An initial assessment of the risk approach to antenatal management in Malaysia
Somboonsook, B.; Wakerman, J.; Hattch, C.T.; Collison, M.; Barnes, A.; Kyi, W.; Karim, R.
Medical Journal of Malaysia 50(3): 212-220
1995
ISSN/ISBN: 0300-5283 PMID: 8926897 Document Number: 304296
In 1990 in Malaysia, 3 distinct surveys were conducted as part of an assessment of a nationwide risk approach system to prenatal management introduced in 1989. After history-taking and examination, a health worker completed a risk checklist, then determined what risk category the pregnant woman belonged to and assigned her chart a color code. Red means a life-threatening condition and immediate labor ward admission. Yellow means risk factors requiring antenatal monitoring and treatment by a physician. White means no risk, so the midwife or the community nurse can monitor the pregnant women. Green means that complications may occur and a senior nurse should monitor the woman's progress. The first survey included all pregnant women attending prenatal clinics in Pasir Mas District, Kelantan State, for the first time. The second survey was a retrospective check of the prenatal cards of all pregnant women attending these clinics within the same area over a 1-week period in January 1990. The third retrospective, record-based survey included all women who delivered in the study area during February 1990. Both the clinic staff and the study team classified 75% of the women as high risk. Only 44.4% of antenatal cards had a completed risk checklist, more than 33% of which were completed after the clinic. The most common risk factors were short birth interval (47.5%) and high parity (i.e., gravida 6 or above) (27.2%). Almost 50% of women coded green delivered at home, when they should have delivered at the hospital, suggesting that they disregarded clinic advice. Sensitivity of the code approach was better at a lower level of risk than at higher levels (71.2% for green vs. 43.2% for yellow and 0 for red). Misunderstanding of risk criteria or coding to own clinical judgment accounted for the incorrect coding by health staff. Overall, midwives were knowledgeable and competent. They knew their communities and clients well. Based on these findings, the researchers suggest replacing the risk checklist with at least 1 laminated reference checklist displayed prominently in the clinic. Further evaluation is needed.