malaysian health and healthcare dr siti hajar binti daud ketua penolong pengarah kanan (perubatan)...

Malaysian Health and Healthcare

Performance Report

General Health Status

Maternal and Child Mortality

2014

MALAYSIAN HEALTHCARE PERFORMANCE UNIT

Authors:

Seet Wymen

Ariza binti Zakaria

Joseph Ng Soon Heng

Mohd Kamarulariffin bin Kamarudin

Editors:

Jamaiyah binti Haniff

Theyveeka Selvy a/p Rajoo @ Balusamy Radia

General Health Status, Maternal and Child Mortality

ii

Disclaimer:

Findings in this report maybe different from other published reports. This is because

analysis for this report was done based on the latest dataset obtained from the

Department of Statistics Malaysia and Family Health Development Division, Ministry

of Health Malaysia.

Acknowledgement of Funding:

This report is supported by National Institutes of Health (NIH), Ministry of Health

Malaysia.

Published by:

Malaysian Healthcare Performance Unit

National Institute of Health,

c/o Deputy Director General (Research and Technical Support) Office

Ministry of Health Malaysia

Block E7, Federal Government Administrative Centre

62590 Putrajaya,

Malaysia.

Tel : (603) 8000 8000

Fax : (603) 8888 6187

Email : [email protected], [email protected]

This report is not copyrighted. Therefore it may be freely reproduced with the

permission of the Malaysian Healthcare Performance Unit. Acknowledgement would

be appreciated. All enquiries should be directed to the editors of this report.

Suggested citation is: Malaysian Health and Healthcare Performance Report 2014.

Malaysian Healthcare Performance Unit. Ministry of Health Malaysia.

mailto:[email protected]

mailto:[email protected]


iii

ACKNOWLEDGEMENTS

We wish to thank YBhg. Datuk Dr Noor Hisham bin Abdullah, Director General of

Health and Dr Shahnaz binti Murad, the Deputy Director General of Health

(Research & Technical Support) for their guidance. A special mention is dedicated to

the Director of National Clinical Research Centre, Dr Goh Pik Pin for her strong

support. Acknowledgement also goes to all our stakeholders as listed below:-

Y.Bhg. Datuk Dr Lokman Hakim bin Sulaiman

Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam)

Kementerian Kesihatan Malaysia

Y.Bhg. Dato' Dr Hj Azman bin Abu Bakar

Pengarah

Bahagian Perkembangan Perubatan


YBhg. Datuk Dr Haji Abdul Rahman bin Hasan

Ketua Perangkawan

Jabatan Perangkaan Malaysia

Dato’ Dr Ahmad Razin bin Dato’ Haji Ahmad Mahir

Pengarah

Jabatan Kesihatan Negeri Kelantan

Y.Bhg. To’ Puan Dr Safurah binti Hj Jaafar

Pengarah

Bahagian Pembangunan Kesihatan Keluarga (BPKK)


Datuk Dr Zulkifli bin Jantan

Pengarah

Jabatan Kesihatan Negeri Sarawak

Dato’ Dr Norhizan bin Ismail

Pengarah

Jabatan Kesihatan Negeri Kedah


iv

Dr Haji Mohammad bin Omar

Pengarah

Jabatan Kesihatan Negeri Terengganu

Dr Zaini bin Hussin

Pengarah

Jabatan Kesihatan Negeri Perlis

Dr Md. Khadzir bin Sheikh Hj. Ahmad

Timbalan Pengarah

Pusat Informatik Kesihatan (PIK)


SPECIAL THANKS FOR FINAL REVIEW

Professor Niek Klazinga

Health Care Quality Indicator Project Directorate for Employment, Label, and

Social Affair (OECD)


v

THE EDITORIAL BOARD

Editors:

Dr Jamaiyah binti Haniff

Ketua Unit



Dr Theyveeka Selvy a/p Rajoo @ Balusamy Radia

Pakar Bedah Umum



Contributors:

Y.Bhg. Dato' Dr Hussain Imam bin Haji Mohammad Ismail

Pakar Perunding Kanan & Ketua Jabatan Pediatrik

Hospital Kuala Lumpur

Dr Ravichandran a/l Jeganathan

Pakar Perunding Kanan & Ketua Jabatan Obstetrik dan Ginekologi (O&G)

Hospital Sultanah Aminah, Johor Bahru

Dr Roslinah binti Ali

Pengarah

Institut Penyelidikan Sistem Kesihatan (IPSK)

Dr Christina Rundi

Pengarah

Jabatan Kesihatan Negeri Sabah

Dr Kamariah binti Hussain

Timbalan Pengarah Kesihatan (Kesihatan Awam)

Jabatan Kesihatan Negeri Perlis

Dr Hayati binti Mohd Radzi

Timbalan Pengarah Kesihatan (Kesihatan Awam)

Jabatan Kesihatan Negeri Kedah

Dr Jamilah binti Hashim

Timbalan Pengarah Kesihatan

Jabatan Kesihatan Negeri Sarawak


vi

En. Ahmad Jessree bin Kamaruddin

Timbalan Pengarah

Bahagian Perangkaan Penduduk dan Demografi


Dr Sharmala Devi Karalasingam

Pakar Perunding Kanan Obstetrik dan Ginekologi (O&G)

Pusat Penyelidikan Klinikal Kebangsaan

Datin Dr Siti Hajar binti Daud

Ketua Penolong Pengarah Kanan (Perubatan)

Jabatan Kesihatan Negeri Terengganu

Dr Mahani binti Abdul Hamidy

Ketua Penolong Pengarah Kanan

Bahagian Perancangan


Dr Siti Sara binti Yaacob


Cawangan Kualiti Penjagaan Perubatan



Dr Arpah binti Ali


Cawangan Perkembangan Perkhidmatan Perubatan



Dr Jafanita binti Jamaludin


Cawangan Perkembangan Perkhidmatan Perubatan



Dr Zul Azuin binti Zulkifli


Bahagian Pembangunan Kesihatan Keluarga



vii

Dr Yeong May Luu


Bahagian Pembangunan Kesihatan Keluarga


Dr Junaideen bin Mohamad Zain

Pegawai Kesihatan Daerah

Jabatan Kesihatan Negeri Kelantan

En. Mohd Sofi bin Ali

Ketua Penolong Pengarah

Bahagian Perangkaan Penduduk & Demografi



viii

SOURCES DATA PROVIDERS

Pusat Informatik Kesihatan (PIK)


Bahagian Pembangunan Kesihatan Keluarga (BPKK)


Bahagian Perangkaan Penduduk & Demografi



ix

THE CORE TEAM MEMBERS

(MALAYSIAN HEALTHCARE PERFORMANCE UNIT)

Project Manager:

Dr Theyveeka Selvy a/p Rajoo @ Balusamy Radia

Team Members:

Dr Seet Wymen

Dr Ariza binti Zakaria

Dr Joseph Ng Soon Heng

Dr Mohd Kamarulariffin bin Kamarudin

Cik Nur Naim binti Ghazali

Cik Nadiah Hanis binti Hashim

Cik Maisarah binti Mahari

En. Muhammad Afiq bin Mohd Jaffar


x

ABBREVIATIONS

ABBREVIATION FULL NAME

APH Antepartum Haemorrhage

BPKK Bahagian Pembangunan Kesihatan Keluarga

CDR Crude Death Rate

DSOM Department Of Statistics Malaysia

FHDD Family Health Development Division

HDP Hypertensive Disorders of Pregnancy

IHSR Institute for Health Systems Research

ISSN International Standard Serial Number

MDG Millennium Development Goal

MHPU Malaysian Healthcare Performance Unit

MMR Maternal Mortality Ratio

MNNR Malaysian National Neonatal Registry

MOH Ministry Of Health, Malaysia

NCRC National Clinical Research Centre

NIH National Institutes of Health

NOR National Obstetric Registry

OECD Organization for Economic Co-operation and Development

PIK Pusat Informatik Kesihatan

PPH Postpartum Haemorrhage

UNICEF United Nations Children's Fund

WHO World Health Organization

WP Wilayah Persekutuan


xi

TABLE OF CONTENTS

ACKNOWLEDGEMENTS .................................................................................................. iii

SOURCES DATA PROVIDERS ...................................................................................... viii

THE CORE TEAM MEMBERS .......................................................................................... ix

ABBREVIATIONS ............................................................................................................. x

TABLE OF CONTENTS..................................................................................................... xi

LIST OF FIGURES .......................................................................................................... xiii

EXECUTIVE SUMMARY .................................................................................................. xv

INTRODUCTION ............................................................................................................... 1

Chapter 1 : GENERAL HEALTH STATUS OF THE NATION ................................................ 2

1.1. Life Expectancy at Birth .......................................................................................... 2

1.1.1. Definition ............................................................................................................. 2

1.1.2. Rationale for use ................................................................................................. 2

1.1.3. Findings .............................................................................................................. 2

1.1.3.1. Internal benchmarking ..................................................................................... 2

1.1.3.2. External Benchmarking .................................................................................... 8

1.2. Mortality .................................................................................................................. 9

1.2.1. Definition of Crude Death Rate ............................................................................ 9

1.2.2. Rationale for use ................................................................................................. 9

1.2.3. Findings .............................................................................................................. 9

1.2.3.1. Internal Benchmarking ..................................................................................... 9

1.2.3.2. External Benchmarking .................................................................................. 12

Chapter 2 : CHILD HEALTHCARE ..................................................................................... 14

2.1. Crude Birth Rate ................................................................................................... 14

2.1.1. Definition ........................................................................................................... 14

2.1.2. Rationale for use ............................................................................................... 14

2.1.3. Findings ............................................................................................................ 14

2.1.3.1. Internal Benchmarking ................................................................................... 15

2.2. Stillbirth ................................................................................................................. 18

2.2.1. Definition ........................................................................................................... 18


2.2.3. Findings ............................................................................................................ 18



xii

2.3. Perinatal Mortality ................................................................................................. 22

2.3.1. Definition ........................................................................................................... 22


2.3.3. Findings ............................................................................................................ 22


2.4. Neonatal Mortality ................................................................................................. 26

2.4.1. Definition ........................................................................................................... 26


2.4.3. Findings ............................................................................................................ 26

2.4.3.1. Internal benchmarking ................................................................................... 27

2.5. Infant Mortality ...................................................................................................... 31

2.5.1. Definition ........................................................................................................... 31


2.5.3. Findings ............................................................................................................ 31



2.6. Under-five Mortality ............................................................................................... 35

2.6.1. Definition ........................................................................................................... 35


2.6.3. Findings ............................................................................................................ 35



2.7. Additional Information on Childhood Mortality Trending ........................................ 39

Chapter 3 : MATERNAL HEALTHCARE ............................................................................. 41

3.1. Maternal mortality ................................................................................................. 41

3.1.1. Definition ........................................................................................................... 41

3.1.2. Rationale of use ................................................................................................ 41

3.1.3. Findings ............................................................................................................ 41



3.2. Millennium Development Goal 5 ........................................................................... 46

Challenges and Recommendations ................................................................................. 47

References ...................................................................................................................... 48


xiii

LIST OF FIGURES

Figure 1.1: Malaysian life expectancy at birth ........................................................................ 3

Figure 1.2: Male life expectancy by states of Malaysia .......................................................... 4

Figure 1.3: Female life expectancy by states of Malaysia ...................................................... 4

Figure 1.4: Life expectancy in Malaysia by ethnicity in 2011 .................................................. 5

Figure 1.5 (a),(b),(c),(d),(e): Life expectancy of Malaysian males .......................................... 6

Figure 1.6 (a),(b),(c),(d),(e): Life expectancy of Malaysian Females ...................................... 7

Figure 1.7: Life expectancy at birth, by country and sex, 1970 vs 2010 3 ............................... 8

Figure 1.8: Number of deaths in Malaysia from 2008 to 2012 .............................................. 10

Figure 1.9: Crude death rate according to states ................................................................. 10

Figure 1.10 (a),(b),(c),(d),(e): Crude death rate of Malaysia according to regions ................ 11

Figure 1.11: Adult mortality rate for ages 15 to 60, 2009 ..................................................... 12

Figure 1.12: All causes, estimated mortality rates, 2008 ...................................................... 13

Figure 2.1: Live birth numbers by states in Malaysia, 2008-2012 ........................................ 15

Figure 2.2: Crude birth rates by states in Malaysia, 2008-2012 ........................................... 15

Figure 2.3 (a),(b),(c),(d),(e): Crude birth rates by regions in Malaysia, 2008-2012 ............... 16

Figure 2.4: Crude birth rates by gender in Malaysia, 2008-2012 ......................................... 17

Figure 2.5: Number of stillbirths by state in Malaysia, 2008-2012 ........................................ 19

Figure 2.6: Stillbirth rates by states in Malaysia, 2008-2012 ................................................ 19

Figure 2.7 (a),(b),(c),(d),(e): Stillbirth rates by regions in Malaysia, 2008-2012 .................... 20

Figure 2.8: Stillbirth rates by gender in Malaysia, 2008-2012 .............................................. 21

Figure 2.9: Number of perinatal mortalities by state in Malaysia, 2008-2012 ....................... 23

Figure 2.10: Perinatal mortality rates by states in Malaysia, 2008-2012 .............................. 23

Figure 2.11 (a),(b),(c),(d),(e): Perinatal mortality rates by regions in Malaysia, 2008-2012 .. 24

Figure 2.12: Perinatal mortality rates by gender in Malaysia, 2008-2012 ............................. 25

Figure 2.13: Number of neonatal mortality by states in Malaysia, 2008-2012 ...................... 27

Figure 2.14: Neonatal mortality rates by states in Malaysia, 2008-2012 .............................. 27

Figure 2.15 (a),(b),(c),(d),(e): Neonatal mortality rates by regions in Malaysia, 2008-2012 . 28

Figure 2.16: Neonatal mortality rates by gender in Malaysia, 2008-2012 ............................. 29

Figure 2.17: Neonatal mortality rates by categories in Malaysia, 2008-2012 ....................... 29

Figure 2.18: Causes of neonatal mortality in Malaysia, 2008-2012 ...................................... 30

Figure 2.19: Number of infant deaths by states in Malaysia, 2008 - 2012 ............................ 32

Figure 2.20: Infant mortality rates by states in Malaysia, 2008 - 2012 ................................. 32

Figure 2.21 (a),(b),(c),(d),(e): Infant mortality rates by regions in Malaysia, 2008-2012 ....... 33

Figure 2.22: Infant mortality rates by gender in Malaysia, 2008-2012 .................................. 34

Figure 2.23: Infant mortality rate, 2010 and decline, 1980 and 2010 3 ................................. 34


xiv

Figure 2.24: Number of under-five mortalities by states in Malaysia, 2008-2012 ................. 36

Figure 2.25: Under-five mortality rates by states in Malaysia, 2008 - 2012 .......................... 36

Figure 2.26 (a),(b),(c),(d),(e): Under-five mortality rates by regions in Malaysia, 2008-2012 37

Figure 2.27: Under-five mortality rates by gender in Malaysia, 2008-2012 .......................... 38

Figure 2.28: Benchmarking Malaysia for under-5 mortality 2012 ........................................ 38

Figure 2.29: Trends between childhood mortality indicators from 2000 to 2012 ................... 39

Figure 2.30: Trends of neonatal mortality, infant mortality and under-five mortality rate of

Malaysia, from 1990 to 2010 ............................................................................. 40

Figure 3.1: Number of maternal mortality by states in Malaysia, 2008-2012 ........................ 42

Figure 3.2: Maternal mortality ratios by states in Malaysia, 2008-2011 ................................ 42

Figure 3.3: Maternal mortality ratios by regions in Malaysia, 2008-2011 .............................. 43

Figure 3.4: Cause of maternal deaths during postpartum stage .......................................... 44

Figure 3.5: Estimated maternal mortality ratios, selected countries, 1990-2010 .................. 45

Figure 3.6: Trend of maternal mortality ratio in Malaysia from 1933 to 2012 ........................ 46


xv

EXECUTIVE SUMMARY

This is the first report that focused on healthcare performance benchmarking. It

covers three chapters on health status (life expectancy at birth and all-cause

mortality), child and maternal healthcare performance indicators (standard mortality

indicators such as stillbirth, perinatal, neonatal, under-five and maternal mortalities).

This report mainly used the 5 years secondary data series 2008-2012 from

Department of Statistics Malaysia and standard indicators. In summary as a nation

the health status in terms of life expectancy has improved. However international

benchmarking showed that the rate of improvement is moderate. Ethnic and state

variation existed.

Stillbirth, perinatal, neonatal, under-five rates has also improved since 1990, yet from

year 2000 onwards these rates have plateaued.

Maternal mortality rate has also improved and performance with international was

below Asia 20 but above OECD. Yet Malaysia has not achieved the MDG 5 target in

2015.

In conclusion, this first report serves as a proof that performance benchmarking of

Malaysian health and healthcare is possible. In order to have better quality and more

timely reporting in the coming years, MHPU need to work closer with partners to

develop a National Performance Framework incorporating meaningful National

Indicators for benchmarking. There is a need for better data governance albeit data

sharing policy and guidelines as well as a need to build and capitalize on big data

analytics. Lastly and most important is to get buy-in from data holders for better

teamwork and quality data.


1

INTRODUCTION

Background

This is the first report that focuses on Malaysian health and healthcare system with

the aim to benchmark the system performance at local and international level.

Apart from feeding information to the health policy makers and planners, the purpose

of the report is also to advocate dissemination of information about our healthcare

performance publicly in a transparent manner.

Methodology

This report leverages on existing indicators used in Ministry of Health (MOH) and

non-MOH agencies that examine trends in health care quality across all the 13

states; Johor, Melaka, Negeri Sembilan, Kedah, Kelantan, Pahang, Perak, Perlis,

Pulau Pinang, Sabah, Sarawak, Selangor, Terengganu, and three federal territories:

WP Labuan, WP Kuala Lumpur and WP Putrajaya.

The indicators were selected on the basis of their relevance to the local health

needs, taking into account their definitions and comparability of existing and

published data.

This report uses routinely collected secondary data. The main sources of data are

the Department of Statistics Malaysia (DOSM) and Family Health Development

Division MOH.

A 5-year data series was constructed from 2008 to 2012. Year 2011 was set as the

index year because data from 2012 was preliminary.

Structure of the report

This report consists of three chapters with each chapter having two subsections;

internal and external benchmarking. Internal benchmarking refers to benchmarking

performance for the 13 states and three federal territories whereas external

benchmarking compares Malaysia with the selected OECD and Asia 20 /22

countries.

Chapter 1 provides an overview of health status of the nation in terms of life

expectancy at birth and all-cause mortality.

Chapter 2 and 3 highlight child and maternal healthcare performance indicators

using standard mortality indicators such as stillbirth, perinatal, neonatal, under-five

and maternal mortalities.


2

Chapter 1 : GENERAL HEALTH STATUS OF THE NATION

This chapter provides an overview of the Malaysian general health status using both

life expectancy at birth and mortality as performance indicator.

1.1. Life Expectancy at Birth

1.1.1. Definition:

Life Expectancy at birth is defined by various institutions and agencies as below;

1. Life Expectancy at birth is the average remaining age (years) for a person

expected to live at birth 1.

2. The average number of years that a new-born could expect to live, if he or she

were to pass through life exposed to the sex- and age-specific death rates

prevailing at the time of his or her birth, for a specific year, in a given country,

territory, or geographic area 2.

3. Life expectancy at birth is the average number of years that a person can be

expected to live, assuming that age-specific mortality levels remain constant 3.

1.1.2. Rationale for use:

Life Expectancy at birth reflects the overall mortality level of a population across all

age groups. Life Expectancy and mortality interact in a reciprocal relationship. If

mortality rate generally decreases, Life Expectancy will generally increase. However,

increase in Life Expectancy does not solely translate into fewer disease incidences

as people can also live longer with diseases through better management.

1.1.3. Findings

1.1.3.1. Internal benchmarking

Figure 1.1 shows gradual increase from 1991 to 2013 in life expectancy at birth for

both genders. The life expectancy at birth in Malaysia from 2002 through 2012p

increased by 2.1% and 2.5% for male and female respectively.


3

78

76

Male 74

Female

72

70

68

e=estimate p = preliminary

66

64

Figure 1.1: Malaysian life expectancy at birth

Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

The estimated life expectancy at birth in 2013e was 72.5 and 77.1 years for male and

female respectively. Sabah and Sarawak population generally lived longer whereas

Kelantan and Terengganu population had the shortest life span (Figure 1.2 and

Figure 1.3). Over the 4-year period (2010-2013), life expectancy at birth improved

steadily across all states. Male from Indian ethnicity had the shortest life expectancy

overall in 2011 (Figure 1.4).

Lif

e e

xp

ec

tan

cy (

ye

ars

)


4

79

78

77

76

75

74

73

72

71

76

74

2010

2011p 72

2012e

2013e

70 p – preliminary e – estimate

68 1 – Includes WP Labuan

2 – Includes WP Putrajaya 66

64

Figure 1.2: Male life expectancy by states of Malaysia Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

80

2010

2011p

2012e

2013e

p – preliminary e – estimate

1 – Includes WP Labuan

2 – Includes WP Putrajaya

Figure 1.3: Female life expectancy by states of Malaysia Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Life e

xp

ecta

ncy (

years

) Life e

xp

ecta

ncy (

years

)


5

75.80 79.30 75.60 Female

67.60 74.60 70.90 Male

Indian Chinese Bumiputera

82

80

78

76

74

72

70

68

66

64

62

60

Figure 1.4: Life expectancy in Malaysia by ethnicity in 2011 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Life e

xp

ecta

ncy (

years

)


6

(a) (b)

(c) (d)

(e)

Figure 1.5 (a),(b),(c),(d),(e): Life expectancy of Malaysian males by regions in Malaysia

Source: Department of Statistics Malaysia. All graphs were generated by the MHPU.


7

(a) (b)

(c) (d)

(e)

Figure 1.6 (a),(b),(c),(d),(e): Life expectancy of Malaysian Females according to regions in Malaysia



8

Japan Hong Kong, China

Australia Singapore

New Zealand Korea, Rep.

Macau, China OECD

Brunei Darussalam Sri Lanka Viet Nam Malaysia Thailand

China Asia - 22

Fiji Indonesia

Korea, DPR Bangladesh Philippines

Nepal Mongolia

Solomon Islands Lao PDR Pakistan

India Myanmar Cambodia

Papua New Guinea

1.1.3.2. External Benchmarking

Malaysian life expectancy was below that of OECD countries but slightly above that

of Asia-22 (22 selected Asian countries) for both genders in 1970 and 2010 (Figure

1.7).

Figure 1.7: Life expectancy at birth, by country and sex, 1970 vs 2010 3


9

1.2. Mortality

Mortality is one of the most common measures of population health. There can be

different rates of mortality depending on specific groups of which they address. The

rate can also be computed based on overall population death.

1.2.1. Definition of Crude Death Rate

Crude death rate (CDR) is the ratio of the number of deaths in a year to the mid-year

population for that year (per thousand population) 7.

1.2.2. Rationale for use

Crude death rate disregards the age structure of the population. Therefore it should

be interpreted as it is and not to be compared with other population with different

ageing population.

1.2.3. Findings

1.2.3.1. Internal Benchmarking

CDR in Malaysia was 4.7 per 1000 population in 2011. The CDR ranged

approximately 4.6 to 4.8 from 2008 to 2012 (Figure 1.9).

The range spanned from a low 2.4 per 1000 in Sabah and WP Labuan to 6.9 per

1000 population in Perlis respectively (Figure 1.9). The range varied widely from

state to state.


10

(a) Numbers of deaths

20,000

15,000

10,000

5,000

0

2008

2009

2010

2011

2012p

p=Preliminary

Number of deaths for WP Putrajaya is incorporated in Selangor for 2008 and 2009 Source : Department of Statistics Malaysia

Total deaths in Malaysia 2008: 134857 2009:130135 2010:130978 2011: 135463 2012p: 136836

Figure 1.8: Number of deaths in Malaysia from 2008 to 2012 according to states


(b) Crude death rate

2008

2009

2010

2011

2012p

p=Preliminary

Crude death rate for WP Putrajaya is incorporated in Selangor during 2008 and 2009

Figure 1.9: Crude death rate according to states


8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Num

ber

of

de

ath

s

Cru

de D

eath

rate

per

10

00 p

opula

tion


11

(a) (b)

(c) (d)

(e)

Figure 1.10 (a),(b),(c),(d),(e): Crude death rate of Malaysia according to regions Source: Department of Statistics Malaysia. All graphs were generated by the MHPU.


12

Males

Females

300

200

100

0


Age standardization will remove the effect of population age structure on mortality

rate between groups under comparison.

Figure 1.12 shows the age standardized mortality rate in Malaysia; 762 deaths per

100 000 population in comparison with selected countries in the neighboring regions.

Malaysia had a higher mortality than the OECD average (474 per 100,000

populations); but lower than the Asia-20 (902 per 100,000 population).

In Malaysia, mortality rate for males is almost twice that of females. Nevertheless,

this phenomenon is in parallel with generally many other countries where figure for

male gender death is always higher (Figure 1.11) 3.

Benchmarking countries in Asia needs to be done with caution because some of the

developing countries do not have complete vital registration system 3 & 4.

400

Figure 1.11: Adult mortality rate for ages 15 to 60, 2009

Source: WHO(2012f);Statlink http:/dx.doi.org/10.1787/888932722905

Per

1 0

00 p

opula

tion


13

Figure 1.12: All causes, estimated mortality rates, 2008

Source: WHO Global Burden of Disease, 20114 and OECD

3, Graph reproduced by MHPU

Myanmar Cambodia Lao PDR Papua New Guinea Pakistan India Bangladesh Nepal Indonesia Fiji Sri Lanka Thailand Asia - 20 Philippines Mongolia Korea DRP Solomon Islands Viet Nam Malaysia China Brunei Darussalam OECD Korea Rep New Zealand Singapore Australia Japan


14

Chapter 2 : CHILD HEALTHCARE

This chapter describes healthcare performance in term of Crude Birth Rate, Stillbirth

Rate, Perinatal Mortality, Neonatal Mortality, Infant Mortality and Under-five Mortality.

2.1. Crude Birth Rate

2.1.1. Definition

Crude birth rate is defined as a ratio of the number of live births during a year to the

mid-year population in that year (per 1000 population) 7.

Live birth refers to the complete expulsion or extraction from its mother of a product

of conception, irrespective of the duration of the pregnancy, which, after such

separation, breathes or shows any other evidence of life - e.g. beating of the heart,

pulsation of the umbilical cord or definite movement of voluntary muscles - whether

or not the umbilical cord has been cut or the placenta is attached. Each product of

such a birth is considered live born 5.


Crude birth rate is an important component of growth in the country which

determines the natural growth rate of the population.

2.1.3. Findings

The birth rates recorded across the different states for the specified time period

appear to be consistent with only few exceptions: the relatively high birth rates seen

in the East Coast states of Kelantan and Terengganu and the remarkably high birth

rate in record for WP Putrajaya.


15


(a) Numbers of live births

120,000

100,000

80,000

60,000

40,000

20,000

-

2008

2009

2010

2011

2012p

p=Preliminary

Number of live births for WP Putrajaya were incorporated into Selangor in 2008 and 2009

Total cases in Malaysia: 2008: 487,346 cases 2009: 496,313 cases 2010: 491,239 cases 2011: 511,594 cases 2012p: 508, 774 cases

(b) Crude birth rate

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

-

2008

2009

2010

2011

2012p

p = Preliminary

Crude birth rates for WP Putrajaya were incorporated into Selangorin 2008 and 2009

Num

ber

of

live b

irth

s

Cru

de b

irth

rate

(pe

r 1

,00

0 p

op

ula

tion

)


16

Crude live birth rates by year for Eastern Peninsular states in Malaysia, 2008-2012

Crude live birth rates by year for Northern Peninsular states in Malaysia, 2008-2012

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

Malaysia

Kelantan

Pahang

Terengga nu

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

-

2008 2009 2010 2011 2012p

-

2008 2009 2010 2011 2012p

(a) (b)

Crude live birth rates by year for Central Peninsular states in Malaysia, 2008-2012

45.0

40.0

35.0

30.0

25.0

Malaysia

Negeri Sembilan Selangor

WP Kuala Lumpur WP Putrajaya

45.0

40.0

35.0

30.0

25.0

Crude live birth rates by year for Southern Peninsular states in Malaysia, 2008-2012

Malaysia

Johor

Melaka

20.0

15.0

10.0

5.0

-

18.4 18.5 17.2 17.6

p=Preliminary

Crude birth

17.2 rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

20.0

15.0

10.0

5.0

- 2008 2009 2010 2011 2012p 2008 2009 2010 2011 2012p

(c) (d)

Crude live birth rates by year for East Malaysia states, 2008-2012

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

Malaysia

Sabah

Sarawak

WP

Labuan

5.0

-

2008 2009 2010 2011 2012p

(e)

Figure 2.3 (a),(b),(c),(d),(e): Crude birth rates by regions in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. All graphs were generated by the MHPU.

18.4 18.5 17.2 17.6 17.2 18.4 18.5

17.2 17.6 17.2

18.4 18.5 17.2 17.6 17.2

18.4 18.5 17.2 17.6 17.2

Cru

de liv

e b

irth

ra

te

(pe

r 1

00

0 p

op

ula

tion

)

Cru

de liv

e b

irth

ra

te

(pe

r 1

,00

0 p

op

ula

tion

)

Cru

de liv

e b

irth

ra

te

(pe

r 1

,00

0 p

op

ula

tion

)

Cru

de liv

e b

irth

ra

te

(pe

r 1

00

0 p

op

ula

tion

) C

rud

e liv

e b

irth

ra

te

(pe

r 1

,00

0 p

op

ula

tion

)


17

17.6

17.2 17.2

18.4 18.5

19.0

18.5

18.0

Total

17.5 Male

Female

17.0

16.5

16.0

2008 2009 2010 2011 2012

Figure 2.4: Crude birth rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Cru

de b

irth

rate


18

2.2. Stillbirth

2.2.1. Definition

Stillbirth is defined as births after 28 completed weeks or more of gestation without

any sign of life during delivery 9.

Unit of Measurement: Deaths per 1,000 total births

Stillbirth rate =


Majority of the causes of stillbirths are preventable. This indicator reflects the quality

of the provision of maternal care. Stillbirth reporting is to include statistics for death

only of potentially viable fetus. Therefore different healthcare institution may use

different data definition depending on the capability of the institution to care for the

newborns.

2.2.3. Findings

From 2008 to 2012, stillbirth rate for Malaysia remained fairly constant between four

and five per 1000 total birth respectively. However, Terengganu and Kelantan were

persistently above the average.

Number of stillbirths in year t x 1000 Number of live births + number of stillbirths in year t


19


(a) Numbers of stillbirths

450

400

350

300

250

200

150

100

50

-

2008

2009

2010

2011

2012p

p=preliminary

Number of stillbirths for WP Putrajaya were incorporated into Selangor in 2008 and 2009 .

Total cases in Malaysia: 2008: 2,128 cases 2009: 2,216 cases 2010: 2,222 cases 2011: 2,305 cases 2012p:2,213 cases

(b) Stillbirth rate

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

2008

2009

2010

2011

2012p

p=preliminary

Stillbirth rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009 .

1.0

-

Figure 2.6: Stillbirth rates by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Stillb

irth

rate

(p

er

10

00 t

ota

l bir

ths)

Num

ber

of

stillb

irth

s


20

Stillbirth rates by year for Northern Peninsular states in Malaysia, 2008-2012

9.0

Stillbirth rates by year for Eastern Peninsular states in Malaysia, 2008-2012

9.0

8.0

7.0

6.0

5.0

4.0

3.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

8.0

7.0

6.0

5.0

4.0

3.0

Malaysia

Kelantan

Pahang

Terengg anu

2.0

1.0

-

2008 2009 2010 2011 2012p

2.0

1.0

-

2008 2009 2010 2011 2012p

(a) (b)

9.0

Stillbirth rates by year for Central Peninsular states in Malaysia, 2008-2012

Malaysia

Stillbirth rates by year for Southern Peninsular states in Malaysia, 2008-2012

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

-

2008 2009 2010 2011 2012p

(c)

Negeri Sembilan

Selangor


p=Preliminary

Stillbirth rate for WP Putrajaya was incorporated into Selangor in 2008 and 2009

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

-

2008 2009 2010 2011 2012p

(d)

Malaysia

Johor

Melaka

Stillbirth rates by year for East Malaysia states, 2008-2012

9.0

8.0

7.0

6.0

5.0

4.0

Malaysia

Sabah

Sarawak

3.0

2.0

WP Labuan

1.0

-

2008 2009 2010 2011 2012p

(e)

Figure 2.7 (a),(b),(c),(d),(e): Stillbirth rates by regions in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. All graphs were generated by the MHPU.

4.3 4.4 4.5 4.5 4.3 4.3

4.4 4.5 4.5 4.3

4.4 4.5 4.5 4.3 4.3 4.3

4.4 4.5 4.5 4.3

4.3 4.4 4.5 4.5 4.3

Stillb

irth

rate

(p

er

10

00 t

ota

l bir

ths)

Stillb

irth

rate

(pe

r 1

00

0 t

ota

l birth

s)

Stillb

irth

rate

(pe

r 1

00

0 t

ota

l birth

s)

Stillb

irth

rate

(pe

r 1

00

0 t

ota

l birth

s)

Stillb

irth

rate

rate

(pe

r 1

00

0 t

ota

l birth

s)


21

5.0

4.8

4.6

4.4

4.2

Total

Male

Female

4.0

3.8

3.6

2008 2009 2010 2011 2012

Figure 2.8: Stillbirth rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

4.3 4.3

4.4

4.5 4.5

Stillb

irth

rate


22

2.3. Perinatal Mortality

2.3.1. Definition

Perinatal mortality refers to stillbirths and deaths of infants aged less than 1 week 9.

Unit of Measurement: Deaths per 1,000 total births

Perinatal mortality rate =


This indicator combines stillbirth and early neonatal death.

2.3.3. Findings

Perinatal mortality rate was relatively constant for overall Malaysia since 2008

(Figure 2.10). Among the states, WP Kuala Lumpur, Selangor and Johor had lower

perinatal mortality whereas Terengganu, WP Labuan and Kelantan harbored

persistently high number of cases per 1000 population.

Number of deaths under 1 week + number of stillbirths in year t x 1000 Number of live births + number of stillbirths in year t


23


(a) Numbers of perinatal mortalities

800

700

600

500

400

300

200

100

0

2008

2009

2010

2011

2012p

p=Preliminary

Perinatal mortality cases for WP Putrajaya were incorporated into Selangor in 2008 and 2009.

Total cases in Malaysia: 2008: 3,560 cases 2009: 3,812 cases 2010: 3,791 cases 2011: 3,896 cases 2012p: 3,757 cases

Figure 2.9: Number of perinatal mortalities by state in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

(b) Perinatal mortality rate

14.0

12.0

10.0

8.0

6.0

4.0

2.0

0.0

2008

2009

2010

2011

2012p

p=Preliminary

Perinatal mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

Figure 2.10: Perinatal mortality rates by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Perin

ata

l M

ort

alit

y R

ate

(pe

r 1

00

0 t

ota

l birth

s)

Num

ber

of

Peri

nata

l M

ort

alit

y


24

7.6 7.7 7.6

7.3 7.4

Perin

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 t

ota

l birth

s)

14.0

Perinatal mortality rates by year for Northern Peninsular states in Malaysia, 2008-2012

14.0

Perinatal mortality rates by year for Eastern Peninsular states in Malaysia, 2008-2012

12.0

10.0

8.0

6.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

12.0

10.0

8.0

6.0

Malaysia

Kelantan

Pahang

Terengganu

4.0 4.0

2.0 2.0

0.0

2008 2009 2010 2011 2012p

0.0

2008 2009 2010 2011 2012p

(a) (b)

14.0

Perinatal mortality rates by year for Central Peninsular states in Malaysia, 2008-2012

14.0

Perinatal mortality rates by year for Southern Peninsular states in Malaysia, 2008-2012

12.0

10.0

8.0

6.0

4.0

2.0

0.0

2008 2009 2010 2011 2012p

Malaysia

Negeri Sembilan

Selangor

WP Kuala

Lumpur

WP Putrajaya

p=Preliminary Perinatal mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

12.0

10.0

8.0

6.0

4.0

2.0

0.0

2008 2009 2010 2011 2012p

Malaysia

Johor

Melaka

(c) (d)

Perinatal mortality rates by year for East Malaysia states, 2008-2012

14.0

12.0

10.0

8.0

6.0

4.0

Malaysia

Sabah

Sarawak

WP Labuan

2.0

0.0

2008 2009 2010 2011 2012p

(e)

Figure 2.11 (a),(b),(c),(d),(e): Perinatal mortality rates by regions in Malaysia, 2008- 2012

Source: Department of Statistics Malaysia. The graphs were generated by the MHPU.

7.3 7.6 7.7 7.6

7.4

7.3 7.6 7.7 7.6 7.4 7.6 7.7 7.6

7.3 7.4

7.3 7.6 7.7 7.6 7.4

Perin

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 t

ota

l birth

s)

Perin

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 t

ota

l birth

s)

Perin

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 t

ota

l birth

s)

Perin

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 t

ota

l birth

s)


25

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012

Total

Male

Female

Figure 2.12: Perinatal mortality rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Perin

ata

l m

ort

alit

y r

ate

7.3 7.6 7.7 7.6

7.4


26

2.4. Neonatal Mortality

Neonatal deaths are subdivided into early neonatal deaths, occurring during the first

seven days of life, and late neonatal deaths, occurring after the seventh day but

before the 28 completed days of life.

2.4.1. Definition

Neonatal mortality refers to deaths of infants less than 28 days 9.

Unit of Measurement: Deaths per 1,000 live births

Neonatal Mortality Rate =


Neonatal deaths account for a large proportion of child deaths. Mortality during

neonatal period is considered a useful indicator of both maternal and newborn care.

Factors such as health of the mother, antenatal care and birth weight are important

determinants of neonatal mortality.

2.4.3. Findings

Neonatal mortality rate was found to be much lower in the Wilayah Persekutuan

Kuala Lumpur and Selangor than the rest.

Number of deaths under 28 days of age in year t x 1000 Number of live births in year t


27


(a) Number of neonatal deaths

450

400

350

300

250

200

150

100

50

0

2008

2009

2010

2011

2012p

p=Preliminary

Neonatal mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

Total cases in Malaysia 2008: 1,922 cases 2009: 2,145 cases 2010: 2,106 cases 2011: 2,133 cases 2012p: 2,049 cases

Figure 2.13: Number of neonatal mortality by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

(b) Neonatal mortality rate

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

2008

2009

2010

2011

2012p

p=Preliminary


0.0

Figure 2.14: Neonatal mortality rates by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

*

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Num

ber

of

ne

on

ata

l M

ort

alit

y


28

Malaysi

Kelanta

Pahang

4.3 4.3 3.9

4.2 4.0 Terengg

8.0

7.0

Neonatal mortality rates by year for Northern Peninsular states in Malaysia, 2008-2012

Malaysia

8.0

7.0

Neonatal mortality rates by year for Eastern Peninsular states in Malaysia, 2008-2012

a

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012p

(a)

Kedah

Perak

Perlis

Pulau Pinang

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012p

(b)

n

anu

8.0

7.0

Neonatal mortality rates by year for Central Peninsular states in Malaysia, 2008-2012

Malaysia


8.0

7.0

Neonatal mortality rates by year for Southern Peninsular states in Malaysia, 2008-2012

Malaysia

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012p

(c)


p=Preliminary


6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012p

(d)

Johor

Melaka

Neonatal mortality rates by year for East Malaysia states, 2008-2012

8.0

7.0

6.0

5.0

4.0

3.0

Malaysia

Sabah

Sarawak

WP Labuan

2.0

1.0

0.0

2008 2009 2010 2011 2012p

(e)

Figure 2.15 (a),(b),(c),(d),(e): Neonatal mortality rates by regions in Malaysia, 2008- 2012


4.3 4.3 3.9 4.2 4.0

4.3 4.3 4.2 3.9 4.0

4.3 4.3 4.2 3.9 4.0

4.3 3.9

4.3 4.2 4.0

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Neon

ata

l m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)


29

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012

Total

Male

Female

Figure 2.16: Neonatal mortality rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

100%

90%

80%

70%

Late Neonatal Death

Early Neontal Death

60%

50%

40%

30%

p = Preliminary

20%

10%

0%

2008

2009

2010

2011

2012

Figure 2.17: Neonatal mortality rates by categories in Malaysia, 2008-2012 Source: Family Health Development Division, MOH Malaysia.

1616 1547 1689 1547 1570

456

476

397

414

476

Perc

enta

ge

of

mo

rtalit

y

Neon

ata

l d

eath

rate

3.9

4.3 4.3 4.2

4.0


30

100%

90%

80%

70%

60%

50%

Unknown

Others

Asphyxia

Infection

Lethal Congenital Malformation Immaturity

40%

30%

20%

10%

0%

2008

2009

2010

2011

2012

Figure 2.18: Causes of neonatal mortality in Malaysia, 2008-2012 Source: Family Health Development Division, MOH Malaysia.

Between 2008 and 2012, data from the Family Health Development Division (FHDD)

unveiled that the main causes of neonatal death were immaturity and lethal

congenital malformations (Figure 2.18).

43 38

780

732 812 772 803

573

661

533

556

616

189 182 200 199

236

226

274

254

279

249

191 153 160

98 28

172

35

144

Perc

enta

ge

of

de

ath

s


31

2.5. Infant Mortality

2.5.1. Definition

Infant mortality refers to deaths of infants aged less than 1 year 9.


Infant Mortality Rate =


Infant mortality reflects the availability, utilization and effectiveness of health care

system, particularly, post-natal care.

2.5.3. Findings

The five years overall trend of infant mortality rates in Malaysia showed a decline.

Notwithstanding that, drilling down to WP Putrajaya, an upward trend of infant

mortality was evident (Figure 2.20).

Number of deaths under 1 year of age in year t x 1000 Number of live births in year t


32


(a) Number of infant mortalities

700

600

500

400

300

200

100

0

2008

2009

2010

2011

2012p

p=Preliminary

Infant mortalities for WP Putrajaya were

incorporated into Selangor in 2008 and 2009.


Figure 2.19: Number of infant deaths by states in Malaysia, 2008 - 2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

(b) Infant mortality rate

12.0

10.0

8.0

6.0

4.0

2.0

2008

2009

2010

2011

2012p

p=Preliminary

Infant mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

0.0

Figure 2.20: Infant mortality rates by states in Malaysia, 2008 - 2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Infa

nt

mo

rtalit

y R

ate

(pe

r 1

00

0 liv

e b

irth

s)

Num

ber

of

Infa

nt M

ort

alit

y


33

6.9 6.7 6.2

6.5 6.3

Infant mortality rates by year for Northern Peninsular states in Malaysia, 2008-2012

Infant mortality rates by year for Eastern Peninsular states in Malaysia, 2008-2012

10.0 10.0

8.0

6.0

4.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

8.0

6.0

4.0

Malaysia

Kelantan

Pahang

Terengganu

2.0 2.0

0.0

2008 2009 2010 2011 2012p

0.0

2008 2009 2010 2011 2012p

(a) (b)

Infant mortality rates by year for Central Peninsular states in Malaysia, 2008-2012

Infant mortality rates by year for Southern Peninsular states in Malaysia, 2008-2012

10.0

8.0

Malaysia


WP Kuala

10.0

8.0

Malaysia

Lumpur 6.9 6.7 Johor

6.0

4.0

2.0

0.0

6.2

6.5 6.3 WP Putrajaya

p=Preliminary Infant mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

6.0

4.0

2.0

0.0

Melaka

2008 2009 2010 2011 2012p 2008 2009 2010 2011 2012p

(c) (d)

Infant mortality rates by year for East Malaysia states, 2008-2012

10.0

8.0

6.0

4.0

Malaysia

Sabah

Sarawak

WP Labuan

2.0

0.0

2008 2009 2010 2011 2012p

(e)

Figure 2.21 (a),(b),(c),(d),(e): Infant mortality rates by regions in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Comparing the infant mortality rates by region from 2008 to 2012, there seems to be

a clustering pattern of certain states in Northern and Eastern Peninsular region that

recorded a much higher still birth rates than the rest (Figure 2.21 (a),(b),(c),(d),(e)).

6.9 6.7

6.2 6.5 6.3

6.9 6.7 6.5 6.2 6.3

7.1 6.8 6.5

6.0 6.5

Infa

nt

mo

rtalit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Infa

nt

mo

rtalit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Infa

nt

mo

rtalit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Infa

nt

mo

rtalit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Infa

nt

mo

rtalit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)


34

8.0

7.0

6.0

5.0

4.0

3.0

Total

Male

Female

2.0

1.0

0.0

2008 2009 2010 2011 2012

Figure 2.22: Infant mortality rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.


Over the last 30 years, there has been marked reduction in infant mortality rate in

Asia/Pacific region. In countries such as Malaysia, Singapore, Republic of Korea,

and Thailand, the decline has been by 75% or more3 (Figure 2.23).

Malaysia was positioned at about the OECD average for infant mortality rate in 2010.

Figure 2.23: Infant mortality rate, 2010 and decline, 1980 and 2010 3

Source: OECD (2012)

6.3 6.2 6.5

6.7 6.9

Infa

nt

mo

rtalit

y r

ate


35

2.6. Under-five Mortality

2.6.1. Definition

Under-five mortality refers to deaths of children under the age of 5 years old 9.


Under-five mortality rate =


The under-five mortality rate reflects the impact of child survival interventions during

the first few years of life. It is a Millennium Development Goal (MDG) 4.

2.6.3. Findings

Under-five mortality rate in Malaysia took a downtrend over the 5 year period (Figure

2.25). However, the pattern was inconsistent at the state level showing peaks at

different point in time. In 2011, Perlis, Pahang and Terengganu ranked atop with

highest mortality rate whereas Selangor, WP Kuala Lumpur and Kedah boasted with

the least (Figure 2.25).

Number of deaths under 5 years of age in year t x 1000 Number of live births in year t


36


(a) Number of under-five mortalities

800

700

600

500

400

300

200

100

0

2008

2009

2010

2011

2012p

p=Preliminary



Figure 2.24: Number of under-five mortalities by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

(b) Under-five mortality rate

14.0

12.0

10.0

8.0

6.0

4.0

2.0

2008

2009

2010

2011

2012p

p=Preliminary

Under 5 mortality rate for WP Putrajaya were incorporated into Selangor in 2008 to 2009

0.0

Figure 2.25: Under-five mortality rates by states in Malaysia, 2008 - 2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Num

ber

of

Un

der-

5 M

ort

alit

y

(pe

r 1

00

0 liv

e b

irth

s)


37

8.5 8.0

8.4 8.0 7.7

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Under-five mortality rates by year for Northern Peninsular states in Malaysia, 2008-2012

Under-five mortality rates by year for Eastern Peninsular states in Malaysia, 2008-2012

14.0

12.0

10.0

8.0

6.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

14.0

12.0

10.0

8.0

6.0

8.0

8.5 8.4 8.0

7.7

Malaysia

Kelantan

Pahang

Terengganu

4.0 4.0

2.0 2.0

0.0

2008 2009 2010 2011 2012p

(a)

0.0

2008 2009 2010 2011 2012p

(b)

Under-five mortality rates by year for Central Peninsular states in Malaysia, 2008-2012

14.0

12.0

Malaysia

Negeri Sembilan

Selangor

14.0

12.0

Under-five mortality rates by year for Southern Peninsular states in Malaysia, 2008-2012

Malaysia

10.0

8.0

6.0

4.0

2.0

0.0

2008 2009 2010 2011 2012p

WP Kuala Lumpur

WP Putrajaya

p=Preliminary

Under-five mortality rates for WP Putrajaya were incorporated into Selangor in 2008 and 2009

10.0

8.0

6.0

4.0

2.0

0.0

2008 2009 2010 2011 2012p

Johor

Melaka

(c) (d)

Under-five mortality rates by year for East Malaysia

states, 2008-2012

14.0

12.0

Malaysia

10.0

8.0

6.0

4.0

Sabah

Sarawak

WP Labuan

2.0

0.0 2008 2009 2010 2011 2012p

(e)

Figure 2.26 (a),(b),(c),(d),(e): Under-five mortality rates by regions in Malaysia, 2008- 2012


8.5 8.4 8.0 8.0 7.7

8.5 8.0 8.4 8.0 7.7

8.5 8.4 8.0 8.0 7.7

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)

Unde

r-five m

ort

alit

y r

ate

(pe

r 1

00

0 liv

e b

irth

s)


38

10.0

9.0

8.0

7.0

6.0

5.0

4.0

Total

Male

Female

3.0

2.0

1.0

0.0

2008 2009 2010 2011 2012

Figure 2.27: Under-five mortality rates by gender in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.


Malaysia is approaching the average of OECD countries in term of under-five

mortality. The principle cause of death was also similar to that of OECD; more death

due to prematurity and congenital anomalies instead of pneumonia.

Figure 2.28: Benchmarking Malaysia for under-5 mortality 2012 Source: UNICEF Childinfo

3 (left); Source: WHO

3 (right)

87

66

63

61

54

51

50

48

35

33

32

32

29

27

23

18

17

17

13

7

6

6

5

5

5

3

3

Pakistan Myanmar

India Papua New Guinea

Lao PDR Cambodia

Nepal Bangladesh Indonesia

Korea Dem Rep Asia - 20 Mongolia

Philippines Solomon Islands

Viet Nam China

Fiji Sri Lanka Thailand

Brunei Darussalam Malaysia

New Zealand Australia

Korea Rep OECD Japan

Singapore

100 75 50 25 0 0 25 Pneum onia

50 75 Prem ity atur

100

Deaths per 1 000 live births Birth asphyxia Other

Congenital anomalies

7.7 8.0 8.0

8.4 8.5

Unde

r-five m

ort

alit

y r

ate


39

2.7. Additional Information on Childhood Mortality Trending

We have seen a 2-fold improvement in all child death statistics over the past 20

years (1990 to 2010). However, since 2000, the rates have been stagnating (Figure

2.29).

10.0

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

Stillbirth rate

Perinatal mortality rate

Neonatal mortality rate

Infant mortality rate

Under 5 mortality rate

p=Preliminary

1.0

-

2000 2002 2004 2006 2008 2010 2012p

Figure 2.29: Trends between childhood mortality indicators from 2000 to 2012 Source: Department of statistics Malaysia, Graph was generated by the MHPU.

Caveat:

Cut off point for definition of live birth has been upgraded from 28 weeks to 22 weeks

in year 2000 in MOH Hospitals. Up to 2011, data were collected from 22 weeks

onwards. However from 2012 onwards, data for both cut offs (22 and 28 weeks)

were collected separately.

per

10

00

liv

e b

irth


40

16

14

12

10

8

6

4

2

0

Neonatal Mortality rate

Infant Mortality rate

Under 5 Mortality rate

1990

8.5

13.1

16.8

2000

3.7

6.5

8.9

2010

4.3

6.7

8.4

18

Figure 2.30: Trends of neonatal mortality, infant mortality and under-five mortality rate of Malaysia, from 1990 to 2010


per

10

00

liv

e b

irth

s


41

Chapter 3 : MATERNAL HEALTHCARE

This chapter describes indicators pertaining to maternal healthcare.

3.1. Maternal mortality

3.1.1. Definition

Maternal deaths refer to deaths which are caused by complications of pregnancy or

childbirth or the puerperium within the period of 42 days after childbirth 9.

Unit of Measurement: maternal deaths per 100 000 live births

3.1.2. Rationale of use

Complications during pregnancy and childbirth remain the major causes of death and

disability among women of reproductive age in Malaysia. The maternal mortality ratio

represents the risk associated with each pregnancy, i.e. the obstetric risk. It is also a

Millennium Development Goal (MDG) 5 indicator.

3.1.3. Findings

Maternal mortality ratio (MMR) for Malaysia remained fairly unchanged (year 2008

through 2011). However, Negeri Sembilan had a steep rise in MMR from 40.9 in

2008 to 45.3 in 2011 respectively. Kelantan demonstrated a consistently high

maternal mortality ratio across 3 consecutive years (Figure 3.2).


42


(a) Number of maternal mortalities

30

2008

25 2009

2010

20 2011

15 Maternal mortalities

for WP Putrajaya were incorporated into Selangor in 2008

10 and 2009

Total cases Malaysia: 2008: 133 cases 2009: 134 cases 2010: 128 cases 2011: 134 cases

0 2012p: 130cases

Figure 3.1: Number of maternal mortality by states in Malaysia, 2008-2012 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

(b) Maternal Mortality Ratio

70.0

60.0

50.0

40.0

30.0

20.0

2008

2009

2010

2011

Maternal mortality ratios for WP Putrajaya were incorporated in Selangor in 2008 and 2009

10.0

0.0

Figure 3.2: Maternal mortality ratios by states in Malaysia, 2008-2011 Source: Department of Statistics Malaysia. Graph was generated by the MHPU.

Mate

rnal M

ort

alit

y R

atio

(pe

r 1

00,0

00 liv

e b

irth

s)

No o

f m

ate

rnal m

ort

alit

y

5


43

27.3 27.0 26.1 26.2

70.0

Maternal mortality ratios by year for Northern Peninsular states in Malaysia, 2008-2011

70.0

Maternal mortality ratios by year for Eastern Peninsular states in Malaysia, 2008-2011

60.0

50.0

40.0

30.0

20.0

Malaysia

Kedah

Perak

Perlis

Pulau Pinang

60.0

50.0

40.0

30.0

20.0

Malaysia

Kelantan

Pahang

Terengganu

10.0 10.0

0.0

2008 2009 2010 2011

0.0

2008 2009 2010 2011

(a) (b)

Maternal mortality ratios by year for Central Peninsular States in Malaysia, 2008-2012

Maternal mortality ratios by year for Southern

Peninsular states in Malaysia, 2008-2011

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

27.3 27.0 26.1 26.2 25.6

2008 2009 2010 2011 2012

Malaysia

Negeri Sembilan

Selangor

WP Kuala Lumpur

WP Putrajaya

Maternal

mortality ratios

for WP

Putrajaya were

incorporated

into Selangor in

2008 and 2009

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0

2008 2009 2010 2011

Malaysia

Johor

Melaka

(c) (d)

Maternal mortality ratios for East Malaysia states, 2008-2011

70.0

60.0

50.0

40.0

30.0

Malaysia

Sabah

Sarawak

WP Labuan

20.0

10.0

0.0

2008 2009 2010 2011

(e)

Figure 3.3: Maternal mortality ratios by regions in Malaysia, 2008-2011 Source: Department of Statistics Malaysia. All graphs were generated by the MHPU.

From 2008-2011, wide differentials exist in these rates from state to state and from

year to year within the certain states (Figure 3.3).

27.3 27.0 26.1 26.2

27.3 27.0 26.1 26.2

27.3 27.0 26.1 26.2

Mate

rnal m

ort

alit

y r

atio

(pe

r 1

00,0

00 liv

e b

irth

s)

Mate

rnal m

ort

alit

y r

atio

(pe

r 1

00,0

00 liv

e b

irth

s)

Mate

rnal m

ort

alit

y r

atio

(pe

r 1

00,0

00 liv

e b

irth

s)

Mate

rnal m

ort

alit

y r

atio

(pe

r 1

00,0

00 liv

e b

irth

s)

Mate

rnal m

ort

alit

y r

atio

(pe

r 1

00.0

00 liv

e b

irth

s)


44

(c) Cause of Maternal Deaths during Postpartum stage

Figure 3.4: Cause of maternal deaths during postpartum stage Source: Family Health Development Division

The main cause of maternal deaths during postpartum stage is concomitant medical

conditions, obstetric embolism and Hypertensive Disorders of Pregnancy (HDP)

(Figure 3.4).

25

20

15

10

5

0

PPH Ectopic

2009 19

2010 11

2011 19

1

0

0

Unspecifie d

complicatio n

1

0

0

Others HDP Obstretric Embolism

6

4

4

14

12

19

13

17

10

Associated Medical

Condition

24

26

19

Obsteric Trauma

APH Puerperal

Sepsis

4

6

9

3

2

3

6

6

2

Nu

mb

er

of

dea

ths


45


Figure 3.5: Estimated maternal mortality ratios, selected countries, 1990-2010

Source: WHO (2012), Health at a Glance: Asia/Pacific 2012 3

Malaysia’s maternal mortality was better in comparison to the Asia-20 but higher

than OECD average (Figure 3.5).


46

3.2. Millennium Development Goal 5

We have seen remarkable progress in maternal care since 1933, however

improvement in maternal mortality has been minimal recently and we are diverting

away from the Millennium Development Goal (MDG) target. The MDG target for

Malaysia is to reduce MMR to 11 deaths per 100,000 live births by 2015 (Figure 3.6).

Figure 3.6: Trend of maternal mortality ratio in Malaysia from 1933 to 2012

Source: Department of Statistics Malaysia and Family Health Development Division, Ministry of Health

1200

1000

800

600

50

45

40

35

30

25

20

15

10

5

0

400

200

0

25.6 26.2 26.1 27 27.9 28.1 46.9 20 40 60 80 150 200 240 280 530 670 770 960 1080 MMR

2012 p

2011 2010 2009 2005 2000 1995 1990 1985 1980 1975 1970 1965 1960 1957 1950 1946 1940 1935 1933

25.6 26.2 26.1 27 29 27.9 28.1 46.9 44 Achievement

11 13.5 16 18.5 21 23.5 26 28 30 35 40 44 Target

2015 2014 2013 2012

p 2011 2010 2009 2007 2005 2000 1995 1991

Comparison between Malaysia’s

Maternal Mortality Ratio with MDG 5

per

10

0,0

00

liv

e b

irth

s


47

Challenges and Recommendations

1. Assignment of state for death statistics.

Death statistics require the denominator to be assigned to a defined population. Prior to 1982, the calculation for death statistics took the place of occurrence (the state where the death occurred) as the denominator. However, after 1982, the place of residence of the person as documented in his or her death registry form by the National Registration Department is used instead.

Recommendations: Statistical computation using either place of residence or place of occurrence (of death) has its own respective implication. Death rate as according to places of residence may reflect long term performance of healthcare delivery to the population in the respective region whereas assorting death data by the place of occurrence gives an opportunity to assess performance at the facility level. Therefore, we recommend the recording and analysis using both variables.

2. Differences in practice of documenting place of residence

There is inconsistency in recording the person’s address in the death registry form. The home address recorded can be either the address on the identification card or the address given by next of kin. Each may be different from the usual place of residence of the person who died. This is especially so when the address on the identification card was not updated. To date, the magnitude of discrepancy is unknown.

Recommendations: To conduct a study measuring the discrepancy between the recorded address in the death registry form and the usual place of residence.

3. Gaps in the methodology of performance and outcome reporting

Whilst completing this 2014 report, we have identified gaps in the methodology of performance and outcome reporting that may lead to misinterpretation in performance benchmarking both internally as well as internationally.

Recommendation: In order to produce a purposeful 2015 publication, we plan to build summary tables of data availability for each service or specialty that we intend to report. In doing so, we hope that we could identify and optimize all data resources and build a clearer picture so as to bridge the limitations that we may face.

Our report uses available published data with the assumption that these are the most up-to-date. This report may impose the need for both new and improved data collection as unavailability or inadequacy of quality data will significantly limit meaningful comparison.


48

References

1. Department of Statistics, Malaysia. Abridged Life Tables, Malaysia 2010-

2013. Putrajaya: Department of Statistics, Malaysia; 2013. 108 p.

2. World Health Organization [Internet]. Life expectancy at birth (years). Indicator

and Measurement Registry version 1.7.0 WHO 2011. Available from:

http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=65

3. Oecd-ilibrary.org [Internet]. OECD/World Health Organization (2012), Health

at a Glance: Asia/Pacific 2012, OECD Publishing. Available from:

http://dx.doi.org./10.1787/9789264183902-en

4. Who.int [Internet]. WHO Civil registration: why counting births and deaths is

important [updated May 2014]. Available from:

http://www.who.int/mediacentre/factsheets/fs324/en

5. Who.int [Internet]. WHO Health statistics and information systems. Available

from: http://www.who.int/healthinfo/statistics/indmaternalmortality/en

6. Oecd.org [Internet]. OECD Health Data 2007: Statistics and Indicators for 30

Countries, OECD, Paris, 2007, Data sources, definitions and methods.

Glossary of Statistical Terms [cited on 24th March 2015]. Available from:

http://stats.oecd.org/glossary/detail.asp?ID=1530

7. Department of Statistics, Malaysia. Yearbook of Statistics, Malaysia 2007.

Putrajaya: Department of Statistics, Malaysia; 2008. 397 p.

8. Oecd.org [Internet]. OECD Underlying Cause of Death. Handbook of Vital

Statistics Systems and Methods, Volume 1: Legal, Organisational and

Technical Aspects, United Nations Studies in Methods, Glossary, Series F,

No. 35, United Nations, New York 1991. Glossary of Statistical Terms [cited

on: 15 February 2015]. Available from:


9. Department of Statistics, Malaysia. Vital Statistics Time Series, Malaysia,

1963-1998: Department of Statistics, Malaysia; 2001. 285 p.



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