title: Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study.
abstract: We investigated associations between maternal characteristics, access to care, and obstetrical complications including near miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons.
  
  
  
  We prospectively collected data on inborn singletons at two hospitals in East Java. Data included socio-demographics, reproductive, obstetric and neonatal variables. Reduced multivariable models were constructed. Outcomes of interest included low and very low birthweight (LBW/VLBW), asphyxia and death.
  
  
  
  Referral from a care facility was associated with a reduced risk of LBW and VLBW [AOR = 0.28, 95% CI = 0.11-0.69, AOR = 0.18, 95% CI = 0.04-0.75, respectively], stillbirth [AOR = 0.41, 95% CI = 0.18-0.95], and neonatal death [AOR = 0.2, 95% CI = 0.05-0.81]. Mothers age <20 years increased the risk of VLBW [AOR = 6.39, 95% CI = 1.82-22.35] and neonatal death [AOR = 4.10, 95% CI = 1.29-13.02]. Malpresentation on admission increased the risk of asphyxia [AOR = 4.65, 95% CI = 2.23-9.70], stillbirth [AOR = 3.96, 95% CI = 1.41-11.15], and perinatal death [AOR = 3.89 95% CI = 1.42-10.64], as did poor prenatal care (PNC) [AOR = 11.67, 95%CI = 2.71-16.62]. Near-miss on admission increased the risk of neonatal [AOR = 11.67, 95% CI = 2.08-65.65] and perinatal death [AOR = 13.08 95% CI = 3.77-45.37].
  
  
  
  Mothers in labor should be encouraged to seek care early and taught to identify early danger signs. Adequate PNC significantly reduced perinatal deaths. Improved hospital management of malpresentation may significantly reduce perinatal morbidity and mortality. The importance of hospital-based prospective studies helps evaluate specific areas of need in training of obstetrical care providers.
authors.affiliation: Center for Family Welfare, Faculty of Public Health, University of Indonesia, Depok, Indonesia.|School of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Trisari
authors.initials: T
authors.lastname: Anggondowati
authors.affiliation: CUNY Graduate School of Public Health and Health Policy, 55 West 125th St., Room 714, New York, NY, 10027, USA.
authors.forename: Ayman A E
authors.initials: AA
authors.lastname: El-Mohandes
authors.affiliation: Center for Family Welfare, Faculty of Public Health, University of Indonesia, Depok, Indonesia.
authors.forename: S Nurul
authors.initials: SN
authors.lastname: Qomariyah
authors.affiliation: CUNY Graduate School of Public Health and Health Policy, 55 West 125th St., Room 714, New York, NY, 10027, USA. michele.kiely@sph.cuny.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Kiely
authors.affiliation: (Formerly) John Snow, Inc., Arlington, VA, USA.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Ryon
authors.affiliation: John Snow, Inc., Boston, MA, USA.
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Gipson
authors.affiliation: U.S. Agency for International Development, Washington, District of Columbia, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zinner
authors.affiliation: School of Public Health, University of Indonesia, Depok, Indonesia.
authors.forename: Anhari
authors.initials: A
authors.lastname: Achadi
authors.affiliation: George Washington University School of Medicine and Health Science, Washington, District of Columbia, USA.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008423:Maternal Age; D015999:Multivariate Analysis; D066087:Perinatal Death; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
keywords: Asphyxia; Indonesia; Obstetrical; Perinatal death; Prematurity