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Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010-2021.

作者信息

Utomo Budi, Romadlona Nohan Arum, Naviandi Uray, BaharuddinNur Ryza Jazid, Makalew Richard, Liyanto Elvira, Nanwani Sandeep, Dibley Michael J, Hull Terence H

机构信息

Department of Population and Biostatistics, and Center for Health Research, Faculty of Public Health Universitas Indonesia, Depok, West Java, Indonesia.

Department of Public Health, Faculty of Sport Science, Universitas Negeri Malang, Malang, East Java, Indonesia.

出版信息

Sci Rep. 2025 Mar 19;15(1):9397. doi: 10.1038/s41598-025-91942-9.


DOI:10.1038/s41598-025-91942-9
PMID:40102491
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11920268/
Abstract

Despite many health program efforts, the maternal mortality in Indonesia has slowly declined and remains high. A comprehensive understanding of social determinants of maternal mortality is needed to guide improved strategies to accelerate reductions in maternal mortality. This study aimed to assess the health-program and social factors that determine maternal mortality in Indonesia through census block-based log-linear regression analysis of recent large surveys. The following data sets were used: (1) the Indonesia Intercensal Population Survey 2015 merged to the Village Potential Census, 2014; and (2) the Indonesia Population Census 2020-Long Form (conducted in 2022) merged to the Village Potential Census, 2021. Both surveys used the same multistage sampling procedure to select 40,728 and 268,223 census blocks. In each selected census block, a "take all take some" procedure was used to randomly select 16 households. Maternal mortality, its health-program, and social factors were measured at the census block level. Since many census blocks had zero maternal death, a log-linear regression, modelled as Ln Y' = α + β X, was employed. Ln Y' is the natural log transform of maternal mortality ratio; X are the factors investigated; β is the regression coefficient of X on Ln Y'. β measures the extent influence of X on Y. On the study results, the maternal mortality has declined but remains high, and geographic and socioeconomic disparities in maternal mortality have reduced, although they are still striking. There are many factors that have influenced the risk of maternal mortality. Proximity to hospital reduced the risk of maternal mortality. The primary health care system is not yet optimal for reducing the risk of maternal death. Traditional birth attendants hinder the referral for maternal complications. Lack of household transportation increases the risk of maternal mortality. The use of contraception to reduce high-risk births also reduces the risk of maternal mortality. Poverty and low maternal education independently increase the risk of maternal death. Households that are too large; have one or more disabled member; and have experienced child loss are at high risk of maternal mortality. Lack of village electrification and a polluted environment independently increase the risk of maternal mortality. The study results imply the need for multiple strategic interventions to accelerate the reduction of maternal mortality. Optimizing the coverage of quality referral hospitals, particularly in the eastern region, is required. There is a need to facilitate easy transportation from households to the nearest functional EmMONC. There is a need to strengthen the primary health care system to early detect, stabilize, and facilitate timely, safe, and effective referral of cases of maternal complications. Social health insurance should not only cover the cost of health care but also improve the quality of healthcare services. The role of traditional birth attendants should be shifted away from delivery care to improve maternal and neonatal health care. Family planning programs should focus on preventing high-risk births. Women's education needs to be improved. Electrification of all villages and control of environmental pollution to reduce maternal deaths.

摘要

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[1]
Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010-2021.

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本文引用的文献

[1]
Reducing maternal mortality in low- and middle-income countries.

Case Rep Womens Health. 2023-9-9

[2]
Geographical and Socioeconomic Inequalities in Maternal Mortality in Ethiopia.

Int J Soc Determinants Health Health Serv. 2023-7

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Contraceptive use and maternal mortality in Indonesia: a community-level ecological analysis.

Reprod Health. 2021-2-17

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