Constructing Sustainable Maternal and Child Health Strategies: Analyzing Factors Associated with Low-Birth-Weight Incidence in Indonesia

ABSTRACTStunting is a linear growth disorder considered as a serious health problem in Indonesia, where its prevalence is related to maternal and child health (MCH) services. This study aimed to compare the coverage of maternal and child health services between two surveys and analyze how they relate to the prevalence of stunting. The study used aggregate data from the 2013 and 2018 Basic Health Research Reports using a cross-sectional approach. The research sample spanned to 34 provinces in Indonesia. Stunting prevalence was taken as aggregate data from individuals based on height-for-age z-scores (HAZ). The independent variable was the achievement of MCH service indicators. Data analysis used variance measures, correlations, simple linear regression, and paired T-tests. The results found variations in the prevalence of stunting, with 25.4% in 2013 and 25.1% in 2018. There was a 7.4% decrease in severe stunting prevalence between 2013 and 2018, but the decrease was not significant (p = 0.506). The analysis results of the 2013 Basic Health Research showed that MCH service indicators related to stunting prevalence were coverage of antenatal care, iron consumption, delivery by health personnel, delivery in health facilities, postpartum maternal health services, low birth weight (LBW) prevalence, neonatal examination, complete immunization, health card ownership, and growth monitoring. The analysis results of the 2018 Basic Health Research showed that MCH indicators were related to the prevalence of antenatal care coverage, delivery by health personnel, and delivery in health facilities, postpartum maternal health services, LBW prevalence, neonatal examination, and complete immunization. There was a significant increase in the coverage of MCH services from 2013 and 2018 (p < 0.0001), except for the coverage of Fe tablet consumption, the prevalence of stunted birth babies, ownership of health cards, provision of vitamin A, and provision of colostrum. The better the coverage of MCH services, the lower the stunting prevalence. Efforts to improve the MCH service programs are required to reduce the prevalence of stunting for Indonesian children. Keywords: stunting, children under five years old, coverage of maternal and child health services

The evolving role of leadership and change in maternal and child health epidemiology.

Background: Weight of a newborn during delivery is a critical determinant of his health and a key element in determining the infant's ability to survive, grow physically and mentally. Additionally, it is a sign of the mother’s well-being. The present study was done to study the prevalence of low birth weight , to describe the factors affecting low birth weight and to suggest remedial measures for prevention of low birth weight. Methods: A cross sectional study was carried out in a community health centre attached with Rajshree Medical Research Institute among 227 mothers for one year. Analysis was done for estimating prevalence of low birth weight and its association with socio-demographic features, maternal clinical characteristics and newborn characteristics. Suitable research analysis was done. Results: 20.3% newborns delivered were low birth weight. Factors which were found to have significant association with low birth weight are maternal age (p<0.05), maternal education (p<0.05), work done during pregnancy (p<0.05), gestational length (p<0.001), iron and folic acid (IFA) prophylaxis (p<0.01) and sex of baby (p<0.01). Conclusions: Our study indicates that maternal age, maternal education, gestational length, IFA prophylaxis, work done during pregnancy and sex of baby are significant determinants of low birth weight. These findings highlight the importance of maternal health and prenatal care interventions in reducing the incidence of low birth weight.

Background: Low birth weight (LBW) is a major cause of infant and neonatal mortality in Indonesia. Data from the 2022 Nutritional Status Survey and the 2023 Indonesia Health Survey reported an increase in the prevalence of LBW from 5.9% to 6.1%. Records from Dr. Moewardi General Hospital, Indonesia, also show a rise in the number of LBW cases, from 392 cases in 2023 to 412 cases in 2024. This study examines the effects of maternal education, household income, antenatal care (ANC), anemia during pregnancy, preeclampsia, and chronic energy deficiency (CED) on the incidence of LBW at Dr. Moewardi hospital. Subjects and Method: This quantitative study employed a case–control design. The research was conducted at Dr. Moewardi hospital and included 100 infants with low birth weight and 100 infants with normal birth weight, selected using fixed-disease and random sampling methods. The dependent variable was LBW. The independent variables were maternal education, household income, ANC, anemia during pregnancy, preeclampsia, and CED. Data were collected through questionnaires and medical records, and analyzed using simple logistic regression and path analysis. Results: LBW was directly associated with maternal CED (b= 0.79; 95% CI= 0.08 to 1.51; p= 0.028), maternal anemia (b= 0.91; 95% CI= 0.17 to 1.65; p= 0.015), and preeclampsia (b= 1.45; 95% CI= 0.77 to 2.13; p < 0.001). LBW was indirectly influenced by ANC visits, family income, and maternal education. The path model demonstrated good fit indices (AIC= 1221.24; BIC= 1283.91). Conclusion: LBW directly increases with maternal CED, maternal anemia, and preeclampsia. LBW indirectly affects by ANC visit, family income, and maternal education.

BackgroundUganda experiences high maternal mortality ratios, with suboptimal utilization of maternal health services like antenatal care (ANC), especially in rural areas. Community Health Workers (CHWs), known as Village Health Teams (VHTs), have shown the potential to enhance maternal and child health (MCH) outcomes in Uganda by educating pregnant women in the community. However, their training models need to be refined to boost their performance.ObjectiveWe evaluated the effectiveness of a contextually tailored educational intervention delivered by VHTs on the knowledge, attitudes, and antenatal care attendance of pregnant women in Eastern Uganda.MethodsWe performed a quasi-experimental study using a pre-post-intervention evaluation conducted over six months in Eastern Uganda. We included pregnant women in their first trimester who consented to participate and excluded those in later trimesters. We performed multistage sampling with villages randomly selected and participants enrolled by trained VHTs. The VHTs were trained using a Maternal Newborn Child Health curriculum developed by a multidisciplinary team of healthcare professionals. The VHTs delivered educational sessions to the participants during home visits throughout their pregnancy. Data was collected on pregnant women’s knowledge, attitudes, and antenatal care attendance before and after the intervention. A score of ≥ 75% was considered sufficient knowledge. The Chi-square test was used to test the difference in the proportional change in knowledge and attitude of pregnant women. A paired two-sample t-test assessed changes in ANC attendance pre- and post-intervention. A p < 0.05 was considered statistically significant.Results228 participants were included, with a mean age of 27 ± 5.90 years and gravidity of 2.92 ± 1.47. There was a 60.7% increase in the proportion of participants with sufficient MCH knowledge after the intervention (19.6–80.3%, p < 0.001). Attitudes toward healthy MCH behaviors also improved. The proportion agreeing that attending eight or more ANC visits is crucial increased by 10.6% (88.1–98.7%, p < 0.001). Recognition of health facilities as the best place for ANC increased by 9.7% (89.9–99.6%, p < 0.001). The average number of ANC visits significantly increased from 1.22 to 6.38 (p < 0.001).ConclusionContextually tailored education delivered by trained VHTs significantly improved maternal health knowledge, attitudes, and ANC attendance among pregnant women in rural Uganda.

To analyze the incidence of low birth weight among single live birth neonates and identify the influencing factors in Shaanxi province. A questionnaire survey was conducted among the childbearing aged women selected through multi stage stratified random sampling in Shaanxi during 2010-2013, all of these childbearing aged women were in pregnancy or had definite pregnancy outcomes. A total of 28 164 childbearing aged women and their infants were investigated. The overall incidence of low birth weight among the single live birth neonates surveyed was 3.4% during 2010-2013 (4.1% in 2010, 4.4% in 2011, 3.1% in 2012, 2.6% in 2013, respectively). The incidence of the low birth weight was 3.8% in southern Shaanxi, 3.4% in northern Shaanxi and 3.2% in central area of Shaanxi. The incidence of the low birth weight was 2.5% in urban area and 3.6% in rural area. Compared with the low birth weight incidence of 2.6% in full-term infant, the low birth weight incidence was 32.0% in preterm infants. The results of logistic regression analysis suggested that being female infant (OR=1.57, 95% CI: 1.36-1.81), preterm delivery (OR=18.28, 95% CI: 15.23-21.96), lower educational level of mothers (OR=1.27, 95% CI: 1.06-1.52), antenatal care times <4 (compared with 4-7, OR=1.36, 95% CI: 1.14-1.63), antenatal care times ≥ 8 (compared with 4-7, OR=1.84, 95% CI: 1.48-2.29), gestational hypertension (OR=3.07, 95% CI: 2.12-4.43), being multipara (OR=1.21, 95% CI: 1.03-1.41), taking no folic acid during pregnancy (OR=1.30, 95% CI: 1.12-1.52) were risk factors for the low birth weight of neonate. The incidence of low birth weight among single live birth neonates was in decline in Shaanxi. The incidence of the low birth weight was higher in rural area than in urban area. The incidence of the low birth weight was lower than national level. Being female neonate, preterm delivery, lower education level of mothers, irregular antenatal care, gestational hypertension, being multipara, taking no folic acid during pregnancy were the risk factors for low birth weight of neonates.

Aim:This study aimed to develop a transparent district-level Maternal and Child Health (MCH) index for Uttar Pradesh (UP), India, using a hybrid methodological framework integrating Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), and Geographic Information Systems (GIS), to support spatially targeted and equitable health planning.Background:MCH is a key indicator of equity and effectiveness within health systems, directly impacting the wellbeing of mothers and children. Despite global efforts, many low-and middle-income countries continue to face preventable maternal deaths and child illnesses. In Uttar Pradesh (UP), substantial inter–district disparities in MCH outcomes persist but are often masked by state-level averages, hindering targeted policy and resource allocation.Methods:We applied a hybrid Multi-Criteria Decision-Making (MCDM) framework. AHP was used to assign weights to nine key MCH indicators covering antenatal care, skilled birth attendance, child immunization, and nutrition based on National Family Health Survey (NFHS-5, 2019–21) data across 75 districts. TOPSIS was then employed to rank districts by overall MCH performance. GIS was used to visualize spatial disparities and identify clusters of high and low performance.Findings:The MCH Index revealed substantial spatial disparities across UP. Districts such as Barabanki, Mahamaya Nagar, and Unnao ranked highest, while eastern UP and Bundelkhand showed lower performance. AHP assigned the highest importance to skilled birth attendance (22%) and antenatal care visits (22%). TOPSIS rankings highlighted gaps in maternal health services in socioeconomically marginalized districts. GIS mapping identified clusters of vulnerability linked to infrastructure and poverty. The AHP-TOPSIS-GIS framework provides a replicable method for sub-state MCH assessment, enabling policymakers to prioritize underserved districts and reduce geographic health outcomes. The findings underscore the need for decentralized, equity-focused strategies tailored to local contexts. Future research should incorporate temporal changes and socio-environmental factors to strengthen planning and monitoring.

Introduction: The high prevalence of Low Birth Weight (LBW) due to Preterm Birth (PTB) and Intrauterine Growth Restriction (IGUR) still persist a challenge in India. This happens due to poor and infrequent utilisation of Antenatal Care (ANC) service. Aim: To assess the difference of PTB and LBW in mothers, who availed ANC at a tertiary care hospital against those who availed ANC at other healthcare facility. Materials and Methods: This cross-sectional study was conducted at Gynaecology Department in Sir Sundarlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. The data was obtained from the delivery register maintained at the Labour Room of the Department. The age of the mother, place where ANC services availed, birth weight of the newborn and the gestational age were recorded on a master chart. The newborn were considered LBW, if birth weight was &lt;2500 gm, PTB if birth occurred &lt;37 completed weeks of gestation and Intrauterine Growth Restriction (IUGR), if birth weight was below the expected weight at birth for the gestational age. The prevalence of PTB, LBW and mean with SD of LBW were obtained. The association of PTB and LBW with place of ANC services availed was judged using Chi-square test. The 95% confidence interval of the prevalence was obtained by using logit transformation. Results: Out of total 2420 deliveries, 1858 mothers and their newborn were analysed. The mean age of mothers was 26.4±4.3 years. Half (50.1%) of the mothers had taken ANC at SS Hospital and the rest at other healthcare facilities. The prevalence of LBW and PTB babies were 29.2% (95% CI: 27.1-31.3) and 28.8% (95% CI: 26.7-30.9), respectively. Overall, both PTB and LBW were found to be significantly associated with the place of ANC services. Prevalence of LBW born in mothers who received ANC at tertiary care hospital was 19.4%; while it was 39.0% in those receiving at other healthcare facilities. The prevalence of PTB and LBW was more than 1.6 times and twice in those taken ANC at other health care facilities than those at TCH irrespective of gestational age. Among the PTB, the LBW were 42.2% in mothers receiving ANC at the Tertiary Care Center (TCH) against 65.6% in those receiving at other healthcare facilities. Among the full-term deliveries also, the LBW born were 13.1% in mothers receiving ANC at tertiary care as against 24.3% in those receiving at other healthcare facilities. Conclusion: The mothers seeking ANC services at other healthcare facilities need education about the advantage of ANC by the service providers, for timely and better adherence to ANC.

Low birth weight (LBW), a key indicator of impaired fetal growth, is strongly associated with infant morbidity, mortality, and long-term health problems, particularly in developing countries such as Bangladesh. LBW reflects complex public health challenges shaped by interlinked factors across health, education, and socioeconomic sectors, where low maternal education, limited household income, poor nutrition, inadequate healthcare access, and insufficient antenatal care contribute to adverse birth outcomes. Understanding these multilevel determinants is essential for designing effective public health interventions. This study examined the prevalence and determinants of LBW in Bangladesh while accounting for both individual- and community-level factors using data from the 2022 Bangladesh Demographic and Health Survey. The analysis included 5,342 newborns with recorded birth weights from births occurring within the five years preceding the survey. Birth weight was classified as LBW, defined as less than 2,500 grams, or normal birth weight of at least 2,500 grams. Binary logistic regression was applied to identify associated risk factors, and adjusted odds ratios with 95% confidence intervals were reported using a significance level of p < 0.05. Multilevel logistic regression models were additionally employed to capture community-level variation and improve model fit and predictive performance. The prevalence of LBW was 9.15%, with significant associations observed for administrative division, place of residence, household wealth index, mode of delivery, number of antenatal care visits, and place of delivery. Random-effects estimates showed reduced cluster-level variability across models, with the intraclass correlation coefficient declining from 10.65% to 6.66% and the median odds ratio decreasing from 1.81 to 1.58, indicating improved explanatory power after adjustment. Overall, LBW in Bangladesh is influenced by maternal characteristics, socioeconomic conditions, healthcare utilization, and contextual factors, underscoring the need for targeted interventions that strengthen maternal healthcare services, expand antenatal care coverage, and address socioeconomic disparities to reduce LBW prevalence and related risks.

Low birth weight (LBW), a key indicator of impaired fetal growth, is strongly associated with infant morbidity, mortality, and long-term health problems, particularly in developing countries such as Bangladesh. LBW reflects complex public health challenges shaped by interlinked factors across health, education, and socioeconomic sectors, where low maternal education, limited household income, poor nutrition, inadequate healthcare access, and insufficient antenatal care contribute to adverse birth outcomes. Understanding these multilevel determinants is essential for designing effective public health interventions. This study examined the prevalence and determinants of LBW in Bangladesh while accounting for both individual- and community-level factors using data from the 2022 Bangladesh Demographic and Health Survey. The analysis included 5,342 newborns with recorded birth weights from births occurring within the five years preceding the survey. Birth weight was classified as LBW, defined as less than 2,500 grams, or normal birth weight of at least 2,500 grams. Binary logistic regression was applied to identify associated risk factors, and adjusted odds ratios with 95% confidence intervals were reported using a significance level of p < 0.05. Multilevel logistic regression models were additionally employed to capture community-level variation and improve model fit and predictive performance. The prevalence of LBW was 9.15%, with significant associations observed for administrative division, place of residence, household wealth index, mode of delivery, number of antenatal care visits, and place of delivery. Random-effects estimates showed reduced cluster-level variability across models, with the intraclass correlation coefficient declining from 10.65% to 6.66% and the median odds ratio decreasing from 1.81 to 1.58, indicating improved explanatory power after adjustment. Overall, LBW in Bangladesh is influenced by maternal characteristics, socioeconomic conditions, healthcare utilization, and contextual factors, underscoring the need for targeted interventions that strengthen maternal healthcare services, expand antenatal care coverage, and address socioeconomic disparities to reduce LBW prevalence and related risks.

Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health

Background: Health Extension Program (HEP) was launched-innovative community health service since 2002 in Ethiopia. Since then, families were graduated as models for the HEP. Maternal and child Health (MCH) was one of the major packages in HEP. This study intended to compare model and non-model families (MFs and NMFs) on MCH behaviors. Method: Correlational study was conducted between mothers' model status and MCH service use in Sebeta Hawas district, Oromia special zone surrounding Finfine. A total of 305 samples were involved in the study from both MFs and NMFs. We applied simple random sampling. A pretested and structured questionnaire adopted from literatures together with discussion guides was used. It mainly composed of utilization of Family Planning (FP), antenatal care (ANC), delivery care (DC), postnatal care (PNC) and immunization. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 16. We used frequency tables to describe model status. Odds Ratio (OR) was used to identify demarcations between MFs and NMFs. Finally, quantitative and qualitative findings was triangulated. Result: The study showed statistically significant key variations between MFs and NMFs over family size, knowledge of (ANC, delivery complications and PNC) and utilization of (FP and ANC visits). These variables were positively linked with being from MFs. For example, 114/201 (56.7%) current FP users, 120/222 (54.1%) any ANC visitors, and 56/82 (68.3%) repeated (>=4) ANC visitors were from MFs compared to NMFs (PV<0.001). However, mothers from MFs & NMFs had no variation on delivery, PNC & immunization utilization. Closure of health posts at work time, inaccessible institutional delivery service (for MFs) and perceived invulnerability to delivery complications (for NMFs) hampered the MCH behaviors. Conclusion: Though MFs and NMF were similar over some MCH service knowledge and utilization, they vary over FP and ANC. MFs can be advocate for enhancing adoption and diffusion of earlier stage MCH behaviors. However, beyond the control contexts hindered MFs from playing their role of modeling late stages MCH behaviors (DC/ PNC/immunization).Therefore, HEP designers and implementers shall work on system challenges and create separate models for those behaviors and assign new name.

Maternal and child health (MCH) remains a critical public health concern in Indonesia, particularly in rural areas. Community midwives play a pivotal role in addressing MCH challenges by providing accessible and culturally sensitive care. This study aimed to evaluate the impact of a community midwifery program on MCH outcomes in Purwakarta, Indonesia, focusing on antenatal care (ANC) utilization, stunting prevalence, and sanitation practices. A quasi-experimental study was conducted in Purwakarta, involving two villages: one intervention village receiving the community midwifery program and one control village with standard care. The program encompassed health education, ANC promotion, growth monitoring, and sanitation improvement initiatives. Data on ANC visits, child growth, and sanitation practices were collected at baseline and after one year. The intervention village demonstrated a significant increase in ANC attendance (p &lt; 0.05) and a reduction in stunting prevalence (p &lt; 0.01) compared to the control village. Improved sanitation practices were also observed in the intervention village. In conclusion, the community midwifery program effectively enhanced MCH outcomes in Purwakarta. The findings underscore the importance of community-based midwifery interventions in improving ANC utilization, reducing stunting, and promoting sanitation practices. Scaling up such programs can contribute significantly to achieving sustainable development goals related to MCH in Indonesia.

Background: The incidence of low birth weight is estimated to be 16% worldwide, 19% in developing countries, and 7% in developed countries. Currently, 13% of Ethiopian babies are born with a low weight; different studies have reported that the prevalence of low birth weight accounts for about 8.8% in Addis Ababa and 10.5% in the Tigray region. This study is primarily aimed at assessing the factors associated with the low birth weight of newborns in selected Addis Ababa public hospitals.Methods: Data collection was conducted in Addis Ababa from March 2021 to April 2021. A facility-based cross-sectional study was used among 466 mothers who gave birth in public hospitals during a reference period. Primary data were collected using a structured questionnaire adopted from previous studies. The sample size was calculated by Epi Info calc using an assumption of 95% CI, 80% power, 20.6 percent exposed, 10.4 percent unexposed, and 2.2 Adjusted Odds Ratio (AOR). Univariate, bivariate, and multiple logistic regression analyses were used. Adjusted odds ratios were used to identify the association between the key predictors and the dependent variable (birth weight).Results: Of the total respondents, 12.4% gave birth to infants with a low birth weight. The median age of the participants was 28 yrs (IQR = 7). The results of multivariable logistic regression showed that the key determinants of low birth weight among the study population were: number of ANC (Antenatal Care) visits (AOR = 0.4, 95% CI: 0.17-0.99), presence of Abnormal Uterine Bleeding (AUB) during recent pregnancy (AOR = 10.9, 95% CI: 2.5-15.8), having pre-eclampsia or eclampsia during recent pregnancy (AOR 9.5, 95% CI: 4.8-10.8), Anemia during pregnancy (AOR = 3.3, 95% CI 3.1-3.6), Chewing Kchat (AOR = 7.9, 95% CI: 3.9-16.1), and pre-pregnancy maternal nutritional (AOR = 0.2, 95% CI: 0.1-0.5).Conclusions: Encouraging pregnant mothers to make frequent ANC visits, behavioral change communications that target pregnant women for improving women's nutritional status, and reducing maternal toxic exposures should be priority areas of interventions to curb the problem.

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.