Norain A, Sutan R, Azmi M T, Rozita A R
Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Community Health, Cheras, Kuala Lumpur, Malaysia.
Bachok District Health Office, Bachok, Kelantan, Malaysia.
Med J Malaysia. 2023 Jan;78(1):25-31.
The under-five mortality (U5M) trend in Malaysia significantly declined from 30.0 per 1000 live births (1980) to 8.0 per 1000 live births (2004), and the trend plateaued over the next two decades. Stillbirths and neonatal deaths were the major contributors to U5M. Scarce literature addressing factors associated with preventable U5M in Malaysia. The objective of this study was to describe preventable stillbirths and neonatal mortality, the associated factors and recommendation for improvement.
The U5M surveillance data from 2015 to 2017 was retrieved for Malaysian cases of stillbirths and neonatal deaths with multiple pregnancies as exclusion. Stillbirth and neonatal death cases were analysed descriptively for socio-demographic and clinical characteristics. Logistic regressions were performed to identify the associated factors.
There were 15,444 cases selected for analysis, of which 55% of stillbirths and 45% of neonatal deaths. There were 21% of preventable deaths (U5M) and the major contributing causes of preventable stillbirths and neonatal deaths were classified as perinatal death (82.5%), infectious and parasitic diseases (4.1%) and congenital malformations (3.5%). The birth weight (aOR 6.03, 95% CI: 4.14-8.79), hypertensive mother (aOR 1.88, 95% CI: 1.66-2.12) and instrumental delivery (aOR 1.64, 95% CI: 1.16-2.31) were significantly associated with preventable stillbirths and neonatal deaths. Higher household income (>RM3000 per month) was noted as a protective factor (aOR 0.79, 95% CI:0.69,0.89). Mothers with ethnicities other thanBumiputera, single mothers and housewives were identified as the group of mothers with higher odds of poor perinatal services. Among the 3242 cases of preventable stillbirths and neonatal deaths with a complete documented level of adequacy and quality of healthcare, the most frequently identified factors were due to insufficient antenatal care (ANC) (20.4%), non-compliance with medical advice (12.3%) and unsuitable place of delivery (8.6%).
Increasing trend of preventable stillbirths and neonatal deaths was noted over 3 years (2015-2017), and one-fifth was related to insufficient ANC service-related factors. Remedial measures in improving the quality of ANC services with an emphasis on the targeted high-risk maternal socio-demographic group (other Bumiputera, older antenatal mothers, nonmarried, poor family income neglected family) and enhancing ANC competency skills among the healthcare provider through adequate training are required to decrease preventable stillbirths and neonatal deaths in Malaysia.
马来西亚五岁以下儿童死亡率（U5M）趋势从1980年每1000例活产30.0显著下降至2004年每1000例活产8.0，且在接下来的二十年中该趋势趋于平稳。死产和新生儿死亡是五岁以下儿童死亡率的主要原因。关于马来西亚可预防的五岁以下儿童死亡率相关因素的文献稀少。本研究的目的是描述可预防的死产和新生儿死亡率、相关因素及改进建议。
检索2015年至2017年马来西亚死产和新生儿死亡的五岁以下儿童死亡率监测数据，排除多胎妊娠病例。对死产和新生儿死亡病例的社会人口学和临床特征进行描述性分析。进行逻辑回归以确定相关因素。
共选择15444例病例进行分析，其中55%为死产，45%为新生儿死亡。可预防死亡（五岁以下儿童死亡率）占21%，可预防死产和新生儿死亡的主要促成原因分类为围产期死亡（82.5%）、传染病和寄生虫病（4.1%）以及先天性畸形（3.5%）。出生体重（调整后比值比6.03，95%置信区间：4.14 - 8.79）、母亲患有高血压（调整后比值比1.88，95%置信区间：1.66 - 2.12）和器械助产（调整后比值比1.64，95%置信区间：1.16 - 2.31）与可预防的死产和新生儿死亡显著相关。家庭收入较高（每月超过3000令吉）被视为保护因素（调整后比值比0.79，95%置信区间：0.69，0.89）。非马来族母亲、单身母亲和家庭主妇被确定为围产期服务较差几率较高的母亲群体。在3242例有完整记录的医疗保健充分性和质量水平的可预防死产和新生儿死亡病例中，最常确定的因素是产前护理不足（20.4%）、不遵守医嘱（~12.3%）和分娩地点不合适（8.6%）。
在2015年至2017年的三年间，可预防的死产和新生儿死亡呈上升趋势，其中五分之一与产前护理服务相关因素不足有关。需要采取补救措施提高产前护理服务质量，重点关注目标高危孕产妇社会人口学群体（非马来族、高龄产前母亲、未婚、家庭收入低、被忽视家庭），并通过充分培训提高医疗保健提供者的产前护理能力，以降低马来西亚可预防的死产和新生儿死亡。
