Abstract
BackgroundNeonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002.MethodsThe data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants.ResultsAt the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00), and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03) compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00) and for infants born to father who were unemployed (OR = 2.99, p = 0.02). The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00), male infants (OR = 1.49, p = 0.01), smaller than average-sized infants (OR = 2.80, p = 0.00), and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00). Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03).ConclusionPublic health interventions directed at reducing neonatal death should address community, household and individual level factors which significantly influence neonatal mortality in Indonesia. Low birth weight and short birth interval infants as well as perinatal health services factors, such as the availability of skilled birth attendance and postnatal care utilization should be taken into account when planning the interventions to reduce neonatal mortality in Indonesia.
Highlights
Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally
Using the 2002–2003 Indonesia Demographic and Health Survey data, this study examined the determinants of neonatal mortality for all singleton infants of the sampled women who were born between 1997 and 2002
Indonesia Demographic and Health Survey (IDHS) data sets have a hierarchical structure, with women or men within households which are within Census Blocks (CB)
Summary
Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. Of 130 million babies born annually, more than 4 million die in the neonatal period [1], and 99 per cent of these deaths occur in developing countries [2]. Evidence-based approach to reduce neonatal mortality in Indonesia, a clear understanding of the associated factors is necessary. Using the 2002–2003 Indonesia Demographic and Health Survey data, this study examined the determinants of neonatal mortality for all singleton infants of the sampled women who were born between 1997 and 2002. Despite accounting for almost 40 per cent of all under-five child deaths and more than half of infant deaths, neonatal mortality is not a target of the Millennium Development Goals (MDGs) [7]. If the MDG target of a two-thirds reduction in child mortality by 2015 is to be achieved neonatal mortality must be addressed
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