Abdullah Asnawi, Hort Krishna, Butu Yuli, Simpson Louise
Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.
Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.
Glob Health Action. 2016 Feb 16;9:30445. doi: 10.3402/gha.v9.30445. eCollection 2016.
Similar 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.
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.
A 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.
Combining 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.
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.
与全球趋势相似，1990年至2010年期间印度尼西亚的新生儿死亡率仅略有下降，且出生后第一周的死亡比例很高。
本研究旨在确定印度尼西亚一个相对贫困省份社区层面可通过卫生服务干预的低出生体重和正常出生体重婴儿新生儿死亡相关危险因素。
2013年在10个月内对选定社区卫生中心（puskesmas）报告的新生儿死亡进行了配对病例对照研究。病例为单胎分娩，在家中或医疗机构经阴道分娩，与两名符合相同标准的对照进行配对。从puskesmas医疗记录和通过家访访谈收集与孕产妇和新生儿危险因素相关的潜在变量。使用Stata 11中的clogit程序进行条件逻辑回归以计算比值比。
将与孕产妇、新生儿和分娩因素相关的所有显著变量纳入单一多变量模型后，发现六个因素与新生儿死亡风险较高显著相关。确定的因素如下：出生时的新生儿并发症；母亲在出生后28天内注意到健康问题；母亲对新生儿危险信号缺乏了解；阿氏评分低；在家分娩；以及孕期并发症史。三个危险因素（分娩时的新生儿并发症；母亲注意到的新生儿健康问题；以及阿氏评分低）与0至7天的早期新生儿死亡显著相关。对于正常出生体重的新生儿，发现三个因素（分娩期间的并发症；缺乏早期母乳喂养；以及母亲对新生儿危险信号缺乏了解）与新生儿死亡风险较高相关。
该研究确定了一些与正常和低出生体重婴儿新生儿死亡相关的可通过卫生服务干预的因素。这些因素包括母亲对危险信号的了解、对父母在第一个月注意到的健康问题的应对、早期母乳喂养以及在家分娩。解决这些因素可降低资源匮乏地区的新生儿死亡率。
