In Malaysia, ensuring effective antenatal care (ANC) is crucial for maternal and child health. Understanding the characteristics of women accessing these services and the structure of healthcare provision is essential for optimizing the system, potentially including a colour coding system for risk stratification and patient management. This analysis delves into the demographics of ANC service users and the inventory of healthcare providers in Malaysian clinics, shedding light on resource allocation and service delivery.
The average age of pregnant women at their first ANC visit was 28.7 years, indicating that services are accessed by a diverse age group within the reproductive years. A significant proportion of these women had attained secondary (56%) and tertiary (37%) education levels, suggesting a relatively high level of health literacy among ANC service users. However, a small percentage had primary education (4%) or no formal education (less than 1%), highlighting the need for adaptable communication strategies to cater to varying educational backgrounds within the ANC system. The average parity was 1.2, with 37% of women being first-time mothers (nulliparous) and 63% having had previous pregnancies (multiparous). This mix of parity status necessitates tailored ANC approaches to address the specific needs of both groups. Notably, 72% of pregnancies were classified as low-risk, while 28% were high-risk. This risk stratification is a critical aspect of antenatal care, and a colour coding system could potentially be employed to visually manage and prioritize care pathways for these different risk categories within the Malaysian healthcare setting. The distribution of ANC service uptake across clinic sizes is also noteworthy. 34% of women received care at clinics with a high daily patient capacity (301–500), 47% at mid-sized clinics (150–300), and 19% at smaller clinics (<150). This distribution pattern reflects the varied infrastructure and resource allocation across different healthcare facilities in Malaysia.
An examination of the healthcare provider inventory reveals a multi-disciplinary approach to ANC service delivery. Community nurses delivered approximately 49% of services, registered nurses with postgraduate qualifications 28%, and medical officers 46%. The significant involvement of community nurses underscores their role in frontline ANC provision, while the participation of specialized nurses and medical officers highlights the tiered structure of expertise within the system. Interestingly, pregnant women on average interacted with both community nurses and medical doctors in nearly half of their total ANC visits, indicating integrated care pathways. In terms of ANC utilization, 21% of women demonstrated inadequate utilization, 16% adequate, and 63% “adequate-plus” utilization. Understanding these utilization patterns is important for ensuring that all pregnant women receive the recommended level of care within the Malaysian context.
Further analysis of clinic staffing reveals resource allocation patterns based on clinic size and patient workload. Clinics with higher daily patient loads (301–500 and 150–300) typically assigned two medical officers to maternal-child health and had access to in-house Family Medicine Specialists for high-risk referrals. Smaller clinics (<150) had one medical officer and access to specialists on a visiting basis. Nursing staff numbers also correlated with clinic size, ranging from 35–40 in larger clinics to 8–9 in smaller clinics. Community nurses formed the majority of nursing staff (40-60%), with specialized staff nurses comprising 20-25%. Staffing patterns were generally consistent within clinic strata, although smaller clinics in less populated areas reportedly faced challenges in attracting specialized nurses. This detailed inventory of healthcare providers and their distribution across clinic types provides valuable insights into the operational capacity of the ANC system in Malaysia, which is crucial context for considering the implementation and effectiveness of systems like a colour coded risk management approach in antenatal care.
