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17. RECOMMENDATIONS
1. Improve overall care
State and District Child Health Committees to be revived or formed and to meet regularly 3 to 6 monthly.
Paediatric Departments to outreach and network with AE departments, outpatient and health clinics, private hospitals and clinics in their State or District.
2. Improve access to services
Access to care for underserved population to be improved by strengthening the present system.
The implementation of tele-primary care and the strategy integrated management of childhood illness for these children to be expanded.
3. Health education
Health care providers to counsel care givers on home care of sick children and also teach them to look for signs of serious illness so that they know when to
take them to the health facility immediately. Health education to care givers to emphasise on prevention of home injuries in
children especially drowning.
4. Train medical personnel
Pre service and in service training of doctors, nurses and medical assistants to include primary care of children, recognising signs of serious illness and
resuscitation of children. More doctors, nurses and medical assistants to be trained in the neonatal
resuscitation programme NRP and paediatric advanced life support PALS.
5. Improve facilities
Facilities and equipment to manage sick children especially appropriate resuscitation equipment to be available in all clinics and AE departments.
Inpatient facilities and equipment for management of sick children especially intensive care to be improved.
Facilities and equipment to diagnose and manage children with congenital malformations, deformations and chromosomal abnormalities to be developed
further.
6. Improve documentation
All certification of deaths to be done by medical personnel. Doctors to be trained to document cause of death according to ICD-10 coding.
Medical certification of cause of death to be standardised in the country. System for verbal autopsy for non hospital deaths to be developed.
7. Research
Research on conditions originating from the perinatal period and congenital malformations deformations and chromosomal abnormalities to be encouraged.
This or similar study to be done every 5 years to monitor trends and progress and to identify areas for improvement and further research.
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18. REFERENCES
1. World Health Organization. Integrated Management of Childhood Illness Information. WHOCHSCAH98.1A REV.1 1999.
2. Family Health Development Division. Ministry of Health Malaysia Perinatal Mortality Report 2006 in print.
3. Kazuo Uemura. Analysis of causes of death. SEAMICIMFJLecture 4A. Kuala Lumpur; 1999.
4. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003; 361: 2226-34.
5. Editorial. The world’s forgotten children. Lancet. 2003; 361:1. 6. Rimsza ME, Schackner RA, Bowen KA, Marshall W. Can child deaths be
prevented? The Arizona child fatality review program experience. Pediatrics. 2002; 1101:11. Available from:
http:pediatrics.aappublications.orgcgicontentfull1101e11. 7. Information and Documentation Unit Ministry of Health Malaysia. Indicators for
monitoring and evaluation of strategy for health for all. May 2002; 41, 45. 8. Khoo TB, Lim YN. Proceedings of the Sixth National Paediatricians Conference
2001. 9. Vital Statistics Malaysia, Department of Vital Statistics Malaysia, 1980-1999.
10. Wong Swee Lan, Hussain Imam Muhammad Ismail. Under Five Deaths in Malaysia 1993-2003. Kuala Lumpur 2008.
11. The State of the World’s Children 2008. New York: Editorial, Design and Publications Section, Division of Communication, UNICEF; December 2007.
12. Disease Control Priorities Project [homepage on the internet]. Child Health: Nearly 11 million children under age five die annually from largely preventable
causes. July 2006. Available from http:www.dcp2.orgfile61DCPP--Child20Health.pdf
13. Tsung-Hsueh L, Wen-Yi S, Tai-Pin S, Meng-Chih L, Ming-Chih C, Chen-Kun L. Factors associated with errors in death certification completion: A national study
in Taiwan. Journal of Clinical Epidemiology. 2001; 54 2001 232-238. 14. Hung LC, Farizan AJ. Improving documentation of cause of death according to
the international statistical classification of diseases and related health problems – tenth edition ICD-10. Kuala Lumpur Hospital Journal of Quality Improvement.
2005; Vol 9 No 1.p13-20
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