Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

Abstract

Background: Information regarding factors associated with postpartum death enhances the understanding of the root cause of the problem; hence, facilitate the formation of effective remedial measure. Literatures on postpartum death in Malaysia are limited despite the increasing trend of mortality in the state of Selangor. This study aimed to determine the associated factors with postpartum death in Malaysia. Method: A case-control was conducted using data from the Selangor State Health Department. All 114 postpartum death cases that were notified to the health department from 2013 to 2016 were selected. Controls (ratio case 1: control 4) were mothers who survived six weeks of postpartum within the same year range and selected via simple random sampling. A set of datasheets was used to gather information on; i) socio-demographic characteristics, ii) past medical/surgical history and iii) obstetrics history. Analyses were conducted using IBM Statistical Product and Service Solution Statistics Version 25.Results: The odds of postpartum deaths were almost three times higher among the non-Malaysian citizen (aOR 2.78, 95% CI: 1.35-5.72). The presence of medical/ surgical problems was associated with a 3-fold increase in the odds of postpartum death (aOR 3.22, 95% CI: 1.85-5.61). The odds of death were nine times higher for those who delivered in non-health facilities (home/en-route) (aOR 9.13,95% CI: 2.05-40.77) than those delivered in health facilities. Women who attended antenatal care at government health facilities and practised family planning had low odds for postpartum deaths [(aOR 0.35, 95% CI: 0.20-0.64) and (aOR 0.46, 95% CI: 0.25-0.85), respectively. Conclusions: Postpartum deaths could be prevented reduce by ensuring adequate health service delivery to the non-citizen, enhanced medical care on underlying medical/surgical illness and restrict delivery in non-health facilities. This reduction can be achieved by promoting attendance to antenatal care in government health facilities and practicing family planning. Future health programme aimed to curb this death should be designed with emphasis on education to these target group as early as pre-pregnancy and throughout the antenatal period.