Exploring Perinatal Asphyxia and Its Determinants in Perinatal Mortality: A 2020-2022 Analysis From Kelantan, Malaysia
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Abstract
Introduction: Perinatal asphyxia significantly contributes to perinatal mortality rates, particularly in low- and middle-income countries. Nevertheless, the exact prevalence and associated risk factors for perinatal asphyxia-related deaths in Malaysia, with a specific focus on the state of Kelantan, remain inadequately characterized. Therefore, this study aims to evaluate the prevalence of perinatal asphyxia and identify its associated determinants among cases of perinatal mortality in Kelantan, Malaysia, from 2020 to 2022. Materials and Methods: This cross-sectional study analyzed secondary data from 397 reported perinatal mortality cases (2020-2022), sourced from the Stillbirth and Under-five Mortality Notification System. It examined sociodemographic, obstetric, and intrapartum factors using descriptive statistics and logistic regression to identify potential correlations and risk factors for perinatal mortality. Results: The proportion of perinatal asphyxia among perinatal mortality cases in Kelantan was 25.9% (95% CI: 21.7, 30.6). The multivariable analysis revealed that non-Malay ethnicity (aOR=2.70, 95% CI: 1.18, 6.22; p=0.019), inadequate or unbooked antenatal care (aOR=2.95, 95% CI: 1.66, 5.22; p<0.001), late preterm gestational age (34-36 weeks) (aOR=2.49, 95% CI: 1.20, 5.18; p=0.014), and cesarean delivery (aOR=2.52, 95% CI: 1.51, 4.21; p<0.001) were significantly associated with an increased risk of perinatal asphyxia. Conclusion: Perinatal asphyxia remains a significant contributor to perinatal mortality in Kelantan, Malaysia. Non-Malay ethnicity, inadequate antenatal care, late preterm birth, and cesarean delivery were identified as key risk factors. Targeted interventions to improve antenatal care, enhance neonatal resuscitation skills, and ensure timely access to emergency obstetric care are crucial to mitigate the burden of perinatal asphyxia in the region.
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UNICEF. Ending Preventable Newborn Deaths And Stillbirths By 2030: Moving Faster Towards High-Quality Universal Health Coverage In 2020–2025. 2020.
McMicking J, Vieira MC, Pasupathy D. Understanding perinatal mortality. 2020.
Khobragade Y, Y KS, S Z, A LA. A Cross-Sectional Study on Perinatal Mortality in Jasin District, Malaysia. Manipal Journal of Medical Sciences. 2021;6(2):4.
Malaysian Healthcare Performance Unit M. Malaysian Health At A Glance 2018. 2020.
Crovetto F, Fumagalli M, De Carli A, Baffero GM, Nozza S, Dessimone F, et al. Obstetric risk factors for poor neonatal adaptation at birth. The Journal of Maternal-Fetal & Neonatal Medicine. 2018;31(18):2429-35.
WHO. World health statistics 2015. 2015.
Ethiopian Public Health Institute E. National Maternal and Perinatal Death Surveillance and Response (MPDSR) System Annual Report of 2013 EFY. 2014.
Family Health Development Division MOH. Under-5 Mortality Review 2016: Looking into The Preventable Deaths. 2022.
Hassan H, Sutan R, Azmi NAM, Ahmad S, Jaafar R. Trend of stillbirths and neonatal deaths in university Kebangsaan Malaysia Medical Centre (UKMMC) from 2004-2010. International Journal of Public Health Research. 2013;3(1):241-8.
Bank W. Mortality rate, under-5 (per 1,000 live births) - Malaysia 2024 [cited 2024 30 May]. Available from: https://data.worldbank.org/indicator/SH.DYN.
Family Health Development Division MOH. Laporan Tahunan SU5MR 2022. 2023.
MOH. Fasiliti Kesihatan - Hospital 2024 [cited 2024. Available from: https://www.moh.gov.my/index.php/pages/view/4374?mid=1448.
MOH. Fasiliti Kesihatan - Klinik Kesihatan: MOH; 2024 [cited 2024. Available from: https://www.moh.gov.my/index.php/pages/view/4378?mid=1501.
MOH. Guideline For Stillbirth And Under Five Mortality Reporting System. 2018.
Bayou G, Berhan Y. Perinatal mortality and associated risk factors: a case control study. Ethiopian journal of health sciences. 2012;22(3).
Behal M, Vinayak R. Maternal risk factors for perinatal mortality. Indian J Obstet Gynecol Res. 2015;2(2):92-6.
DOSM. Key Findings Population And Housing Census Of Malaysia 2020. 2022.
Mahat D, Chandran A, S R, Mr R. Recent Trends In Under-Five Mortality In The District Of Petaling, Selangor2016.
Hamzah TNT, Ibrahim WN, Daud A. A Five-Year Review of Perinatal Deaths at Pasir Mas District. International Medical Journal. 2008;15(3):193-8.
Ghimire PR, Agho KE, Renzaho AM, Nisha MK, Dibley M, Raynes-Greenow C. Factors associated with perinatal mortality in Nepal: evidence from Nepal demographic and health survey 2001–2016. BMC pregnancy and childbirth. 2019;19:1-12.
Liyew EF, Yalew AW, Afework MF, Essén B. Maternal near-miss and the risk of adverse perinatal outcomes: a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia. BMC Pregnancy and Childbirth. 2018;18(1):345.
Khobragade S, Khobragade Y, Abas AL. Comparative study of Perinatal Mortality, Stillbirths, and Neonatal Mortality from 2010 to 2018 in developing and developed nations with reference to Malaysia. Manipal Journal of Medical Sciences. 2021;6(1):6.
Getiye Y, Fantahun M. Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study. BMC Pregnancy and Childbirth. 2017;17(1):245.
Teka H, Yemane A, Abraha HE, Berhe E, Tadesse H, Gebru F, et al. Clinical presentation, maternal-fetal, and neonatal outcomes of early-onset versus late onset preeclampsia-eclampsia syndrome in a teaching hospital in a low-resource setting: A retrospective cohort study. PLoS One. 2023;18(2):e0281952.
Wondie WT, Zeleke KA, Wubneh CA. Incidence and predictors of mortality among low birth weight neonates in the first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia comprehensive specialized hospitals, 2022. Multi-center institution-based retrospective follow-up study. BMC Pediatrics. 2023;23(1):489.
Benjamin A, Sengupta P, Singh S. Perinatal mortality and its risk factors in Ludhiana: a population-based prospective cohort study. Health and Population: Perspectives and Issues. 2009;32(1):12-20.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The lancet. 2012;379(9832):2162-72.
Yousuf NA, Yousuf IA, Talukder NU, Kutubi A, Nahar PAS, Hena SB. Maternal risk factors for perinatal mortality. Higher education. 2011;2:02.
WHO. Low birth weight: WHO; 2024 [cited 2024 26 May]. Available from: https://www.who.int/data/nutrition/nlis/info/low-birth-weight#:~:text=Low%20birth%20weight%20is%20caused,and%20NCDs%20later%20in%20life.
WHO. Global nutrition targets 2025: low birth weight policy brief. Geneva: World Health Organization; 2014.
Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115(Supplement_2):519-617.
Msemo G, Massawe A, Mmbando D, Rusibamayila N, Manji K, Kidanto HL, et al. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics. 2013;131(2):e353-e60.
Neogi SB, Sharma J, Negandhi P, Chauhan M, Reddy S, Sethy G. Risk factors for stillbirths: how much can a responsive health system prevent? BMC pregnancy and childbirth. 2018;18:1-10.
Sala A, Luppi CG. Trend of preventable deaths up to the 6th day of life in the state of São Paulo–2008 to 2017. Revista de saude publica. 2020;54.
Sutan R. A review of determinant factors of stillbirths in Malaysia. Journal Community Health. 2008;14:68-77.
Schmiegelow C, Minja D, Oesterholt M, Pehrson C, Suhrs HE, Boström S, et al. Factors associated with and causes of perinatal mortality in northeastern Tanzania. Acta obstetricia et gynecologica Scandinavica. 2012;91(9):1061-8.
Daripa M, Caldas HMG, Flores LPO, Waldvogel BC, Guinsburg R, Almeida MFBd. Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths. Revista Paulista de Pediatria. 2013;31:37-45.
Rifqatussa'adah, Purnamawati D. Determinants of birth asphyxia in the province of Yogyakarta. Public Health Department Faculty of Sports Science Semarang State University Accessed March. 2021;10:201-6.
Alderliesten ME, Stronks K, van Lith JMM, Smit BJ, van der Wal MF, Bonsel GJ, et al. Ethnic differences in perinatal mortality: A perinatal audit on the role of substandard care. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2008;138(2):164-70.
Muglia LJ, Katz M. The enigma of spontaneous preterm birth. New England Journal of Medicine. 2010;362(6):529-35.
Kupek E, Petrou S, Vause S, Maresh M. Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales. BJOG: An International Journal of Obstetrics and Gynaecology. 2002;109(3):265-73.
Bayih WA, Birhane BM, Belay DM, Ayalew MY, Yitbarek GY, Workie HM, et al. The state of birth asphyxia in Ethiopia: An umbrella review of systematic review and meta-analysis reports, 2020. Heliyon. 2021;7(10):e08128.
Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, Hoffman M, et al. Respiratory morbidity in late preterm births. Jama. 2010;304(4):419-25.
Ishiguro A, Namai Y, Ito YM. Managing "healthy" late preterm infants. Pediatr Int. 2009;51(5):720-5.
Jain L, Dudell GG, editors. Respiratory transition in infants delivered by cesarean section. Seminars in perinatology; 2006: Elsevier.