The history of MPSU:The Malaysian Paediatric  Surveillance Unit was formed in 1994 and most of the work was undertaken by Dr Jackie Ho. Dr Amar Singh and Dato' Dr A Jai Mohan.The paediatricians from Ipoh ran the MPSU until the year 2000. The studies which were most helpful to the paediatricians in the country included the study on asthma deaths (see below), acute liver necrosis and congenital heart disease in the newborn period. The MPSU has been funded by grants from the Malaysian Paediatric Foundation and fees collected from researchers. After a period of 6 years the MPSU has now been taken over by a team from Hospital USM, Kubang Kerian, Kelantan (to be announced). The MPA would like to thank Dr Jackie Ho, Dr Amar Singh, Dato' Dr A Jai Mohan and their team in Ipoh, Perak for their good effort and hard work over the many years.

BRONCHIAL ASTHMA DEATHS IN MALAYSIAN CHILDREN: A 3 1/12 YEAR SURVEILLANCE STUDY (presented at the 21st Annual Congress of the MPA 5-8/9/99)

GL Kuan Departnient of Paediatrics, Hospital Malacca, Malacca, Malaysia

With the help of the Malaysian Paediatric Surveillance Unit (MPSU) a surveillance system conducted by Malaysian Paediatric Association (MPA), a 3 1/2 year study (March 1994 - August 1997) was conducted to (1) determine the number of asthma deaths that occur in children less then 12 years old, (2) study the risk factors associated with these deaths and finally (3) identify if these deaths were preventable. Within the study period, the MPSU were notified monthly by paediatricians who were members of MPA throughout the country, of any asthma deaths that occurred. The MPSU would notify the author, who would then contact the paediatricians concerned to fill up a data sheet. During the study period, there were 35 notifications but only 12 replies (34% response rate). Of the 12 cases reported, only 10 cases will be discussed as two cases had incomplete data There was no seasonal pattern in the occurrence of the deaths. The male:female ratio in this series of 10 deaths were equal; 7 were Malays, 3 were Chinese and 1 was an Indian child. The ages of the patients ranged from 1.4 years to 11 years; the mean age was 5.6 years. All were known asthmatics except one; and 8 patients had history of onset of asthma at <2 years of age. Eight of the patients had reduced growth (weight <3%). Only 4 patients were on prophylaxis. Long term under supervision and under treatment was felt to be the underlying preventable contributory factor in 6 of the deaths. Poor perception of the fatal attack on the part of the parents was felt to be a preventable contributory factor in 7 of the cases; and on the part of the attending doctor in one of the cases. There was delay in seeking treatment in the fatal cases in 6 of the cases; a suboptimal treatment in 3 of the cases. Asthma deaths in children is not as uncommon as perceived by most doctors and parents. Nine of the deaths were potentially avoidable had more emphasis been put on doctor and patient education to improve long term undersupervision and under treatment. Deaths from asthma in children is a reality that should be impressed on parents to spur them to be more proactive and to seek treatment early; and on doctors to provide optimal treatment.