Materia Medica Malaysiana

July 21, 2008

Why mortality rate still high

Filed under: Uncategorized — malaysianmedicine @ 11:03 pm

Daily Express Sabah’s maternal mortality rate is still on the high side compared with other states, according to State Health Director Dr Hj Marzukhi Md Isa.
He attributed this trend to the presence of illegal immigrants who don’t come for antenatal check-up and encounter problems during pregnancy but are not identified.
“The majority of maternal deaths are associated with illegal immigrant mothers. They come to us when they develop complications during delivery. By then, it’s too late.

“In 2007, the maternal mortality rate (mother’s death during delivery) was one per 1,000 deliveries. It’s still high. So far, the best figure we had reported was 0.79 per 1,000 deliveries in 2002.
“The same year, the rate of perinatal death (within one week before and after delivery) was 16 per 1,000 deliveries while that for infant mortality (0-1 year old) 9.6 per 1,000 deliveries. The lowest reported rate for infant mortality was 9.47 per 1,000 deliveries in 2006.
“As for neonatal mortality rate (babies 0-1 month old), it was 7.1 per 1,000 deliveries. The best reported figure was 5.47 per 1,000 deliveries in 2006,” he told reporters, Friday after launching the lst National Paediatric Nursing Congress at Pacific Sutera Hotel here.
The two-day event is organised by the Malaysian Paediatric Association (MPA) led by Dr Soo Thian Lian who is Organising Chairman cum Head of the Paediatric Department at Likas Hospital. Some 380 nurses from Malaysia, Singapore and Negara Brunei are attending the congress which ends today (Saturday).
Dr Marzukhi said the statistics do not cover children of illegals because when they (children) fall sick, they don’t seek immediate treatment, and neither do the babies come for immunisation.
However, free immunisation is provided for all infants even if they are delivered at private hospitals, including those of illegal immigrants when they approach the health clinic or klinik desa.
“We do not want illegal children to transmit diseases like TB, tetanus and polio to local children. So immunisation is a preventive measure.”
On why the Health Ministry is monitoring the maternal, perinatal, neonatal, infant and toddler mortality rates, Dr Marzukhi said it will reflect effectiveness or otherwise of health services provided to the community.
“If the neonatal or infant mortality rate is high, that means the health services are not good enough. This can be used as an indicator when comparing at inter-state and inter-country levels. Even globally, we use this as an indicator to measure health delivery in the community or country itself,” he pointed out.
Asked why after 50 years of independence, our maternal and infant mortality rates are still high, the State Health Director said overall, Malaysia as a whole is better off compared with the rates in other developing countries.
Dr Marzukhi said an expectant mother from one of the Philippine islands (off Kudat), suffering from hypertension, even sought treatment from the Kudat Hospital recently.
“In this particular case, the nearest hospital in the Philippines was six hours by boat. But it took only two hours to go to Pulau Banggi. From this island, it took another hour to reach Kudat. Because of her condition, she was sent to the Queen Elizabeth Hospital, which meant a three-hour road journey.”
According to the Fees Act, a migrant mother who delivers at a government hospital is required to pay RM400 per delivery or RM100 at a government health clinic or klinik desa per delivery.
“The fees are standardised throughout Malaysia.”

On a reporter’s remark that pregnant women from the Philippines are deliberately taking advantage of Sabah’s better health facilities, Dr Marzukhi said doctors would not see it in that light.
“We look at everybody as human beings.”
In response to another reporter’s suggestion that mothers from the Philippines, who are in an advanced stage of pregnancy, should be stopped from crossing over to Sabah, he said:
“That is beyond ourÉthat is a policy matter. We cannot control, it’s very difficult to stop even healthy people from coming in. What more sick and pregnant women!
“But if they come for regular treatment, we charge them accordingly. In cases, where foreigners brought in are in a very bad condition and can’t pay for the health service, we don’t force them but will treat where necessary.”
When told that Sabah leaders have voiced concern, saying illegal immigrants are draining the State of its health resources, Dr Marzukhi said: “I won’t comment on that. As far as we (health professionals) are concerned, our key responsibility is to treat sick people when they come for help.”
When told of expectant mothers lying on mattresses on the floor due to congestion in the maternity ward of a government hospital, he said there was no choice as migrants also have to be treated on humanitarian grounds.
“As health professionals, we have to treat all human beings who are sick, regardless of whether they are Malaysian citizens or illegal immigrants.
This is part of our code of ethics. Our task is to save lives whether you are a local or illegal immigrant. We (doctors) have no authority to talk about boundaries.
“We do ask them for passports or identification papers but based on human rights, we still treat them even if they don’t possess these documents.”
On reports that foreigners owe hospitals a huge sum of money (as reveaeld by a former Health Minister), he said this was true.
“One way to counter this problem is to make non-citizens pay a deposit first before admission. However, if their illness is not bad enough for them to get admitted, we just treat them as outpatients for which they also have to pay. There is no free treatment even at the klinik kesihatan or rural health centre. They have to pay RM15 each.”
ALTHOUGH the incidence of malaria in Sabah has been reduced, Dr Marzukhi said it is still high. “The Health Ministry’s target is to eliminate the disease here by 2020,” he said.
He said Sabah alone in 1995 contributed 44,000 malaria cases out of 65,000 for the whole of Malaysia that year. “With extra funding and manpower, we managed to bring the figure down to 3,191 last year.”
On the earlier announcement that Sabah will have more mobile clinics in rural areas, he said it is a policy “and we are expanding the number”.

Dr Marzukhi, who visited Banggi Island last week, conceded that more mobile teams have to be deployed to the island because it is not covered regularly.
“So far, the team has been there only twice a month or even once a month.
Now we want to have more manpower to provide health services not only for children but also adults. There are still a lot of malaria cases here.”

THE problem of getting doctors to come to Sabah is yet to be resolved, said Dr Marzukhi.
“COLA (Cost Of Living Allowance) is still not good enough to attract them. We are going to propose a few things to the Health Ministry to ensure that doctors are willing to serve in remote areas. We have already discussed the issue at state levelÉit’s a policy matter. I cannot tell you (reporters),” he said when asked what was being done to address the doctor shortage in Sabah.
Under the Ninth Malaysia Plan (9MP), the State Health Director said the Government’s priority is to provide more services to the rural population, particularly in Sabah and Sarawak.
“Despite our limited manpower, we are doing our best. We even have doctors visiting the klinik desa to see mothers and children.”
Noting that Sabah is a very big state, Dr Marzukhi said one pressing issue is the problem of accessibility.
“The facilities are actually thereÉeven with the availability of health centres in remote areas, getting to these places for healthcare still poses a problem. When people are sick, they don’t get treatment immediately for want of accessibility. That is the issue now in Sabah.”

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