Information on determinants of postpartum death enhances understanding of the fundamental causes of mortality. Studies on postpartum death in Malaysia are limited despite increasing trends of postpartum mortality. This study aimed to ascertain the determinants of postpartum death in Selangor, Malaysia. A case control was conducted using data from the Maternal Death Registry, Selangor State Health Department, Malaysia. A total of 144 postpartum death cases were included for analysis after the removal of fortuitous and unknown death. Controls were mothers who survived six weeks after childbirth and were selected via simple random sampling. The odds of postpartum death among multiparous was almost two times higher (aOR; 1.76 95% CI 1.10,2.82). The presence of pre-existing medical or surgical problems were associated with a three-folds increase in the odds of postpartum death (aOR 3.23; 95% CI 1.91,5.47). The odds of postpartum death were ten times higher for those who gave birth in non-health facilities (aOR 10.62; 95% CI 2.64,42.74). Women who underwent caesarean section had almost three times more odds (aOR 2.50; 95% CI 1.60,3.91) for death. Women who received antenatal care in government health facilities had low odds (aOR 0.34; 95% CI 0.19,0.60) for postpartum death. The determinants showed significant association with postpartum death in Selangor, Malaysia which included the presence of pre-existing medical or surgical illness, place of birth, mode of birth, place of antenatal care and Malaysian ethnicity-citizenship. In the future, health programmes should not only aim to reduce postpartum deaths by emphasising maternal education and empowerment, but should also enhance pre-pregnancy care, provide continual obstetric emergency skill training to healthcare providers, collaborate with several agencies and underwrite migrants’ maternal healthcare fees.
Seven Years Analysis of Postpartum Death in Selangor, Malaysia: A Lesson Learnt
Abstrak
Maklumat tentang penentu kematian selepas bersalin meningkatkan pemahaman tentang punca asas kematian. Kajian mengenai kematian selepas bersalin di Malaysia adalah terhad walaupun terdapat peningkatan trend kematian selepas bersalin. Kajian ini bertujuan untuk mengenal pasti faktor penentu kematian selepas bersalin di Selangor, Malaysia. Kawalan kes telah dijalankan menggunakan data dari Rekod Pendaftaran Kematian Ibu, Jabatan Kesihatan Negeri Selangor, Malaysia. Sebanyak 144 kes kematian selepas bersalin dimasukkan untuk analisis selepas mengeluarkan kes kematian yang tidak disengajakan dan tidak diketahui. Kawalan adalah ibu yang terselamat enam minggu selepas bersalin dan dipilih melalui persampelan rawak mudah. Kebarangkalian kematian selepas bersalin di kalangan multipara adalah hampir dua kali ganda lebih tinggi (aOR; 1.76 95% CI 1.10,2.82). Kehadiran masalah perubatan atau pembedahan yang sedia ada dikaitkan dengan peningkatan tiga kali ganda dalam kebarangkalian kematian selepas bersalin (aOR 3.23; 95% CI 1.91,5.47). Kebarangkalian kematian selepas bersalin adalah sepuluh kali lebih tinggi bagi mereka yang bersalin di fasiliti bukan kesihatan (aOR 10.62; 95% CI 2.64,42.74). Wanita yang menjalani pembedahan caesar mempunyai kebarangkalian hampir tiga kali ganda (aOR 2.50; 95% CI 1.60,3.91) untuk kematian. Wanita yang menerima penjagaan antenatal di fasiliti kesihatan kerajaan mempunyai kebarangkalian rendah (aOR 0.34; 95% CI 0.19,0.60) untuk kematian selepas bersalin. Faktor penentu menunjukkan perkaitan yang signifikan dengan kematian selepas bersalin di Selangor, Malaysia, termasuk kehadiran penyakit perubatan atau pembedahan yang sedia ada, tempat bersalin, cara kelahiran, tempat penjagaan antenatal dan status kewarganegaraan Malaysia. Program kesihatan masa depan sepatutnya bukan hanya bertujuan untuk mengurangkan kematian selepas kematian melalui pendidikan dan pemerkasaan, tetapi juga mempertingkatkan jagaan pra-kehamilan, menyediakan latihan untuk kemahiran kecemasan obstetrik kepada kakitangan perubatan, bekerjasama dengan beberapa agensi dan manaja jamin yuran perubatan maternal bagi migran.
Kata kunci
Abstract
Keywords
|
|
|
