INTRODUCTION: In recent years, there has been a steady change in trends of delivery patterns worldwide. The overall increase in Caesarean section rates with the decline of vaginal deliveries also raises many growing concerns. Caesarean deliveries have proven to increase the risk of maternal and infant morbidity.1 Similarly, Organisation for Economic Co-operation and Development (OECD) reports a significantly increased risk of obstetric trauma with instrumental deliveries.2 These trends, including sharp differentials between public and private hospitals, are expected to worsen in view of the unparalleled rapid development of private health sector.

OBJECTIVE: This study aims to shed light on the influence of private practice on modes of deliveries in Malaysia as compared to public hospitals by estimating the relative risk of Caesarean sections and instrumental deliveries in both sectors.

METHOD: Data was obtained from the National Healthcare Establishments and Workforce Survey (NHEWS) 2010. The survey sampled 315 hospitals in Malaysia that provided obstetrics services, of which 133 were public and 182 were private hospitals. Data obtained was compared to the NHEWS 2008-09.3 Poisson regression was used to generate the relative risk.

RESULTS: A total of 504,104 deliveries were reported in 2010. The overall vaginal delivery rate was 72.6% and instrumental delivery rate was 5.4%. The total lower segment Caesarean section rate in Malaysia increased from 20.8% in 2008-09 to 21.9% in 2010. The relative risk of private patients, compared with patients in public hospitals, to undergo Caesarean and instrumental delivery was 1.789 (95 % CI 1.767 to 1.812) and 4.503 (95% CI 4.397 to 4.612) respectively. (Figure 1)

CONCLUSION: This first study locally demonstrated the association of private practice with significantly higher Caesarean sections and instrumental deliveries which could lead to infant and maternal implications with unclear benefits. There is also marked variations of practice between the different states in Malaysia. Further studies are required to explore the different case-mix of both sectors to substantiate this statement to set future national standards and improvement of obstetrics services in the country.

REFERENCES:1. Villar et al.,World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with cesarean delivery: multicentre prospective study.

2. OECD (2011), Health At A Glance 2011: OECD Indicators

3. National Healthcare Establishments & Workforce Statistics (Hospital) 2008-2009

Sheamini Sivasampu, Arunah Chandran, Faizah AhmadClinical Research Centre, 3rd floor, MMA building, 124, Jalan Pahang, 53000 Kuala Lumpur.

*We would like to thank Director General of Health, Malaysia for permission to publish this poster

Figure 1: Modes of Deliveries by Sector in 2010 Figure 2: LSCS Deliveries by Sector in 2008-09 & 2010�

Figure 3: LSCS Deliveries by State & Sector in 2010 Figure 4: Instrumental Deliveries by State & Sector in 2010

Relat ive R isk of LSCS in Pr ivate Pat ients Compared to Publ ic= 1 .789Relative Risk of Instrumental Deliveries in Private Patients Compared to Public= 4.503

Public Private

21.9%

5.4%