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Fulltext Comparative review of fourteen years maternal mortality in achieving MDG5 in Malaysia and UKMMC

Abd Rahman, R., Ismail, N.M., Yassin, M.A., Sulaiman, A.S.

Malaysian Journal of Public Health Medicine, 2013;13(1):59-63.
MyJurnal

Worldwide maternal mortality rate had reduced tremendously including Malaysia. At the 2000 Millenium Summit, eight Millenium Development Goals (MDGs) were established with target for the year 2015. Three years remained until the deadline to achieve MDG5, which comprised of two targets and one being reducing the maternal mortality ratio by 75%.This review compared the trend of maternal mortality and its causes in our centre to the national data. The national data had shown a reduction from 44 to 27.6 in 100,000 live births in1991 and 2008 respectively. The subsequent rate had stabilized for the past seven years. In contrast the UKM Medical Centre (UKMMC) data in the past 15 years had not been stable. The target of MDG5 seemed to be achievable by our country but may require longer time as we have yet to find ways to overcome medical care inadequacy in remote areas.

Matched MeSH terms: Maternal Mortality
Venous thromboembolism and pregnancy: A review of the literature

Abdelhafez MM, Ahmed KA, Daud MN, Eldiasty AM, Amri MF, Jeffree MS, et al.

Afr J Reprod Health, 2023 May;27(5):81-94.
PMID: 37584933 DOI: 10.29063/ajrh2023/v27i5.8

This review aims to provide the mother carers with the most recent evidence-based guidelines in the context of managing of pregnancy-associated VTE, where an extensive search through the medical journals addressing the topic including the medical database such as Pubmed, Medline, Sience direct,Embase and others using the title and key-words in order to gather the most concerned as well as the up-to-date publications concerned with the problem under research, the search resulted in recognising pregnancy as a significant risk factor for the development of VTE, both during the prenatal and postnatal periods, with an estimated increased likelihood risk of five and sixty times, respectively and concluded that venous thromboembolism (VTE) is one of the leading causes of maternal mortality hence, all pregnant women should be assessed for the risk of developing the condition as early as possible (when scheduling a booking antenatal appointment) or even in the pre-pregnancy clinic.

Matched MeSH terms: Maternal Mortality
Maternal mortality rate in the Obstetric Unit of University Kebangsaan Malaysia: 1981-1990

Abdullah A, Mahmood JH, Adeeb N

J Obstet Gynaecol (Tokyo 1995), 1995 Jun;21(3):299-303.
PMID: 8590370

This paper analyses maternal mortality as seen in the Obstetric Unit of the University Kebangsaan Malaysia. During the 10 year study period, the maternal mortality rate was 74/100,000 total births. Women who were non-booked, aged above 40 years, gradmultiparous and of India ethnicity were at the highest risk of maternal death. The commonest causes of death were hemorrhage, hypertension, embolism and sepsis. Post-mortem examinations were performed in only 8.2% of women who died.

Matched MeSH terms: Maternal Mortality*
Fulltext Perioperative mortality review in relation to pregnancy-related deaths

Achanna KS, Zaleha AM, Sachchithanantham, Farouk AM

Med J Malaysia, 2006 Aug;61(3):312-9.
PMID: 17240582 MyJurnal

Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.

Matched MeSH terms: Maternal Mortality*
Maternal mortality in the government hospitals, West Malaysia 1967-1969

Ariffin Bin Marzuki, Thambu JA

Med J Malaysia, 1973 Mar;27(3):203-6.
PMID: 4268925
Matched MeSH terms: Maternal 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: Maternal 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: Maternal Mortality
"NO LOSS WITHOUT PROFIT" A STUDY IN MATERNAL MORTALITY

BROWNE AD

Med J Malaysia, 1963 Jun;17:306-15.
PMID: 14060509
Matched MeSH terms: Maternal Mortality*
The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region

Binns C, Lee MK, Low WY, Zerfas A

Asia Pac J Public Health, 2017 Oct;29(7):617-624.
PMID: 29094630 DOI: 10.1177/1010539517736441

The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals (MDCs) in 2015, which included several goals and targets primarily related to nutrition: to eradicate extreme poverty and hunger and to reduce child mortality and improve maternal health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries as a group, infant and child mortality were reduced by more than 65% between 1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were not achieved by several smaller countries. The SDGs are broader in focus than the MDGs, but include several goals that relate directly to nutrition: 2 (zero hunger-food), 3 (good health and well-being-healthy life), and 12 (responsible consumption and production-sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education and equality in gender-education and health for girls and mothers, which is very important for infant health) and 13 (climate action). Goal 3 is "good health and well-being," which includes targets for child mortality, maternal mortality, and reducing chronic disease. The Global Burden of Disease Project has confirmed that the majority of risk for these targets can be attributed to nutrition-related targets. Dietary Guidelines were developed to address public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year. Improving diets and iron supplementation are important public health interventions in the APACPH region. Chronic disease and obesity rates in the APACPH region are now a major challenge and healthy life course nutrition is a major public health priority in answering this challenge. This article discusses the role of public health nutrition in achieving the SDGs. It also examines the role of APACPH in education and advocacy and in fulfilling the educational needs of public health students in public health nutrition.

Matched MeSH terms: Maternal Mortality
ABORTION -- A SURVEY OF 1,000 CASES

CHOON HS

Med J Malaysia, 1963 Jun;17:282-7.
PMID: 14060505
Matched MeSH terms: Maternal Mortality*
Fulltext Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States

Cameron NA, Molsberry R, Pierce JB, Perak AM, Grobman WA, Allen NB, et al.

J Am Coll Cardiol, 2020 Dec 01;76(22):2611-2619.
PMID: 33183896 DOI: 10.1016/j.jacc.2020.09.601

BACKGROUND: Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes.
OBJECTIVES: The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies.
METHODS: We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas.
RESULTS: Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018.
CONCLUSIONS: Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted.

Matched MeSH terms: Maternal Mortality/trends*
A short investigation of infantile mortality and child welfare on estates in Kedah

Cross B

Journal of the Malaya Branch of the British Medical Association, 1940;4:141-63.

Matched MeSH terms: Maternal Mortality
Fulltext Anaesthetic related maternal deaths in Malaysia--a review

Dalina AM, Inbasegaran K

Med J Malaysia, 1996 Mar;51(1):52-63.
PMID: 10967980

The anaesthetic hazards for the obstetric patient are well known. Based on results of the first two reports on the confidential enquiry into maternal deaths in Malaysia for 1991 and 1992, ten cases of anaesthetic related deaths were analysed. There were 3 in 1991 and 7 in 1992 accounting for 1.34% and 2.8% of maternal deaths respectively. It was estimated that the crude mortality rate for the obstetric patient was 11.4 per 100,000 operative deliveries or a four-fold risk compared to the general surgical patient. One case resulted from administration of intravenous sedation while the rest involved general anaesthesia, seven of which were done under emergency conditions. Inadequate airway management and ventilation in the perioperative period, including during interhospital transfer was the single most important factor causing the majority of these deaths. The use of regional anaesthesia for Caesarean sections is strongly advocated. Substandard care was also present in all cases. Other issues pertinent to improvement of obstetric anaesthetic services are also discussed which include the quality of anaesthetic manpower, upgrading of infrastructure, facilities and staffing of operating and recovery areas, the use of regional anaesthesia, expanding the role of the anaesthetist and the quality of the anaesthetic services in general.

Matched MeSH terms: Maternal Mortality*
Geographical epidemiology of the toxemias of pregnancy

Davies AM

Isr. J. Med. Sci., 1971 Jun;7(6):751-821.
PMID: 5560013
Matched MeSH terms: Maternal Mortality
Integrating health interventions for women, newborn babies, and children: a framework for action

Ekman B, Pathmanathan I, Liljestrand J

Lancet, 2008 Sep 13;372(9642):990-1000.
PMID: 18790321 DOI: 10.1016/S0140-6736(08)61408-7

For women and children, especially those who are poor and disadvantaged, to benefit from primary health care, they need to access and use cost-effective interventions for maternal, newborn, and child health. The challenge facing weak health systems is how to deliver such packages. Experiences from countries such as Iran, Malaysia, Sri Lanka, and China, and from projects in countries like Tanzania and India, show that outcomes in maternal, newborn, and child health can be improved through integrated packages of cost-effective health-care interventions that are implemented incrementally in accordance with the capacity of health systems. Such packages should include community-based interventions that act in combination with social protection and intersectoral action in education, infrastructure, and poverty reduction. Interventions need to be planned and implemented at the district level, which requires strengthening of district planning and management skills. Furthermore, districts need to be supported by national strategies and policies, and, in the case of the least developed countries, also by international donors and other partners. If packages for maternal, newborn and child health care can be integrated within a gradually strengthened primary health-care system, continuity of care will be improved, including access to basic referral care before and during pregnancy, birth, the postpartum period, and throughout childhood.

Matched MeSH terms: Maternal Mortality/trends
Fulltext Advances in Family Health Programme in Malaysia

Faridah Abu Bakar

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):3-3.
MyJurnal

The Family Health Programme in Malaysia started off with a humble beginning in the 1920s by the introduction of midwifery legislation under the Straits Settlement Ordinance and the Federal Malay states Midwifery Enactment. Institutionalisation of nursing training took placed in the 1940s while the rural health services for pregnant women and children were established in the 1950’s. In 1967, the school health program was initiated, followed by the de-livery of the school health services in 1972. The Ministry of Health (MoH) set up a Maternal and Child Health unit within the MoH organisation in 1974 to oversee the maternal, child and school health activities. In 1996, the Family Health Development Division was established with the prenatal, adolescent, adult, people with disability and nu-trition health services were incorporated into the family health activities. Subsequently, the age-group wellness and population genetic screening were introduced in year 2000. The family health programme has embraced the public health approach as its building blocks. Throughout the years, individual patient care has advanced the most through the improvement of standards and quality of services within the health clinics. Plateauing of maternal mortality ratio and under-5 mortality rate, increasing trend of non-communicable diseases, remerging of communicable diseases, urbanisation and globalization, and increasing ageing population are new challenges in the delivery of family health services to the community. In order to cater for these challenges, it is crucial to recognise the population health as one of the main component in the family health programmes. Transformation in the scope of new family and popu-lation health is needed to improve the delivery of family programme beyond the boundary of MoH facilities.

Matched MeSH terms: Maternal Mortality
Changing sex ratio of mortality in the Semai Senoi, 1969-1987

Fix AG

Hum Biol, 1991 Apr;63(2):211-20.
PMID: 2019414

An excess of male over female deaths is characteristic of modern national populations, whereas in some high-mortality societies female mortality exceeds that of males. Among the Semai Senoi, a Malaysian Orang Asli ("aboriginal") population, women experienced higher mortality than males in the decades before 1969. This differential occurred in all age classes older than 15 years so that the sex ratio progressively increased with age. A recent (1987) restudy of the Semai population found that sex-specific differential mortality is much reduced. A comparison of the 1969 and 1987 life tables shows a sharp shift in the sex ratios of mortality for the post-15-year-old age classes (the geometric means of age classes 15-44 were 0.768 in 1969 and 0.997 in 1987) so that male and female expectations of further life at age 15 are now nearly identical. In contrast to the best-known cases of high female mortality (mostly in South Asia), Semai sex differential mortality does not include the childhood ages. The Semai have traditionally been relatively sexually egalitarian, and sex bias in care has not occurred. Analysis of sex-specific causes of death for the pre-1969 population suggests that maternal mortality is the major cause of the excess female deaths. The reduced number of maternal deaths seems largely due to better health care, particularly the availability of hospital services. Interestingly, the reduction in female mortality has occurred simultaneously with increased fertility, and overall mortality has continued at relatively high levels (eO less than 36). Thus, rather than forming a component of a unitary demographic transition, declining sex differences in mortality can be accounted for by a specific factor, better maternal care.

Matched MeSH terms: Maternal Mortality
Fulltext Evaluation of the service provision of emergency obstetric care in a tertiary care centre: a clinical audit

Francis Paul, Kent Kong Kian Keong, Jennifer Tan, Anna Lee En Moi, Alen Lim Chung Chieh

Borneo Journal of Medical Sciences, 2020;3(101):5-6.
MyJurnal

Introduction: Maternal death is a sensitive health indicator being monitored closely by the Ministry of Health. Obstetric emergency (OE) protocol is introduced to manage OE and to improve maternal outcome. However, there is no national OE guideline available and the OE protocol varies among different institutions. The current audit aims to evaluate the service quality during OE in Duchess of Kent Hospital (DOKH) in accordance with OE protocol DOKH revision-2017.

Matched MeSH terms: Maternal Mortality
Maternal mortality in Nigeria compared with earlier international experience

Hartfield VJ

Int J Gynaecol Obstet, 1980 7 1;18(1):70-5.
PMID: 6106608
Matched MeSH terms: Maternal Mortality*
Fulltext Measuring maternal mortality in Malaysia

Hematram, Y.

JUMMEC, 2006;9(1):30-34.
MyJurnal

There has been a significant decline in maternal mortality in Malaysia since independence. The issue of measuring maternal mortality accurately is a problem in all countries. Another major problem is whether we can reduce the mortality further. The definition of maternal mortality includes two major components, which are causation of death and the time of death. To improve data collection on maternal deaths, we need to collect all data on maternal deaths, which are omitted or misclassified. Deaths from accidental causes that are not normally used in the calculations of maternal mortality need to be carefully reexamined to be excluded. The time of death means that in maternal mortality calculations, it includes up to six weeks after delivery, but recent World Health Organization (WHO) publication (ICD-10) suggests that the collection of maternal deaths even after six weeks should be reviewed because there are many maternal deaths which occur after six weeks. Measuring maternal mortality rate should be encouraged rather than maternal mortality ratio. Another measurement of maternal mortality is the lifetime risk of the women. The lifetime risk is the measure of maternal mortality that takes into account the probability of becoming pregnant and the probability of dying as a result of pregnancy. Many countries have started reporting the lifetime risk, which is considered to be better indicator to measure maternal health.

Matched MeSH terms: Maternal Mortality

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