.

Matched MeSH terms: Infant Mortality
Neonatal infections in China, Malaysia, Hong Kong and Thailand

Al-Taiar A, Hammoud MS, Cuiqing L, Lee JK, Lui KM, Nakwan N, et al.

Arch. Dis. Child. Fetal Neonatal Ed., 2013 May;98(3):F249-55.
PMID: 22942104 DOI: 10.1136/archdischild-2012-301767

Neonatal sepsis is a major cause of neonatal deaths in Asia but data remain scarce. We aimed to investigate the causative organisms and antibiotic resistance in neonatal care units in China, Malaysia, Hong Kong and Thailand.

Matched MeSH terms: Infant Mortality
Fulltext Use of Wigglesworth pathophysiological classification for perinatal mortality in Malaysia

Amar HSS, Abdul Hamid M, Wong SL

Arch. Dis. Child. Fetal Neonatal Ed., 1996 Jan;74(1):F56-9.
PMID: 8653438

A one year prospective study of perinatal deaths was conducted to test the feasibility of using the Wigglesworth pathophysiological classification in the Malaysian health service. Four regions with high perinatal mortality rates were selected. Deaths were actively identified. Nursing staff were trained to use the classification and every death was reviewed by a clinician. A total of 26,198 births and 482 perinatal deaths were reported. The perinatal mortality rate was 18.4. Only 14 (2.9%) deaths had their Wigglesworth category reclassified. Most deaths were in the normally formed macerated stillbirths (34.4%), asphyxial conditions (26.8%), and immaturity (20.1%) subgroups. The results were compared with data from other countries that used this classification. This study has shown that the Wigglesworth pathophysiological classification can be applied to perinatal deaths in the existing Malaysian health service.

Matched MeSH terms: Infant Mortality*
The effect of health programs on breastfeeding and child mortality in Peninsular Malaysia

Anderson KH

Res Popul Econ, 1984;5:87-112.
PMID: 12266419
Matched MeSH terms: Infant Mortality*
Study of perinatal mortality 1970, Maternity Hospital. Kuala Lumpur

Ariffin Bin Marzuki, Thambu JA

Med J Malaysia, 1973 Mar;27(3):198-202.
PMID: 4268924
Matched MeSH terms: Infant Mortality*
The National Family Planning Program: its impact on perinatal mortality

Arshat H, Kader HA, Ali J, Noor Laily Abu Bakar

Malays J Reprod Health, 1984 Dec;2(2):83-95.
PMID: 12280343
Matched MeSH terms: Infant Mortality*
An overview of the population dynamics in Malaysia

Arshat H, Tey Nai Peng

Malays J Reprod Health, 1988 Jun;6(1):23-46.
PMID: 12281592
Matched MeSH terms: Infant Mortality
Health trends in three Asian countries--Ceylon, Malaysia and Singapore

Arumanayagam P, San SJ

Int J Epidemiol, 1972;1(2):101-9.
PMID: 4204766
Matched MeSH terms: Infant Mortality
Perinatal outcome amongst the Malays in an urban hospital

Arumugam K

Asia Pac J Public Health, 1992;6(1):32-4.
PMID: 1304776 DOI: 10.1177/101053959200600109

National data show that the perinatal mortality amongst the Malays is higher than that of the Chinese but less than that of the Indians. These figures include data from both urban and rural areas. In the University Hospital, Kuala Lumpur, however, the perinatal mortality amongst the Malays was found to be the lowest; an odds-ratio of 0.72 (95% confidence limits; 0.59-0.87; P < 0.0005) when compared to the non-Malays. This occurred despite a significantly higher parity amongst the Malays. The Malays in this group of patients however, had a significantly better social class distribution.
Publication year: 1992-1993

Matched MeSH terms: Infant Mortality*
Fulltext The determinants of total fertility rate in selected Asian countries: an empirical study using panel data

Asef Raiyan Hoque, Mohd Yusof Ibrahim, Mohammad Zahirul Hoque

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):18-18.
MyJurnal

Introduction: In recent years, the variation in total fertility rate (TFR) has sparked public interest for demographic concerns on the global population shift towards an older age structure. This study aims to investigate the determi-nants of total fertility rate among Brunei, Indonesia, Malaysia and Philippines East Asian Growth Area (BIMP-EAGA) region. Methods: Our empirical study consists of data collected from the United Nations Development Report of the UNDP, World Development Indicators (WDI) of the World Bank and World Health Organization (WHO) report 2018. We investigated the socio-economic determinants of fertility rate by analyzing a panel data set consisting of 28 years from 1990-2017 of the four countries. A statistical and econometric software EViews version 10 (HIS Global Inc., Irvine, CA, USA) were used to run a Pearson’s Correlation and a multiple regression analysis by panel least squares method. To investigate the determinants of TFR we have selected five socio- economic factors, these are- Infant mortality rate (IMR), Gross National Income Per Capita, PPP (GNI), Human Development Index (HDI), percentage of population living in urban areas (URB) and lastly Female Labor Force Participation Rate (FLP). Results:Pearson’s correlation showed that a statistically significant negative relationship exists between TFR and the 3 vari-ables- GNI, URB and HDI. A statistically strong positive relationship exists between IMR and TFR. However, our results from the empirical multiple regression model indicates that there is a statistically significant negative relation-ship exists between TFR and two of the independent variables GNI and FLP. Conclusion: The results of present study showed that an increase in the national income and female labor participation rate in the workforce could result in a decrease in total fertility rate. These findings may have implications for countries national policy for planning, development and resource allocation.

Matched MeSH terms: Infant Mortality
Admission hypothermia among VLBW infants in Malaysian NICUs

Boo NY, Guat-Sim Cheah I, Malaysian National Neonatal Registry

J Trop Pediatr, 2013 Dec;59(6):447-52.
PMID: 23774951 DOI: 10.1093/tropej/fmt051

This study aimed to determine the prevalence of admission hypothermia (AH) among very-low-birth-weight (≤1500 g) infants in 32 Malaysian neonatal intensive care units (NICUs). This was a retrospective analysis of prospectively collected data of all very-low-birth-weight infants admitted and a questionnaire survey of the practice of AH prevention. Of the 3768 (99.8%) infants with admission temperature recorded, 64.8% (n = 2440) were hypothermic: 40.3% (n = 983) mildly (36.0-36.4°C), 58.5% (n = 1428) moderately (32.0-35.9°C) and 1.2% (n = 29) severely (<32.0°C). Mean ambient temperature of these NICUs was 22.8°C (SD = 2.7, n = 28) in labour rooms and 20.1°C (SD = 1.6, n = 30) in operation theatres. None of the NICUs practised complete care bundle against AH at birth (i.e. use of pre-warmed radiant warmer and cling wrap, ambient temperature of at least 25°C and use of pre-warmed transport incubator). Care bundle against neonatal hypothermia should be actively promoted in Malaysian labour rooms and operation theatres.

Matched MeSH terms: Infant Mortality*
Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

Boo NY, Cheah IG, Neoh SH, Chee SC, Malaysian National Neonatal Registry

Neonatology, 2016;110(2):116-24.
PMID: 27074004 DOI: 10.1159/000444316

BACKGROUND: Early nasal continuous positive airway pressure (EnCPAP) therapy after birth for very low birth weight (VLBW; <1,500 g) neonates has been reported to be beneficial in developed countries. Its benefits in developing countries, such as Malaysia, are unknown.
OBJECTIVES: This study aimed to determine EnCPAP rates in 36 neonatal intensive care units of the Malaysian National Neonatal Registry (MNNR) in 2013, to compare the outcomes of VLBW neonates with and without EnCPAP, and to determine whether the availability of CPAP facilities and unit policies played a significant role in EnCPAP rates.
METHODS: First, a retrospective cohort study was conducted of VLBW neonates born in the hospitals participating in the study without major congenital abnormalities in the MNNR. This was followed by a questionnaire survey of these hospitals focussed on CPAP facilities and unit policies.
RESULTS: Of the 2,823 neonates, 963 (34.1%) received EnCPAP. Amongst EnCPAP neonates significantly fewer deaths were recorded (10.9 vs. 21.7%; p < 0.001), less bronchopulmonary dysplasia was observed (BPD; 8.0 vs. 11.7%; p = 0.002) and fewer mechanical ventilation days were necessary (p < 0.001) than in non-EnCPAP neonates. Logistic regression analysis showed that EnCPAP was significantly associated with a lower mortality (adjusted OR 0.623; 95% CI 0.472, 0.824; p = 0.001) and BPD among survivors (adjusted OR 0.585; 95% CI 0.427, 0.802; p = 0.001). The median EnCPAP rate of the 36 hospitals was 28.4% (IQR 14.3-38.7). Hospitals with CPAP facilities in the delivery suites (p = 0.001) and during transport (p = 0.001) and a policy for EnCPAP (p = 0.036) had significantly higher EnCPAP rates.
CONCLUSION: EnCPAP reduced mortality and BPD in Malaysian VLBW neonates. Resource-strapped developing countries should prioritise the use of this low-cost therapy.

Matched MeSH terms: Infant Mortality/trends*
The role of expressed breastmilk and continuous positive airway pressure as predictors of survival in extremely low birthweight infants

Boo NY, Puah CH, Lye MS

J Trop Pediatr, 2000 Feb;46(1):15-20.
PMID: 10730035

A case-control study was carried out on 152 extremely low birthweight (ELBW, < 1000 g) infants born consecutively in a large Malaysian maternity hospital during a 21-month period to determine the significant predictors associated with survival at discharge. Forty-nine (32.2 per cent) of these infants survived and 103 (67.8 per cent) died. The survivors weighed significantly heavier (mean = 888 g, SD = 99) than infants who died (mean = 763 g, SD = 131; p < 0.0001). They were also of higher gestational age (mean = 28.7 weeks, SD = 2.2) than those who died (mean = 26.7 weeks, SD = 2.5; p < 0.0001). Logistic regression analysis showed that, after controlling for various confounders, only three factors were significantly associated with the survival of these infants. These were: (1) increasing birthweight of the infants (with every gram increase in birthweight, adjusted odds ratio of survival was: 1.009; 95 per cent CI 1.004, 1.015; p = 0.0006); (2) given nasal continuous positive airway pressure for treatment of respiratory distress syndrome (adjusted odds ratio of survival: 4.2; 95 per cent CI 1.2, 14.0; p = 0.02); and (3) given expressed breastmilk (adjusted odds ratio of survival: 57.5; 95 per cent CI: 7, 474; p = 0.0002). Maternal illness, intrapartum problems, ethnicity, gestational age, use of antenatal steroid, modes of delivery, Apgar scores, congenital anomalies, respiratory distress syndrome, persistent ductus arteriosus, septicemia, necrotising enterocolitis, chronic lung disease, oxygen therapy, intermittent positive pressure ventilation, surfactant therapy, and blood transfusion were not significant factors associated with increased survival.

Matched MeSH terms: Infant Mortality/trends*
Six year trend of neonatal septicaemia in a large Malaysian maternity hospital

Boo NY, Chor CY

J Paediatr Child Health, 1994 Feb;30(1):23-7.
PMID: 8148183

A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaemia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.

Matched MeSH terms: Infant Mortality
Fulltext Morbidity and mortality of infants of diabetic mothers born at the Maternity Hospital, Kuala Lumpur

Boo NY

Med J Malaysia, 1992 Mar;47(1):56-9.
PMID: 1387451

A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.

Matched MeSH terms: Infant Mortality*
Fulltext Outcome of very low birthweight neonates in a developing country: experience from a large Malaysian maternity hospital

Boo NY

Singapore Med J, 1992 Feb;33(1):33-7.
PMID: 1598605

Between January 1989 to April 1990 (16 months), a prospective observational study was carried out on 329 consecutive very low birthweight (VLBW) less than or equal to 1500 grams) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur before their first discharge from the hospital. The objectives of the study were to determine the common causes of early morbidity and mortality of this group of Malaysian neonates. The study shows that the incidence of Malaysian VLBW neonates was 9.9 per 1000 livebirths (95% confidence intervals 9.0 to 10.8). The mean duration of stay in the hospital was 19.3 days (SD = 21.4). One hundred and ninety-six (59.6 percent) of the VLBW neonates died. They accounted for 60 percent (196/334) of all neonatal deaths in the hospital during the study period. Mortality was significantly higher in neonates of birthweight less than 1000 grams (p less than 0.01) and of gestation of less than 33 weeks (p less than 0.001). The three most common clinical problems were respiratory distress syndrome (RDS) (72.6 percent), septicemia (28.0 percent) and intraventricular haemorrhage (IVH) (21.9 percent). Death occurred in 71.1 percent of the septicemic patients. The most common causative organisms of septicemia were multiresistant klebsiella (52.3 percent) and multiresistant acinetobacter (14.7 percent). RDS (33.2 percent), septicemia (29.6%) and IVH (17.9 percent) were the three most common causes of death. Improvement in the nursing staff situation and basic neonatal care facilities in this hospital and prevention of premature delivery could help to decrease morbidity and mortality in this group of neonates.

Matched MeSH terms: Infant Mortality*

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