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Maternal health and well-being have extended to international consideration since the global launching of WHO’s Safe Motherhood Initiative in 1987. In 1990, Malaysia set itself an ambitious vision to achieve high income and developed status by 2020. A relatively low maternal mortality rate (23.2 in 2012), noteworthy increase in the proportion of safe deliveries and antenatal coverage have been achieved. Introduction of Confidential Enquiries into Maternal Deaths (CEMD) in 1991 was an important step towards a full-fledged audit taking into consideration the identification of shortfalls in the care of pregnant mothers and taking cognizance of the remedial measures set forth, thus improving standards of care.
The High-Risk Approach system, the introduction of a colour coding system for identification of pregnancies that were at greater risk than average risk, the strengthening of referral systems, and home based maternity assessment cards kept by the patient present at any level of antenatal care were used as additional tools.
Swift development of rural infrastructure, increase in skilled personnel to attend deliveries, and recruitment of traditional birth attendants (TBAs) as a short-gap measure was undertaken. In addition, midwives in rural areas were allowed to administer heparin as thromboprophylaxis, antenatal steroids to mothers with preterm labour and intramuscular magnesium sulphate to mothers with hypertension. These drugs are given under guidance by the Ministry of Health protocols and given before transfer to tertiary centres.
In addition, partograph use, protocol development and creation of a “red alert system” in hospitals to mobilize specialists and other healthcare personnel were deployed to reinforce existing measures. In 1985, MOH initiated a national quality assurance programme (QAP). This programme was used as a managerial tool to justify the needs for further resources in terms of money, manpower, machinery and materials.
Malaysia’s significant decline in maternal mortality has been as a result of development of rural health services (introduction of maternal and child health programmes and TBAs) , adopting specific approaches (strengthening of referral system and colour coding system), assuring quality of care by tracking progress (outcome), providing standardize care, and identifying outliers that needed further improvement.
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2. Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics 22nd edition, New York. McGraw 2005
3. Taj Mahal History and Pictures http://www.indianchild.com/taj_mahal.htm
4. Starrs AM, Safe Motherhood Initiative. 20 years and counting. Lancet 2006, 368: 1130-32
5. World Health Organization, World Health Report 2000. Health systems: Improving performance. WHO 2000
6. Mortality Rates Decline in Malaysia. Population Head, Nov 1991::200:2
7. Yadav H. Hospital management. University Malaya Press, 2006
8. Sirajoon Noor Ghani, Hematram Yadav. Health Care in Malaysia. University of Malaya Press 2003
9. K.Siva Achanna, Postpartum Haemorrhage: A continuing Tragedy in Malaysia. Med J Malaysia 66 (1): 1-3
10. O’Driscoll, JM Strange, M.Minogue. Active management of labour. Br Med J 1973, July 21, 3(5872): 135-137
11. Ravindran J, Did we do it right? An evaluation of colour coding system for Antenatal Care in Malaysia. Med J Malaysia 2003, Mar 58 (1); 37-53
12. Siva Achanna K, Deepika Monga, Hamzah W.M. Role of Alternative Birthing Centres- Philosophy of Pregnancy care and Childbirth,Kota Bharu Hospital J Med Sciences 1999; 2 (2): 3-8
13. Yadav H, Utilization of Traditional Birth Attendants (TBAs) in MCH Care in Rural Malaysia. Singapore Med J Dec 1987; 28 (6): 520-525
14. J.Ravichandran, J.Ravindran. Lessons from the confidential enquiry into maternal deaths, Malaysia. BJOG 2014; 121 (Suppl. 4)
15. Zeeman GG, Obstetric critical care: A blueprint for improved outcomes. Crit Care Med 2006; 34, 9 (Suppl.)
16. Health Information and Management System (HIMS), Health Information Centre, Planning Division, MOH, 2015
17. Noor Hisham Abdullah (Datuk), Director General of Health Malaysia, letter dated 11.04.2013
18. Adolescent pregnancy, WHO fact sheet, May 2012
19. Yadav H, Poverty and Health Development, Med J Malaysia 2007; 62 (4): 278-281