Sydney School of Public Health, University of Sydney, NSW, Australia.
Health Policy Plan. 2012 Aug;27(5):405-16. doi: 10.1093/heapol/czr053. Epub 2011 Aug 2.
Access to skilled birth attendants and emergency obstetric care are thought to prevent early neonatal deaths. This study aims to examine the association between the type of delivery attendant and place of delivery and early neonatal mortality in Indonesia. Four Indonesia Demographic and Health Surveys from 1994, 1997, 2002/2003 and 2007 were used, including survival information from 52 917 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey. Cox proportional hazards regression models were used to obtain the hazard ratio for univariable and multivariable analyses. Our study found no significant reduction in the risk of early neonatal death for home deliveries assisted by the trained attendants compared with those assisted by untrained attendants. In rural areas, the risk of early neonatal death was higher for home deliveries assisted by trained attendants than home deliveries assisted by untrained attendants. In urban areas, a protective role of institutional deliveries was found if mothers had delivery complications. However, an increased risk was associated with deliveries in public hospitals in rural areas. Infants of mothers attending antenatal care services were significantly protected against early neonatal deaths, irrespective of the urban or rural setting. An increased risk of early neonatal death was also associated with male infants, infants whose size at birth was smaller than average and/or infants reported to be born early. A reduced risk was observed amongst mothers with high levels of education. Continuous improvement in the skills and the quality of the village midwives might benefit maternal and newborn survival. Efforts to strengthen the referral system and to improve the quality of delivery and newborn care services in health facilities are important, particularly in public hospitals and in rural areas.
人们认为，获得熟练的接生员和紧急产科护理可以预防新生儿早期死亡。本研究旨在检验印度尼西亚分娩接生员类型和分娩地点与新生儿早期死亡率之间的关联。本研究使用了来自 1994 年、1997 年、2002/2003 年和 2007 年的四次印度尼西亚人口与健康调查数据，包括每个调查前 5 年内最近一次分娩的母亲的 52917 名单胎活产婴儿的生存信息。采用 Cox 比例风险回归模型进行单变量和多变量分析，以获得风险比。我们的研究发现，与未经培训的接生员相比，接受经过培训的接生员上门接生的新生儿早期死亡风险没有显著降低。在农村地区，接受经过培训的接生员上门接生的新生儿早期死亡风险高于接受未经培训的接生员上门接生的新生儿早期死亡风险。在城市地区，如果母亲有分娩并发症，那么机构分娩会起到保护作用。然而，在农村地区的公立医院分娩会增加风险。如果母亲参加了产前保健服务，那么婴儿发生新生儿早期死亡的风险会显著降低，而不论所处的城市或农村环境如何。男婴、出生体重小于平均值的婴儿和/或报告早产的婴儿，其新生儿早期死亡的风险也会增加。母亲受教育程度较高，其新生儿早期死亡的风险也会降低。不断提高乡村助产士的技能和质量可能会使母婴的生存受益。努力加强转诊系统并改善卫生机构的分娩和新生儿护理服务质量非常重要，特别是在公立医院和农村地区。
