title: Risk factors associated with neonatal deaths: a matched case-control study in Indonesia.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.|Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.|Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia; Asnawi.Abdullah@fkm.unmuha.ac.id.
authors.forename: Asnawi
authors.initials: A
authors.lastname: Abdullah
authors.affiliation: Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.|Nossal Institute for Global Health, University of Melbourne, Parkville, Australia.
authors.forename: Krishna
authors.initials: K
authors.lastname: Hort
authors.affiliation: Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.
authors.forename: Yuli
authors.initials: Y
authors.lastname: Butu
authors.affiliation: Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.
authors.forename: Louise
authors.initials: L
authors.lastname: Simpson
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003151:Community Health Centers; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007407:Interviews as Topic; D000068097:Maternal Health; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Indonesia; matched case–control study; maternal health and neonatal health; neonatal death; risk factors