Abstract
BackgroundSimilar to global trends, neonatal mortality has fallen only slightly in Indonesia over the period 1990–2010, with a high proportion of deaths in the first week of life.ObjectiveThis study aimed to identify risk factors associated with neonatal deaths of low and normal birthweight infants that were amenable to health service intervention at a community level in a relatively poor province of Indonesia.DesignA matched case–control study of neonatal deaths reported from selected community health centres (puskesmas) was conducted over 10 months in 2013. Cases were singleton births, born by vaginal delivery, at home or in a health facility, matched with two controls satisfying the same criteria. Potential variables related to maternal and neonatal risk factors were collected from puskesmas medical records and through home visit interviews. A conditional logistic regression was performed to calculate odds ratios using the clogit procedure in Stata 11.ResultsCombining all significant variables related to maternal, neonatal, and delivery factors into a single multivariate model, six factors were found to be significantly associated with a higher risk of neonatal death. The factors identified were as follows: neonatal complications during birth; mother noting a health problem during the first 28 days; maternal lack of knowledge of danger signs for neonates; low Apgar score; delivery at home; and history of complications during pregnancy. Three risk factors (neonatal complication at delivery; neonatal health problem noted by mother; and low Apgar score) were significantly associated with early neonatal death at age 0–7 days. For normal birthweight neonates, three factors (complications during delivery; lack of early initiation of breastfeeding; and lack of maternal knowledge of neonatal danger signs) were found to be associated with a higher risk of neonatal death.ConclusionThe study identified a number of factors amenable to health service intervention associated with neonatal deaths in normal and low birthweight infants. These factors include maternal knowledge of danger signs, response to health problems noted by parents in the first month, early initiation of breastfeeding, and delivery at home. Addressing these factors could reduce neonatal deaths in low resource settings.
Highlights
Similar to global trends, neonatal mortality has fallen only slightly in Indonesia over the period 1990Á2010, with a high proportion of deaths in the first week of life
The risk factors were as follows: 1) neonatal complications at delivery; 2) neonatal health problem requiring a visit to a healthcare provider; 3) lack of maternal knowledge of neonatal danger signs; 4) low Apgar score; 5) maternal complications during pregnancy; 6) delivery at home; 7) history of complications in previous pregnancies; 8) not using the kangaroo method of care; 9) not receiving early initiation of breastfeeding; 10) a high-risk maternal pregnancy; and 11) mother’s age at marriage
Socio-economic status factors including level of income, education, poverty, accessibility, and social support were investigated in our study, but we found that only the variables of accessibility, poverty, and social support reached a statistically significant association with a higher risk of neonatal death This is a result of our study design, as cases and controls were selected from the same village, where large variations between households in levels of income and education were unlikely
Summary
Neonatal mortality has fallen only slightly in Indonesia over the period 1990Á2010, with a high proportion of deaths in the first week of life. Objective: This study aimed to identify risk factors associated with neonatal deaths of low and normal birthweight infants that were amenable to health service intervention at a community level in a relatively poor province of Indonesia. Conclusion: The study identified a number of factors amenable to health service intervention associated with neonatal deaths in normal and low birthweight infants These factors include maternal knowledge of danger signs, response to health problems noted by parents in the first month, early initiation of breastfeeding, and delivery at home. Addressing these factors could reduce neonatal deaths in low resource settings. The 2012 IDHS showed the NMR in some provinces in eastern Indonesia to be three times higher than in western Indonesia [3]
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