METHODS: Age-standardized mortality rates were calculated for 16 amenable causes of death in Singapore for six 5-year periods (1965-1969,..., 1990-1994), and for each of the three main ethnic groups for three periods (1989-1991, 1992-1994, 1995- 1997). Amenable mortality rates were divided into those which can be reduced by timely therapeutic care for 'treatable' conditions (e.g. asthma and appendicitis), or by primary preventive measures for 'preventable' conditions (e.g. lung cancer and motor vehicle injury).
RESULTS: Amenable mortality was higher in males (age-standardized rate 109.7 per 100 000 population) than in females (age-standardized rate 60.7 per 100 000 population). Amenable mortality declined by 1.77% a year in males and 1.72% a year in females. By comparison, the average yearly decline in non-amenable mortality was 0.91% in males and 1.17% in females. The decline in amenable mortality was largely due to 'treatable' causes rather than a decline in mortality due to 'preventable' causes of death. Amenable mortality was lowest for Chinese and highest for Malays. Over the recent 9-year period from 1989 to 1997, amenable mortality declined more in Chinese than in Malays and Indians. However, Indian females showed by far the sharpest decline, whereas Indian males, by contrast, showed an increase in amenable mortality, due to both treatable and preventable causes.
CONCLUSIONS: In line with findings from European countries, amenable mortality in Singapore declined more than non-amenable mortality. There were more significant gains in mortality outcomes from medical care interventions than from primary preventive policy measures. Gender and ethnic differences in amenable mortality were also observed, highlighting issues of socioeconomic equities to be addressed in the financing and delivery of health care.
METHODS: Retrospective analysis of all children (< 12 years) dying in the PICU from January 1995 to December 1995 and January 1997 to June 1998 (n = 148).
RESULTS: The main mode of death was by limitation of treatment in 68 of 148 patients, failure of active treatment including cardiopulmonary resuscitation in 61, brain death in 12, and withdrawal of life support with removal of endotracheal tube in seven. There was no significant variation in the proportion of limitation of treatment, failure of active treatment, and brain death between the two periods; however, there was an increase in withdrawal of life support from 0% in 1995 to 8% in 1997-98. Justification for limitation was based predominantly on expectation of imminent death (71 of 75). Ethnic variability was noted among the 14 of 21 patients who refused withdrawal. Discussions for care restrictions were initiated almost exclusively by paediatricians (70 of 75). Diagnostic uncertainty (36% v 4.6%) and presentation as an acute illness were associated with the use of active treatment.
CONCLUSIONS: Limitation of treatment is the most common mode of death in a developing country's PICU and active withdrawal is still not widely practised. Paediatricians in developing countries are becoming more proactive in managing death and dying but have to consider sociocultural and religious factors when making such decisions.
METHOD: A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.
RESULTS: Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208-1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies (n = 66, and nine of them also had incomplete records) and incomplete records (n = 82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.
CONCLUSION: The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.