PENYEBAB UTAMA KEMATIAN DI HOSPITAL KERAJAAN 2006

Jadual di atas menunjukkan 10 penyebab utama kematian di hospital KKM tahun 2006.

1. Septisemia (keracunan darah/ jangkitan dalam darah) ...16.87%

2. Penyakit jantung serta sirkulatori paru-paru.....15.7%

3. Kanser ...............10.59%

4. Strok / angin ahmar/CVA...................................8.49%

5. Pneumonia (radang paru-paru)...............................................5.81%

6. Kemalangan Jalan raya.............................................................5.59%

7. Penyakit Sistem Penghadzaman..............................................4.47%

8. Keadaan tertentu yang berlaku semasa period perinatal....4.20%


9. Penyakit buah pinggang seperti nefritis dan lain-lain...........3.83%

10. Keadaan yang tidak jelas.........................................................3.03%


(40,056 jumlah kematian)

Di USA, septisemia juga merupakan penyebab utama kematian di Unit Rawatan rapi bukan-jantung dan merupakan penyebab kesepuluh kematian di sana. Septisemia lebih kerap berlaku di kalangan warga emas, pesakit yang daya tahan melawan penyakit agak rendah dan pesakit yang kritikal.

Penyakit jantung Iskemia atau iskemia otot jantung, adalah sejenis penyakit di mana bekalan darah ke otot jantung berkurangan biasanya disebabkan oleh ateroma (plak kolesterol dan lain-lain) pada arteri koronari. Risiko penyakit jantung meningkat dengan peningkatan umur, merokok, kandungan kolesterol yang tinggi dalam darah (hiperkolesterolemia), kencing manis (diabetes melitus), penyakit tekanan darah tinggi (hipertensi), sejarah keluarga dan lain-lain.

Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG).

It is the most common cause of death in most Western countries, and a major cause of hospital admissions. There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk

Ischemic heart disease may present with any of the following problems:

• Angina pectoris (chest pain on exertion, in cold weather or emotional situations)
• Acute chest pain: acute coronary syndrome, unstable angina or myocardial infarction ("heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage)
• Heart failure (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle)

The medical history distinguishes between various alternative causes for chest pain (such as dyspepsia, musculoskeletal pain, pulmonary embolism). As part of an assessment of the three main presentations of IHD, risk factors are addressed. These are the main causes of atherosclerosis (the disease process underlying IHD): age, male sex, hyperlipidaemia (high cholesterol and high fats in the blood), smoking, hypertension (high blood pressure), diabetes, and the family history.

Stroke or cerebrovascular accident (CVA) is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism, or due to a hemorrhage.^[1] In medicine, a stroke, fit, or faint is sometimes referred to as an ictus [cerebri], from the Latin icere ("to strike"), especially prior to a definitive diagnosis.

Stroke is a medical emergency and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated. It is the third leading cause of death and the leading cause of adult disability in the United States and Europe. It is predicted that stroke will soon become the leading cause of death worldwide. Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischaemic attack (TIA), diabetes, high cholesterol, cigarette smoking, atrial fibrillation, migraine with aura, and thrombophilia (a tendency to thrombosis). Blood pressure is the most important modifiable risk factor of stroke.

The traditional definition of stroke, devised by the World Health Organisation in the 1970s,^[3] is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. It divides stroke from TIA, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. With the availability of treatments that, when given early, can reduce stroke severity, many now prefer alternative concepts, such as brain attack and acute ischemic cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.

Treatment of stroke is occasionally with thrombolysis ("clot buster"), but usually with supportive care (physiotherapy and occupational therapy) and secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood pressure control, statins and anticoagulation (in selected patients).^[5]

Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display the traits of uncontrolled growth (growth and division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not.

Cancer may affect people at all ages, even fetuses, but risk for the more common varieties tends to increase with age. About 7.6 million people died from cancer in the world during 2007. Apart from humans, forms of cancer may affect other animals and plants.

Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are often activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are often inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system.

Cancer is usually classified according to the tissue from which the cancerous cells originate, as well as the normal cell type they most resemble. These are location and histology, respectively. A definitive diagnosis usually requires the histologic examination of a tissue biopsy specimen by a pathologist, although the initial indication of malignancy can be symptoms or radiographic imaging abnormalities. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments.

Berdasarkan perbincangan di atas, pihak berwajib haruslah memberi penekanan fokus terhadap pencegahan penyakit yang menyumbang kepada kematian dan kesengsaraan rakyat Malaysia. Berdasarkan statistik di atas, kempen besar-besaran yang meluas, termasuk kanak-kanak sekolah, program berkala dan "kos-effective" hendaklah dijalankan sepanjang tahun bagi meningkatkan kefahaman rakyat tentang pembunuh utama negara sekaligus kualiti hidup mereka. Kesungguhan dan kesedaran ahli politik dalam menangani masalah ini amat diperlukan. Kakitangan Kementerian Kesihatan Malaysia hanya menjalankan dasar dalam ruanglingkup yang terhad dan terbatas oleh peruntukan kewangan. Budget tahunan untuk aktiviti dan program pencegahan penyakit tak-berjangkit serta kronik harus dipertingkatkan di samping keperluan dan program Kementerian Kesihatan yang lain.

Sila rujuk posting saya bertajuk "Healthcare System In Dire Need Of Change" pada 26 Mac 2008 tentang peruntukan kewangan yang harus diberikan kepada sektor kesihatan.

What we need in order to implement preventive measures against diseases, disorders, mortality and morbidity in the community is POLITICAL WILL.