pekeliling pengarah kesihatan negeri jabatan

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PEKELILING PENGARAH KESIHATAN NEGERI JABATAN KESIHATAN NEGERI PERAK B'L 1I2O1O GARISPANDUAN LAPORAN SIASATAN KEMATIAN KANAK-KANAK DI BAWAH UMUR 5 TAHUN 1. TUJUAN: Memperkenalkan borang-borang bagi melaporkan dan menyiasat kematian kanak-kanak di bawah umur 5 tahun dandefinisi-definisiyang digunakan. 2. LATAR BELAKANG : Statistiks kematian adalah pentingsebagai indikator kepada status kesihatan golongan tertentu di dalam komuniti. Sebanyak 70% - 80% dari kematian kanak-kanak di bawah 5 tahun berlaku dalam tahun pertama manakala 50% darikematian ini berlaku di peringkat neonatal. Kadar kematian kanak-kanak di bawah 5 tahun di Malaysia adalah di antara 6.0 - 8.0 per 1,000 kelahiran hidup bagi jangka masa 10 tahun yang lalu (The Sfafe of the Wortd's Children). Kadar ini adalah lebih tinggi darikadar kematian di Singapura danBrunei tetapi lebih rendah dari kadarkematian di Thailand, Filipina dan Indonesia (Kementerian Kesihatan Malaysial. 2.1 ?.2 2.3 PERIK -l-

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Page 1: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

PEKELILING PENGARAH KESIHATAN NEGERI

JABATAN KESIHATAN NEGERI PERAK B'L 1I2O1O

GARISPANDUAN LAPORAN SIASATAN KEMATIAN KANAK-KANAK

DI BAWAH UMUR 5 TAHUN

1. TUJUAN:

Memperkenalkan borang-borang bagi melaporkan dan menyiasat kematian

kanak-kanak di bawah umur 5 tahun dan definisi-definisiyang digunakan.

2. LATAR BELAKANG :

Statistiks kematian adalah penting sebagai indikator kepada status

kesihatan golongan tertentu di dalam komuniti.

Sebanyak 70% - 80% dari kematian kanak-kanak di bawah 5 tahun

berlaku dalam tahun pertama manakala 50% dari kematian ini berlaku

di peringkat neonatal.

Kadar kematian kanak-kanak di bawah 5 tahun di Malaysia adalah di

antara 6.0 - 8.0 per 1,000 kelahiran hidup bagi jangka masa 10 tahun

yang lalu (The Sfafe of the Wortd's Children). Kadar ini adalah lebih

tinggi dari kadar kematian di Singapura dan Brunei tetapi lebih rendah

dari kadar kematian di Thailand, Filipina dan Indonesia (Kementerian

Kesihatan Malaysial.

2 .1

?.2

2.3

P E R I K

- l -

Page 2: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

2.4 Sebab utama kematian di kalangan kanak-kanak di antara umur 1

tahun dan 5 tahun adalah penyakit berjangkit dan parasitik, kecacatan

kongenital dan kecederaan. Hampir 3 darikematian ini dapat dielakkan

dengan tindakan-tindakan pencegahan yang sesuai.

3. OBJEKTIF

Menyeragamkan laporan siasatan kematian kanak-kanak di bawah

umur 5 tahun di Negeri Perak dan memudahkan proses pengumpulan

dan analisa data.

Maklumat yang diperolehi boleh digunakan untuk mengenalpasti

keutamaan perkhidmatan kesihatan, merancang dan melaksanakan

program-program pencegahan yang sesuai.

Memastikan kanak-kanak di bawah umur 5 tahun mendapat

perkhidmatan kesihatan yang optima bertujuan untuk mencapai

Millennium Developmental Goal yang mana sasarannya adalah untuk

menggurangkan sebanyak 3 kematian kanak-kanak di bawah 5 tahun

menjelang 2015.

4. CARTA ALIRAN KERJA

Lampiran 1: Carta Alir Laporan Siasatan Kematian Kanak-kanak di

bawah umur 5 Tahun

5. BORANG.BORANG DAN GARISPANDUAN MENGISI BORANG

Lampiran 2a: Borang Laporan Siasatan Kematian Kanak-kanak

bawah umur 5 Tahun yang berlaku di Hospital

1 . 3

1 . 1

1 . 2

4 . 1

5 . 1

a- L -

Page 3: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

5.2 Lampiran 2b: Garispanduan Pengisian Borang Laporan Siasatan

Kematian Kanak-kanak di bawah 5 Tahun yang

berlaku di Hospital

Lampiran 3a: Borang Laporan Siasatan Kematian Kanak-kanak di

bawah 5 Tahun yang tidak berlaku di Hospital

Lampiran 3b: Garispanduan Pengisian Borang Laporan Siasatan

Kematian Kanak-kanak di bawah 5 Tahun yang tidak

berlaku di Hospital

6. pTAGNOS|S

6.1 Lampiran 4: Rumusan Diagnosis mengikut ICD-10

7. TANGGUNGJAWAB

7.1 Adalah menjadi tanggungjawab Pakar Pediatrik atau Pegawai Perubatanyang menjaga kes untuk melengkapkan borang laporan siasatan bagikes-kes kematian yang berlaku di hospital.

7.2 Bagi kematian di luar hospital, Pegawai Kesihatan Daerah adalahbertanggungjawab untuk melengkapkan borang laporan siasatan.

7.3 Adalah menjadi tanggungjawab Pakar Pediatrik atau Pegawai Perubatanyang menjaga kes untuk menghantar satu salinan borang siasatankematian yang lengkap ke Pejabat Kesihatan Daerah untuk dikumpuldan dianalisa.

7.4 Seorang jururawat di Pejabat Kesihatan Daerah (koordinator) diberitanggungjawab untuk mengumpul semua laporan siasatan dan

5.3

5.4

- 3 -

Page 4: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

memastikan semua laporan siasatan diisi dengan lengkap. Sekiranya

laporan siasatan tidak lengkap, adalah menjadi tanggungjawabnya untuk

menghantar laporan itu semula kepada pegawai berkenaan untuk

disempurnakan.

8. TARIKH KUATKUASA

8.1 Perkelil ing ini berkuatkuasa pada 1 Julai 2010.

9. PERTANYAAN

Sebarang pertanyaan boleh dirujuk kepada:

Bahagian Pembangunan Kesihatan Keluarga,

Jabatan Kesihatan Negeri,

Jalan Panglima Bukit Gantang Wahab,

30590 lpoh,

Perak

Tel: 05-2084200 ert271 I 362

TO' HJ. AHMAD MAHIR )Pengarah Kesihatan Negeri

Perak Darul Ridzuan

- 4 -

Sekian, terima kasih.

( DATO'� DR. HAJ! AHMAD RAZTN B.

Page 5: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

Lampiran 1

CARTA ALIR LAPORAN SIASATAN KEMATTAN KANAK-KANAKDI BAWAH 5 TAHUN

TanggungjawabPegawai

Perubatan

TanggungjawabKoordinatordi Hospital

Kematiankanak-kanak dibawah 5 tahun

Lengkapkan BorangLaporan Siasatan

Kematian Kanak-kanakdi bawah 5 tahun di

Hospital

Lengkapkan BorangLaporan SiasatanKematian Kanak-kanak di bawah 5

tahun di luar Hospital

Satu salinan borang kePejabat Kesihatan

Daerah

Semua borangd ikumpu ldandianal isa d i

Pejabat KesihatanDaerah

TanggungjawabKoordinator di

Pejabat KesihatanDaerah

Page 6: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

fltr,tyxio tto

fluoners tc

flratner's tc

EGuardian's lC

No, specify: (eg. passport)(Please till in the MyKid number, lf there is no MyKd no, till in new or old lC ofmother ot father or guardian or any other identitication document number, Pleasetick ("'l) the lD document tor the lD no given.)

E Malay E orang AsliE Chinese El Bumiputra Sabah, specifo:E Indian E Bumiputra Sarawak, specify:

lll Other Malaysian, specify:E Non Citizen, speciry:

E Mate lll Female E Indeterminate E Unknown

E p t c u E p n o w E u a i n t c u E e a e E p a e d M e d i c a t W a r dE PaeO Surgical Ward, specify: E Others, specify:

E Ptcu E pnow E tr,tain tcuE Paed Surgical Ward, specify:

E n a e E P a e d M e d i c a l W a r dE Others, specify:

E H oE Gonsultant

E tr,toE others:

Not able to drlnk / feed

(Tick (,,1) one)

ElYes ------+

E Traditional / complementary treatment

E No transport

Unaware child is seriously ill

: l-Tl AM / PM

A M / P M

Hospital Death Form - July 2010

Page 7: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

Larnpiran 2b

Guidelines for Data Collection: Hospital Deaths

Definition of Gaseschildren aged 28 days up to 5 years old. lnclude all Malaysian and non-MalaysianFor Neonates (0-27 days) use existing perinatal form

Definition of Hospital Death:Any patient who arrived at the hospital with signs of life and had treatment whether in A & E, ward,intensive care, etc, before they died. This includes all death occurring during ambulance transportationfrom one hospital to another.

Guidelines on Data Collectiona. All data is from case notes, referral notes and staff interviews. Opinions on "ls death preventable" is

based on subjective judgment from medical records & information. This is one of the most vital areasof information. Narrative details must be provided.

b. For Hospitalwith Pediatrician - Sister from PICU/HDWPaeds wards to identify all deaths and tracecase notes for MO to fill in forms but must discuss with Paediatrician (especially remedial section)

c. Hospital without Pediatrician - Sister in charge of Paeds wards to identify all deaths and trace casenotes for MO to fill in forms but must discuss with visiting Paediatrician (especiallypreventable/remedial section). Can be discussed with Paediatrician at mortally review but will needcase notes.

d. Indicate name of Paediatrician involved on form in comments section.e. Keep copy of data at district level and send original to MCH at JKN.

S c Guidelines# Item/ Variable Name Details,| Name Name of child who died2 ldentification Card Number MyKid no or other lD number. lf no MyKid use mothe/s or father's ic/passoort3 RN No Child's hospital registration no.4 Usual residencv City / town, district and state of usual residence5 Ethnicitv Please use the ethnicitv of father. or if unavailable then mother6 Gender7 Date of birth Written in day/month/year format (eq. 030405 for 3 April 2005)I Date and time of admission Written in day/month/year format (eq. 030405 for 3 Aoril 2005)I Date and time of death1 0 Place of death Tick only one for each

PICU -Pediatrics Intensive Care Unit, PHDW-Pediatric High Depend WardMain ICU - Main Intensive Care Unit, A&E - Accident & EmergencyPaed Medical Ward - Paedielric ward, Paed Surrrical Ward - Dlease soucifv

11a Hospital Treatrnent Highest level care received , Tick only one for eachPICU -Pediatrics Intensive Care Unit, PHDW-Pediatric High Depend WardMain ICU - Main Intensive Care Unit, A&E - Accident & EmergencyPaed Medical Ward - Paediatric ward. Paed Suroical Ward - olease soecifu

1 1 b Person Managing Highest level of person managing, Tick only one for eachHO - House Officer, MO - Medical Officer, Specialist, Consultant, Other

12a Symptom(s) of the currentillness leading to deathDuration

Duration of symptoms of current illness before admission'Not applicable' - for sudden death E g : Motor vehicle accident or drowningBut if less than 1 day state number of hours't2b Treatments(s) received for

current illness?The place of any pre hospital treatment. Government Hospital: including armyhospital. Treatment: does not include self-medication & traditional/comolementarv medication

1 3 Co-morbid condition Tick one or more boxes14a lmmediate cause of death Enter only 1 cause. Do not enter terminal events such as cardiac arrest or

respiratory arrest. Do not abbreviate. E.g.: Pneumonia14b Condition predisposing

cause of deathEnter only 1 cause on a line. Add additional lines if necessaryE.q.:'Malnutrition'. on next line'Soastic ouadrioleoia"

1 5 ICD classification of death Tick only one & specify - important to write details1 6 ls death preventable Based on subiective iudqment of Paediatrician1 7 Comments Comments on whv vou think death is oreventable - imoortant to write details

Page 8: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

l l lOther lD documentNo, specify: (eg. passport)

(Pleaso fill in the MyKid number. lt there is no MyKd no, fill in new or old lC ofmother or father or guadian or any other identificatlon document number, Pleasetick ("1) the lD document for tha lD no given.)

pMother's tC

EFathe/s lc

Ecuardian's lC

E MahyE chineseE Indian

LIJ Orang Asli

E Bumiputra Sabah, specify:E Bumiputra Sarawak, specify:

l-ll Other Malaysian, speci!:E Non Citizen, specify;

E Male El Female E Indeierminate E Unknown

E Home

E ctinicE On way to hospital

El others, specifo:

El Medical, specify: E Non-medical, specify:

(Tick (',1) one or more boxes below)

E Not Applicabte

able to drink / feed

l-!l Self-medication

E Traditional / complementary treatment

l.!j No transport

E Unaware child is seriously ill

A M / P M

Non Hospital Death Form - July 2010

Page 9: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

Lamp i ran 3b

Guidelines for Data Gollection: Non-Hospital Deaths

Definition of CasesChildren aged 28 days up to 5 years old. Include all Malaysian and non-Malaysian.For Neonates (0-27 days) use existing perinatalform

Non-Hospital DeathDefined as death that occurs outside the hospital, which also includes:a. Those brought in dead to the hospitalb. Death while on the way to carelhospitalc. Death in clinics/polyclinicsd. Death at homes or elsewhere

Guidelines on Data Collectiona. An active enquiry into under 5 deaths is needed (as with perinatal deaths). The District Health Sisters

& Public Health Nurses should check with local police station for any reported deaths monthly.b. The relevant Public Health Nurse or MO should do a home visit to the deceased's home as soon as

possible after death (preferably 3 days after death to allow for some grieving). Use the Non-HospitalDeath Form and it is important to write as detailed a narrative account as possible.

c. Alldata is from the interview, Birth certificate, MyKid, Death certificate, Police station and homebased child health card.

d. Data to be reviewed at 3 monthly meetings at district level. Committee to include MedicalOfficer ofHealth (MOH), Maternal and Child Health (MCH) officer or Family Medicine Specialist, Paediatriciancovering the region, Health Sister and nurse(s).

e. Opinions on "ls death preventable" is based on subjective judgment from medical records &information. This is one of the most vital areas of information. Narrative details must be orovided.

f. Indicate name of Paediatrician involved on form in comments section.g. Keep copy of data at district level and send original to MCH at JKN.

i f ic Guidelines# Item/ Variable Name DetailsI Name Name of child who died2 ldentification Card Number MyKid no or other lD number. lf no MyKid use mother's or father's idpassport3 Usual residencv City / town, district and state of usual residence4 Ethnicitv Please use the ethnicitv of father, or if unavailable then mother5 Gender6 Date of birth Written in dav/month/vear format (eo, 030405 for 3 Aoril 2005)7 Date and time of death Written in day/month/year format (eq, 030405 for 3 April 2005)8 Place of death Place where child died. Tick only one

Home, Clinic, On way to hospital, Others : eg: swimminq Dool,etcI Person certifying Death Person who certified the death

Tick only one - e.g Medical: Doctor, MA , Non-Medical : Policeman10a Symptom(s) of current illness

leading to death'Not applicable'- for sudden deathE.q; Motor vehicle accident or drowninq

Duration Duration of symptoms of current illness before death.'Not applicabfe' - for sudden death E g : Motor vehicle accident or drowningBut if less than 1 day state number of hours

10b Treatment(s) received forcurrent illness

The place of any treatment received. Government Hospital: includes army,estate hospital. Treatment: does not include self-medication & traditional /comolementarv medication

1 1 Co-morbid condition Tick one or more boxes12 Certified cause of death in

death certificateE. g : Cause of death given by police

13a lmmediate cause of death Enter only 1 cause. Do not enter terminal events such as cardiac arrest orrespiratory arrest, Do not abbreviate. E.o.: Pneumonia

13b Condition predisposingcause of death

Enter only 1 cause on a line. Add additional lines if necessaryE.q.:'Malnutrition', on next line'Spastic ouadrioleoia"

1 4 ICD classification of death Tick onlv one & soecifu - imoortant to write details1 5 ls death oreventable Based on subiective iudqment of Paediatrician & committee1 6 Comments Comments on whv vou think death is oreventable - imoortant to write details

Page 10: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

Lampiran 4

Guidelines for Data Gollection: IGD-l0Diagnosis

Summary of ICD Diagnosis

1. Certain Infectious & Parasitic DiseasesSpecific communicable/ transmissible diseases (except intestinal infections & STD)Exclusion: local infections of skin, respiratory system (eg influenza, pneumonia), certain bacterialmeningitis, infections in perinatal period (except Tetanus & STD)Examples: Acute gastroenteritis, Tuberculosis, Meningococcaemia, Viral meningitis, DengueHaemorrhagic fever, HlV, Tetanus neonatorum

2. NeoplasmsFunctionalactivity, morphology & site. Includes all malignant, in-situ neoplasms & benign neoplasmsExamples: Hepatocellular carcinoma, Retinoblastoma, ALL, Cerebellar tumours, Osteosarcoma

3. Diseases of Blood & lmmune systemExcludes autoimmune diseases, certain conditions originating in perinatal period, congenitalmalformations, endocrine/ metabolic, neoplasms, HlV, poisoning & S/S with abnormalclinical & labfinding Not Elsewhere Classified (N.E.C)Examples: Beta thalassaemia, Haemolytic Uraemic Syndrome, Haemophilia A & B,Agammaglobulinaemia, Severe Combined lmmunodeficiency

4. Endocrine, Nutritional, Metabolic DiseasesExcludes S/S & abnormal clinical & lab findings N.E.C, transitory endocrine & metabolic disorders innewbornExamples: Congenital Hypothyroidism, lnsulin Dependent D. Mellitus, Marasmic Kwashiorkor,Mucopolysaccharidosis, Cystic Fibrosis, Hyperkalaemia, Fliud Overload

5. Nervous SystemExcludes perinatal origin, congenital malformations, endocrine/ metabolic causes, neoplasms, S/S withabnormalclinical& lab finding N.E.c, certain infections, injury & external causesExamples: Haemophilus meningitis, Spinal Muscular Atrophy, Cord Compression, Spastic Cerebral palsy,Acquired Hydrocephalus, Toxic Encephalopathy (specify toxic agent)

6. Clrculatqry SystemExcludes perinatal origin, congenital malformations, endocrine/ metabolic causes, neoplasms, S/S withabnormalclinical& lab finding N.E.C, certain infections, injury & externalcauses, systemic connectivetissue disorders, transient cerebral ischaemic attacksExamples: Rheumatic Valvular Diseases, Hypertension, Primary Pulmonary Hypertension, lnfectivePericarditis, Acute Myocarditis, Obstructive Hypertrophic Cardiomyopathy, Cerebral Infarction

7. Respiratory SystemExcludes certain infections, perinatal origin, congenital malformations, endocrine/ metabolic carlses,neoplasms, injury & external causes, S/S with abnormal clinical& lab finding N.E.CExamples: Pneumonia due to Strep pneumonia, Retropharyngealabscess, Pulmonary Oedema, Lungabscess with pneumonia, Adult RDS

8. GastroJntestinal (Digestive)Excludes certain infections, perinatalorigin, congenital malformations, endocrine/ metabolic causes,neoplasms, injury & external causes, s/s with abnormalclinical& lab finding N.E.cExamples: Acute appendicitis with generalised peritonitis ,lntestinal perforation, lntussusception, Toxicliver disease, Acute pancreatitis

9. Genitourinary TractExcludes certain infections, perinatal origin, congenital malformations, endocrine/ metabolic causes,neoplasms, injury & external causes, S/S with abnormalclinical& lab finding N.E.C

(continue on next page)

Page 11: PEKELILING PENGARAH KESIHATAN NEGERI JABATAN

Examples: Acute Nephritic Syndrome ,Nephrotic Syndrome, Chronic Renal Failure, Obstructive Uropathy,Acute Renalfai lure

10. Conditions from Perinatal Periodlncludes conditions that have their origin in perinatal period though death or morbidity occurs later.Excludes congenital malformations, endocrine/ metabolic, neoplasms, injury/ poisoning & tetanusneonatorumExamples: Extremely low birth weight, Severe birth asphyxia, Intraventricular haemorrhage, CongenitalRubella Syndrome, Kernicterus, Bronchopulmonary Dysplasia

I 1 . Con genital Malformations, Deformations & Ch romosomal AbnormalitiesExcludes inborn errors of metabolismIncludes congenital heart diseasesExamples: Congenital hydrocephalus, Spina Bifida, Ebstein Anomaly, Diaphragmatic hernia, Biliaryatresia, Edwards Syndrome, Epidermolysis Bullosa,

12. Injuries, Poisoning & ExternalCausesExcludes birth traumaIncludes all kinds of injuries, foreign bodies, burns, corrosions, drowning, complications of procedures,MVA, NAIetcExamples: Fracture of base of skull, Injury of spleen, Burns & corrosions, Carbon Monoxide poisoning,Anaphylactic shock, Bone marrow transplant rejection, Assault, Accidental drowning

13. symptoms, signs & abnormal findings, NEG (Not elsewhere classified)Excludes perinatal origin.Symptoms & signs of various organ systems but unspecifiedExamples: Cardiogenic shock, Respiratory arrest, Sudden infant death syndrome, Unattended death

14. OthersMental & behavioural disorders: Severe mental retardation, Developrnental dyslexiaDiseases of eye & adnexae: Optic neuritis, Purulent endophthalmitisDiseases of ear & mastoid process: Acute mastoiditis, suppurative otitis mediaDiseases of skin & & subcutaneous tissue: Staphylococcal scalded skin syndromeDiseases of musculoskeletal & connective tissue: Seropositive rheumatoid arthritis, Systemic lupuserythematosus