Indonesia Maternal Health Articles - Abstracts - Neonatal

Indonesia and Maternal Health – 2.
5 years of articles
Sent on: Thu Feb 15 16:08:25 2018
71 selected items
PubMed Results
Items 1 -71 of 71 (Display the 71 citations in PubMed)
1. Int J Womens Health. 2017 Dec 29;10:11-24. doi: 10.2147/IJWH.S144828. eCollection 2018.
Trends and inequities in use of maternal health care services in

Indonesia, 1986-2012.
Nababan HY1, Hasan M2, Marthias T1,3, Dhital R4, Rahman A2, Anwar I2.
Author information:
1
Nossal Institute for Global Health, Melbourne School of Population and Global
Health, the University of Melbourne, Parkville, Melbourne, VIC, Australia.
2
Health Systems and Population Studies Division, icddr,b, Mohakhali, Dhaka,
Bangladesh.
3
Center for Health Policy and Management, Faculty of Medicine, Universitas Gadjah
Mada, Yogyakarta, Indonesia.
4
FIGO Post-Partum IUD Initiative - Nepal, Nepal Society of Obstetrician and
Gynaecologists (NESOG), Kathmandu, Nepal.
Abstract
Purpose:
Overall health status indicators have improved significantly over the past three decades in
Indonesia. However, the country's maternal mortality ratio remains high with a stark
inequality by region. Fewer studies have explored access inequity in maternal health care
service over time using multiple inequality markers. In this study, we analyzed Indonesian
Demographic and Health Survey (DHS) data to explore trends and inequities in use of any
antenatal care (ANC), four or more ANC (ANC4+), institutional birth, and cesarean section
(c-section) birth in Indonesia during 1986-2012 to inform policy for future strategies ending
preventable maternal deaths.
Methods:
Indonesian DHS data from 1991, 1994, 1997, 2002/3, 2007, and 2012 surveys were
downloaded, merged, and analyzed. Inequity was measured in terms of variation in use by
asset quintile, parental education, urban-rural location, religion, and region. Trends in use
inequities were assessed plotting changes in rich:poor ratio, rich:poor difference, and
concentration indices over period based on asset quintiles. Sociodemographic determinants for
service use were explored using multivariable logistic regression analysis.
Findings:
Between 1986 and 2012, institutional birth rate increased from 22% to 73% and c-section rate
from 2% to 16%. Private sector was increasingly contributing in maternal health. There were
significant access inequities by asset quintile, parental education, area of residence, and
geographical region. The richest women were 5.45 times (95% CI: 4.75-6.25) more likely to
give birth in a health facility and 2.83 times (95% CI: 2.23-3.60) more likely to give birth by
c-section than their poorest counterparts. Urban women were 3 times more likely to use
institutional birth and 1.45 times more likely to give birth by c-section than rural women. Use
of all services was higher in Java and Bali than in other regions. Access inequity was
narrowing over time for use of ANC and institutional birth but not for c-section birth.
Conclusion:
Ongoing pro-poor health-financing strategies should be strengthened with introduction of

innovative ways to monitor access, equity, and quality of care in maternal health.
PMCID: PMC5749568 Free PMC Article

PMID: 29343991
Similar articles
Conflict of interest statement
Disclosure The authors report no conflicts of interest in this work.

2. J Public Health (Oxf). 2018 Jan 9. doi: 10.1093/pubmed/fdx175. [Epub ahead of print]
Maternal and Child Health Handbook use for maternal and child
care: a cluster randomized controlled study in rural Java,
Indonesia.
Osaki K1,2, Hattori T2, Toda A2, Mulati E3, Hermawan L4, Pritasari K5, Bardosono S6, Kosen
S7.
Author information:
1
Japan International Cooperation Agency, Tokyo, Japan.
2
Japan International Cooperation Agency, Jakarta, Indonesia.
3
Directorate of Medical Device and Household Product Inspection, Ministry of Health,
Jakarta, Indonesia.
4
Directorate of Family Health, Ministry of Health, Jakarta, Indonesia.
5
Agency for Development and Empowerment of Human Resources for Health,
Ministry of Health, Jakarta, Indonesia.
6
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
7
Indonesia Agency for Health Research and Development, Ministry of Health, Jakarta,
Indonesia.
Abstract
Background:
Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet
for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and
home care in rural Java, a low service-coverage area.
Methods:
We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention

included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health
personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the
MCHHB.
Results:
The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the
intervention area received consecutive MCH services including two doses of tetanus toxoid
injections and antenatal care four times or more during pregnancy, professional assistance
during child delivery and vitamin A supplements administration to their children, after
adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In
the intervention area, home care (continued breastfeeding; introducing complementary
feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough),
perceived support by husbands, and lower underweight rates and stunting rates among
children were observed.
Conclusion:
MCHHB use promoted continuous care acquisition and care at home from pregnancy to early
child-rearing stages in rural Java.
PMID: 29325171
Similar articles
3. J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):48. doi: 10.1186/s41043-017-0126-9.
Summary findings from a mixed methods study on identifying

and responding to maternal and newborn illness in seven
countries: implications for programs.
Charlet D1, Moran AC2, Madhavan S2.
Author information:
1
University Research Co., LLC, Bethesda, MD, USA. dcharlet@urc-chs.com.
2
Bureau for Global Health, United States Agency for International Development,
Washington, DC, USA.
Abstract
BACKGROUND:
There is a lack of systematic information documenting recognition of potentially life-

threatening complications and decisions to seek care, as well as reaching care and the specific
steps in that process. In response to this gap in knowledge, a multi-country mixed methods
study was conducted to illuminate the dynamics driving Delays 1 and 2 across seven countries
for maternal and newborn illness and death.
METHODS:
A common protocol and tools were developed, adapted by each of seven study teams
depending on their local context (Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda, and
Nepal). Maternal and newborn illness, and maternal and newborn death cases were included.
Trained interviewers conducted event narratives to elicit and document a detailed sequence of
actions, from onset of symptoms to the resolution of the problem. Event timelines were
constructed, and in-depth interviews with key informants in the community were conducted.
Transcripts were coded and analyzed for common themes corresponding to the three main
domains of recognition, decision-making, and care-seeking.
RESULTS:
Maternal symptom recognition and decision-making to seek care is faster than for newborns.
Perceived cause of the illness (supernatural vs. biological) influences the type of care sought
(spiritual/traditional vs. formal sector, skilled). Mothers, fathers, and other relatives tend to be
the decision-makers for newborns while husbands and elder females make decisions for
maternal cases. Cultural norms such as confinement periods and perceptions of newborn
vulnerability result in care being brought in to the home. Perceived and actual poor quality of
care was repeatedly experienced by families seeking care.
CONCLUSION:
The findings link to three action points: (1) messaging around newborn illness needs to
reinforce a sense of urgency and the need for skilled care regardless of perceived cause; (2)
targeted awareness building around specific maternal danger signs that are not currently
recognized and where quality care is available is needed; and (3) designing appropriate
contextualized messages. This research links to and supports a number of current global
initiatives such as Ending Preventable Maternal Mortality, the Every Newborn Action Plan,
the WHO Quality of Care framework, and the WHO guidelines on simplified management of
newborn sepsis at the community level. This type of research is invaluable for designing
programs to improve maternal and newborn survival to achieve ambitious global targets.

PMID: 29297392
Similar articles
Methodology for a mixed-methods multi-country study to

assess recognition of and response to maternal and newborn
illness.
Moran AC1, Charlet D2, Madhavan S3, Aruldas K4, Donaldson M2, Manzi F5, Okuga M6,
Rosales A7, Sharma V8, Celone M2, Brandes N3, Sherry JM2,9.
Author information:
1
United States Agency for International Development, Bureau for Global Health,
Washington, DC, USA. allisynmoran@gmail.com.
2
University Research Co., LLC, Bethesda, MD, USA.
3
United States Agency for International Development, Bureau for Global Health,
Washington, DC, USA.
4
Population Council, New Delhi, India.
5
Ifakara Health Institute, Dar es Salaam, Tanzania.
6
Makerere University School of Public Health, Makerere University College of Health
Sciences, Kampala, Uganda.
7
World Vision, Washington, DC, USA.
8
The Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology,
Cambridge, MA, USA.
9
School of Public Health, City University of New York, New York, New York, USA.
Abstract
BACKGROUND:
Although maternal and newborn mortality have decreased 44 and 46% respectively between
1990 and 2015, achievement of ambitious Sustainable Development Goal targets requires
accelerated progress. Mortality reduction requires a renewed focus on the continuum of
maternal and newborn care from the household to the health facility. Although barriers to
accessing skilled care are documented for specific contexts, there is a lack of systematic
evidence on how women and families identify maternal and newborn illness and make
decisions and subsequent care-seeking patterns. The focus of this multi-country study was to
identify and describe illness recognition, decision-making, and care-seeking patterns across
various contexts among women and newborns who survived and died to ultimately inform
programmatic priorities moving forward.
METHODS:
This study was conducted in seven countries-Ethiopia, Tanzania, Uganda, Nigeria, India,
Indonesia, and Nepal. Mixed-methods were utilized including event narratives (group
interviews), in-depth interviews (IDIs), focus group discussions (FDGs), rapid facility
assessments, and secondary analyses of existing program data. A common protocol and tools
were developed in collaboration with study teams and adapted for each site, as needed.
Sample size was a minimum of five cases of each type (e.g., perceived postpartum
hemorrhage, maternal death, newborn illness, and newborn death) for each study site, with a
total of 84 perceived PPH, 45 maternal deaths, 83 newborn illness, 55 newborn deaths, 64
IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding
within and across cases, identifying broad themes on recognition of illness, decision-making,
and patterns of care seeking, and corresponding contextual factors. Technical support was
provided throughout the process for capacity building, quality assurance, and consistency
across sites.
CONCLUSION:
This study provides rigorous evidence on how women and families recognize and respond to
maternal and newborn illness. By using a common methodology and tools, findings not only
were site-specific but also allow for comparison across contexts.

PMID: 29297390
Similar articles
5. Matern Child Health J. 2018 Feb 10. doi: 10.1007/s10995-018-2465-6. [Epub ahead of print]
Sustainability of a Community-Based CHOICE Program to

Improve the Health and Nutrition Status of Mothers and Infants
in Indonesia.
Eder C1, Khatiwada LK2, Schooley J3.
Author information:
1
Strategic Information for Impact, Project Concern International (PCI), 5151 Murphy
Canyon Rd, Suite 320, San Diego, CA, 92123, USA.
2
Notre Dame Initiative for Global Development (NDIGD), University of Notre Dame,
3144 Jenkins Nanovic Halls, Notre Dame, IN, 46556, USA. lkhatiwa@nd.edu.
3
Programs, Project Concern International, 5151 Murphy Canyon Rd, Suite 320, San
Diego, CA, 92123, USA.
Abstract
Objectives Few studies have been undertaken to determine whether and how project results
are sustained. University of Notre Dame (ND) and Project Concern International conducted a
Post-Project Sustainability Study (PSS) of a USAID-funded program (CHOICE),
implemented in Indonesia, Banten province, between 2003 and 2007, in order to determine
lasting effects and improve PSS methodologies. Methods Sustainability was measured
through a comparison of data collected on mother-infant pairs in 2014 with final evaluation
data from 2007; and through a comparison of 2014 data collected from the CHOICE villages
and comparison villages. Results The analysis showed positive differences in multiple
indicators in CHOICE villages between 2007 and 2014, including births attended by skilled
personnel (Mean Difference 48.56, 95% CI 38.68 to 58.43) and treatment of diarrhea (MD
16.42, 95% CI - 0.94 to 33.37). However, only one statistically significant difference between
intervention and comparison groups in 2014 was observed, infants with diarrhea whose
mothers sought advice or treatment (MD - 5.48, 95% CI - 9.55 to 1.39), showing more
mothers in intervention group sought advice or treatment. Because contextual factors were not
studied in detail and baseline data was not available for the comparison villages, it is difficult
to determine the reasons for the results. Given that longitudinal data was not collected, it is
also difficult to determine whether results fluctuated between 2007 and 2014. Conclusions for
practice This PSS contributes to the limited body of knowledge in sustainability research.
Lessons learned from this study will increase potential for sustainable impact of projects, as
more rigorous measurement will lead to greater overall understanding of how sustainability
actually "happens".
PMID: 29429132
Similar articles
6. Lancet. 2018 Jan 30. pii: S0140-6736(18)30183-1. doi: 10.1016/S0140-6736(18)30183-1.

[Epub ahead of print]
Status and drivers of maternal, newborn, child and adolescent

health in the Islamic world: a comparative analysis.
Akseer N1, Kamali M2, Bakhache N2, Mirza M2, Mehta S2, Al-Gashm S2, Bhutta ZA3.
Author information:
1
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Dalla
Lana School of Public Health, University of Toronto, Toronto, Canada.
2
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
3
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Dalla
Lana School of Public Health, University of Toronto, Toronto, Canada; Center of
Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
Electronic address: zulfiqar.bhutta@sickkids.ca.
Abstract
BACKGROUND:
The Millennium Development Goal (MDG) period saw dramatic gains in health goals MDG 4
and MDG 5 for improving child and maternal health. However, many Muslim countries in the
south Asian, Middle Eastern, and African regions lagged behind. In this study, we aimed to
evaluate the status of, progress in, and key determinants of reproductive, maternal, newborn,
child, and adolescent health in Muslim majority countries (MMCs). The specific objectives
were to understand the current status and progress in reproductive, maternal, newborn, child,
and adolescent health in MMCs, and the determinants of child survival among the least
developed countries among the MMCs; to explore differences in outcomes and the key
contextual determinants of health between MMCs and non-MMCs; and to understand the
health service coverage and contextual determinants that differ between best and poor or
moderate performing MMCs.
METHODS:
In this country-level ecological study, we examined data from between 1990 and 2015 from
multiple publicly available data repositories. We examined 47 MMCs, of which 26 were
among the 75 high-burden Countdown to 2015 countries. These 26 MMCs were compared
with 48 non-Muslim Countdown countries. We also examined characteristics of the eight best
performing MMCs that had accelerated improvement in child survival (ie, that reached their
MDG 4 targets). We estimated adolescent, maternal, under-5, and newborn mortality, and
stillbirths, and the causes of death, essential interventions coverage, and contextual
determinants for all MMCs and comparative groups using standardised methods. We also did
a hierarchical multivariable analysis of determinants of under-5 mortality and newborn
mortality in low-income and middle-income MMCs.
FINDINGS:
Despite notable reductions between 1990 and 2015, MMCs compared with a global esimate of
all countries including MMCs had higher mortality rates, and MMCs relative to non-MMCs
within Countdown countries also performed worse. Coverage of essential interventions across
the continuum of care was on average lower among MMCs, especially for indicators of
reproductive health, prenatal care, delivery, and labour, and childhood vaccines. Outcomes
within MMCs for mortality and many reproductive, maternal, newborn, child, and adolescent
health indicators varied considerably. Structural and contextual factors, especially state
governance, conflict, and women and girl's empowerment indicators, were significantly worse
in MMCs compared with non-MMCs within the high-burden Countdown countries, and were
shown to be strongly associated with child and newborn mortality within low-income and
middle-income MMCs. In adjusted hierarchical models, among other factors, under-5
mortality in MMCs increased with more refugees originating from a country (β=23·67,
p=0·0116), and decreased with better political stability or absence of terrorism (β=-0·99,
p=0·0285), greater political rights or government effectiveness (β=-1·17, p<0·0001),
improvements in log gross national income per capita (β=-4·44, p<0·0001), higher total adult
literacy (β=-1·69, p<0·0001), higher female adult literacy (β=-0·97, p<0·0001), and greater
female to male enrolment in secondary school (β=-16·1, p<0·0001). The best performing
MMCs were Azerbaijan, Bangladesh, Egypt, Indonesia, Kyrgyzstan, Morocco, Niger, and
Senegal, which had higher coverage of family planning interventions and newborn or child
vaccinations, and excelled in many of the above contextual determinants when compared with
moderate or poorly performing MMCs.
INTERPRETATION:
The status and progress in reproductive, maternal, newborn, child, and adolescent health is
heterogeneous among MMCs, with little indication that religion and its practice affects
outcomes systemically. Some Islamic countries such as Niger and Bangladesh have made
great progress, despite poverty. Key findings from this study have policy and programmatic
implications that could be prioritised by national heads of state and policy makers,
development partners, funders, and the Organization of the Islamic Cooperation to scale up
and improve these health outcomes in Muslim countries in the post-2015 era.
FUNDING:
US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child
Survival, the Centre for Global Child Health, Hospital for Sick Children, and the Aga Khan
University.
Copyright © 2018 Elsevier Ltd. All rights reserved.

PMID: 29395272
Similar articles
Recognition of and care-seeking for maternal and newborn

complications in Jayawijaya district, Papua province,
Indonesia: a qualitative study.
Rosales A1, Sulistyo S2, Miko O3, Hairani LK3, Ilyana M3, Thomas J4, Hirata E4, Holloway
R4, Bantung M2, Pabate K2, Wijaya C2, Cherian D4.
Author information:
1
Department of Health, World Vision US, 300 I Street NE, Washington, DC, 20002,
USA. arosales@worldvision.org.
2
World Vision Indonesia, Jl. Wahid Hasyim 33, Jakarta Pusat, DKI, Jakarta, Indonesia.
3
Center of Epidemiology Research and Surveillance, University of Indonesia (CERS
UI), Faculty of Public Health, University of Indonesia, Building G, 2nd Floor, Room
201, UI Campus, Depok, West Java, 16424, Indonesia.
4
Department of Health, World Vision US, 300 I Street NE, Washington, DC, 20002,
USA.
Abstract
BACKGROUND:
Indonesia's progress on reducing maternal and newborn mortality rates has slowed in recent
years, predominantly in rural areas. To reduce maternal and newborn mortality, access to
quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is
often delayed when maternal and newborn complications arise. Using the "Three Delays"
model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the
decision to seek care, delaying arrival at a health facility, and delaying the receiving of
adequate care, may help in establishing more focused interventions to improve maternal and
newborn health in this region.
METHODS:
This qualitative study focused on identifying, analyzing, and describing illness recognition
and care-seeking patterns related to maternal and newborn complications in the Jayawijaya
district of Papua province, Indonesia. Group interviews were conducted with families and
other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal
or newborn illness or maternal or newborn death.
RESULTS:
For maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the
process to decide to seek care was relatively quick. The decision-making process was mostly
dominated by the husband. Most care was started at home by birth attendants, but the majority
sought care outside of the home within the public health system. For newborn cases, most of
the caregivers could not easily recognize newborn danger signs. Parents acted as the main
decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or
hospital, were only made when healthcare workers could not handle the case within the home.
All newborn deaths were associated with delays in seeking care due to caretaker limitations in
danger sign identification, whereas all maternal deaths were associated with delays in
receiving appropriate care at facility level.
CONCLUSIONS:
For maternal health, emphasis needs to be placed on supply side solutions, and for newborn
health, emphasis needs to be placed on demand and supply side solutions, probably including
community-based interventions. Contextualized information for the design of programs aimed
to affect maternal and newborn health is a prerequisite.

PMID: 29297380
Similar articles
8. Compr Child Adolesc Nurs. 2017;40(sup1):145-151. doi: 10.1080/24694193.2017.1386983.
Maternal Self-Efficacy of Pregnant Indonesian Teens:

Development and Validation of an Indonesian Version of the
Young Adult Maternal Confidence Scale and Measurement of
Its Validity and Reliability.
Wardani DA1, Rachmawati IN1, Gayatri D1.
Author information:
1
a Faculty of Nursing , Universitas Indonesia, Jalan Bahder Djohan Campus , Depok ,
Indonesia.
Abstract
Pregnant teens often feel uncertain in the last trimester about their ability to take care of their
baby. At this time, maternal confidence in the ability to care for the baby is an important step
in the preparation for becoming a mother. The purpose of this study was to examine the
validity and reliability of an Indonesian version of the Young Adult Maternal Confidence
Scale (YAMCS) as an instrument to measure maternal self-efficacy of pregnant teens in the
last trimester. The study consisted of 90 pregnant teens, age of respondents less than 19 years
and living in 1 of 3 sub-districts: Cilember, Sukamanah and Megamendung, Bogor Regency.
West Java. All the participants completed a questionnaire based on the YAMCS to assess
maternal self-efficacy. The YAMCS consists of 3 dimensions (perception of ability,
uncertainty, and mothering behaviors) and 10 items. All items of the YAMCS had corrected
item-total item correlation more than 0.3 and had 0.859 Cronbach's α scores. Based on the
findings of this study, this questionnaire is a valid and reliable measure of maternal self-
efficacy of pregnant teens in Indonesia. Health workers can use the questionnaire to assess the
confidence of pregnant women, especially that of adolescents, in caring for their baby and
being a good mother.
PMID: 29166192
Similar articles
9. Compr Child Adolesc Nurs. 2017;40(sup1):169-182. doi: 10.1080/24694193.2017.1386986.
The Development of an Interactive Health Education Model

Based on the Djuwita Application for Adolescent Girls.
Djuwitaningsih S1, Setyowati1.
Author information:
1
a Faculty of Nursing , Universitas Indonesia, Jalan Bahder Djohan Campus , Depok ,
Indonesia.
Abstract
Alarming incidents of maternal deaths in Indonesia are due to three major causes: bleeding,
sepsis, and hypertension, in addition to other non-obstetric causes and unsafe abortions.
Adolescent girls contributed to maternal mortality based on early marriage, unwanted
pregnancy, and childbirth. Prevention efforts have been taken through government programs
and non-governmental organizations, but in practice those were considered ineffective. Thus,
a preventative effort in the form of health education should be made, preferably embedded in
a popular mobile application that most teenagers would be apt to use. This study aimed to
develop an interactive health education model based on adolescent-friendly applications,
according to their needs. The design of this research was mixed-method. A quantitative
approach was used by conducting a survey of 188 teenagers aged 15-19 years in Bogor, West
Java, Indonesia through questionnaires. This research also contained a qualitative component
via in-depth interviews with students, parents, and counseling teachers. The quantitative
results showed that respondents' knowledge was low about male and female reproductive
organs, prevention of pregnancy, and the use of condoms. Respondents' attitudes toward risky
behaviors indicate a positive attitude about smoking, drinking, and illegal drugs, as well as
premarital sex, while respondents have a negative attitude toward unwanted pregnancies.
Respondents' attitudes toward application-based health education shows a high interest.
Respondents desired that the application have privacy, up-to-date information, interesting
features, can be discussed with peer groups and health workers, include a game, animation,
and simulation, and can identify reproductive health independently. Qualitative results
indicate the need for reliable, accessible, and personal sources of information. The next
research recommendation is to develop an interactive health education model based on the
application of Djuwita and evaluate its influence on the knowledge, attitudes, and self-efficacy
of young women in maintaining their reproductive health.
PMID: 29166183
Similar articles
10. BMC Womens Health. 2017 Nov 9;17(1):102. doi: 10.1186/s12905-017-0455-2.

Pre-pregnancy body mass index and gestational weight gain
and their effects on pregnancy and birth outcomes: a cohort
study in West Sumatra, Indonesia.
Soltani H1, Lipoeto NI2, Fair FJ3, Kilner K3, Yusrawati Y4.
Author information:
1
Centre for Health and Social Care Research, Sheffield Hallam University, Mundella
House, 34 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP, England.
h.soltani@shu.ac.uk.
2
Faculty of Medicine, Andalas University, Padang, West Sumatra, Indonesia.
3
Centre for Health and Social Care Research, Sheffield Hallam University, Mundella
House, 34 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP, England.
4
Department of Obstetrics and Gynaecology, Faculty of Medicine, Andalas
University, Padang, West Sumatra, Indonesia.
Abstract
BACKGROUND:
Indonesia has a considerably high incidence of maternal and infant mortality. The country
has however been experiencing a social and economic transition, influencing its general
population demographics and nutritional status including the state of health and nutrition of
pregnant women. This study aimed to explore body mass index (BMI) and gestational
weight gain (GWG), and their relationship with pregnancy outcomes in a sample of
Indonesian pregnant women.
METHODS:
This observational cohort study included a total of 607 pregnant women who were recruited
in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and
regression analyses were undertaken to compare pregnancy and birth outcomes for different
BMI and GWG, using normal weight women and women with a recommended weight gain
as the referent groups.
RESULTS:
The prevalence of underweight (BMI < 18.5 kg/m2) in pregnancy was high at 20.1%; while
21.7% of women were overweight (BMI: 23.0-27.4 kg/m2) and 5.3% obese
(BMI ≥ 27.5 kg/m2) using the Asian BMI classifications. The incidence of overweight (BMI:
25.0-29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) according to the international BMI
classifications were 13.5% and 1.1% respectively. The majority of women gained inadequate
weight in pregnancy compared to the Institute of Medicine (IOM) recommendations,
especially those who had a normal BMI. Birthweight adjusted mean difference aMD (95%
confidence interval) 205 (46,365) and the odds of macrosomia adjusted odds ratio aOR 13.46
(2.32-77.99) significantly increased in obese women compared to those with a normal BMI.
Birthweight aMD -139 (-215, -64) significantly decreased in women with inadequate GWG
compared to those with recommended GWG, while SGA aOR 5.44 (1.36, 21.77) and
prematurity aOR 3.55 (1.23, 10.21) increased.
CONCLUSIONS:
Low nutritional status and inadequate GWG remain a cause for concern in these women. The
higher odds of macrosomia with increasing maternal BMI and higher odds of prematurity
and small for gestational age infants with inadequate weight gain also require attention.
Research and practice recommendations: Urgent attention is required by researchers, policy
makers and decision-makers to facilitate development of culturally sensitive interventions to
enhance nutritional status and health of mothers and babies, in an area known for its high
incidence of maternal and neonatal mortality.

PMID: 29121896
Similar articles
11. Eval Program Plann. 2018 Feb;66:102-110. doi: 10.1016/j.evalprogplan.2017.10.011. Epub

2017 Oct 19.
Use of most significant change (MSC) technique to evaluate

health promotion training of maternal community health
workers in Cianjur district, Indonesia.
Limato R1, Ahmed R2, Magdalena A3, Nasir S4, Kotvojs F5.
Author information:
1
Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430,
Indonesia. Electronic address: ralalicia_5to@yahoo.com.
2
Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430,
Indonesia; Department of Clinical Sciences, Liverpool School of Tropical Medicine,
Pembroke Pl, Liverpool L3 5QA, UK. Electronic address:
Rukhsana.ahmed@lstmed.ac.uk.
3
Consortium Tirta Global, BP Tangguh LNG Clinic, Teluk Bintuni, Papua Barat,
Indonesia. Electronic address: drameliamagdalena@gmail.com.
4
Faculty of Public Health, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10,
Tamalanrea Makassar 90245, Sulawesi Selatan, Indonesia. Electronic address:
sudirmannasir@gmail.com.
5
Kurrajong Hill Pty Ltd, 701 Dignams Creek, Narooma 2546, New South Wales,
Australia. Electronic address: Fiona@kurrajonghill.com.au.
Abstract
Maternal health promotion is a defined activity in the community integrated posts

(Posyandu) in Indonesia. However, it is often neglected due to limited knowledge and skills
of the community health workers (kader). We conducted health promotion training for the
kader and village midwives in four villages in Cianjur district. This study describes the use
of "most significant change" (MSC) technique to evaluate impact of health promotion to the
beneficiaries and community at large. The MSC uses stories as raw data. Through interviews
focused on perception of change, stories were collected from four pregnant women, eight
kader and three village midwives. A Panel consisting of policy and programme managers
and implementers read all the stories. The story by a pregnant woman who routinely attended
Posyandu was selected as the story with most significant change. Her story highlighted
changes in kader's knowledge and communication of health messages and attitude towards
pregnant women. She expressed these changes impacted community awareness about health
and to seek help from kader.The MSC technique enabled stakeholders to view raw data and
evaluate the impact of health promotion from the beneficiary's perspective. At the same time,
recipients of health promotion contributed to the decision process of evaluation through their
stories. The different perspectives on the MSC reflected individual's objectives of the health
promotion. The application of this technique is limited in maternal health promotion
programme in Indonesia, and none have been published in peer reviewed journals.
Free Article
PMID: 29091785
Similar articles
12. Health Care Women Int. 2018 Jan;39(1):3-18. doi: 10.1080/07399332.2017.1393077. Epub
2017 Dec 6.
Factors influencing Indonesian women's use of maternal

health care services.
Kurniati A1,2, Chen CM3, Efendi F4, Berliana SM5.
Author information:
1
a Institute of Allied Health Sciences, College of Medicine, National Cheng Kung
University , Tainan , Taiwan.
2
b Center for Planning and Management of Human Resources for Health, BPPSDMK,
Ministry of Health , Jakarta , Indonesia.
3
c Department of Nursing , Institute of Gerontology, Institute of Allied Health
Sciences, College of Medicine, National Cheng Kung University , Tainan , Taiwan.
4
d Department of Mental Health and Community Health Nursing , Faculty of Nursing,
Universitas Airlangga , Surabaya , Indonesia.
5
e Institute of Statistics (STIS), BPS-Statistics of Indonesia , Jakarta , Indonesia.
Abstract
Employing the 2012 Indonesia Demographic and Health Survey data, we aimed to examine
factors influencing married women to use maternity services. Data of married women who
had given birth in the last five years before the survey were included in the analysis (n =
14,672). Factors of education, employment, women's age at first marriage, age at first birth,
spousal education difference, contraceptive use, place of residence, and woman's attitude
toward wife beating were associated with the use of antenatal care, institutional delivery, and
postnatal care services. The likelihood of women using those recommended maternal health
care services increased along with the increased educational attainment among women and
their spouses, and the older age at first birth. Higher schooling years may contribute to
improving adequate maternal health care. Community awareness on maternal health issues
should be promoted and include the prevention of early marriage, teenage pregnancies, and
domestic violence.
PMID: 29053439
Similar articles
13. Lancet Glob Health. 2017 Nov;5(11):e1090-e1100. doi: 10.1016/S2214-109X(17)30371-6.
Modifiers of the effect of maternal multiple micronutrient

supplementation on stillbirth, birth outcomes, and infant
mortality: a meta-analysis of individual patient data from 17
randomised trials in low-income and middle-income countries.
Smith ER1, Shankar AH2, Wu LS3, Aboud S4, Adu-Afarwuah S5, Ali H3, Agustina R6,
Arifeen S7, Ashorn P8, Bhutta ZA9, Christian P3, Devakumar D10, Dewey KG11, Friis H12,
Gomo E13, Gupta P14, Kæstel P12, Kolsteren P15, Lanou H16, Maleta K17, Mamadoultaibou
A18, Msamanga G19, Osrin D10, Persson LÅ20, Ramakrishnan U21, Rivera JA22, Rizvi A23,
Sachdev HPS24, Urassa W4, West KP Jr3, Zagre N25, Zeng L26, Zhu Z26, Fawzi WW27,
Sudfeld CR28.
Author information:
1
Department of Global Health and Population, Harvard T.H. Chan School of Public
Health, Boston, MA, USA; Division of Gastroenterology, Hepatology and Nutrition,
Boston Children's Hospital, Boston, MA, USA.
2
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,
USA; Summit Institute of Development, Mataram, Indonesia.
3
The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha,
Bangladesh; Center for Human Nutrition, Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
4
Department of Microbiology and Immunology, Muhimbili University of Health and
Allied Sciences, Dar es Salaam, Tanzania.
5
Department of Nutrition and Food Science, University of Ghana, Legon, Accra,
Ghana.
6
Summit Institute of Development, Mataram, Indonesia; Department of Nutrition,
Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General
Hospital, Jakarta, Indonesia.
7
International Centre for Diarrhoeal Diseases Research Bangladesh (ICDDR,B),
Dhaka, Bangladesh.
8
Centre for Child Health Research and Department of Paediatrics, University of
Tampere School of Medicine and Tampere University Hospital, Tampere, Finland.
9
Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada;
Center of Excellence in Women and Child Health, The Aga Khan University,
Karachi, Pakistan.
10
UCL Institute for Global Health, London, UK.
11
Department of Nutrition and Program in International and Community Nutrition,
University of California-Davis, Davis, CA, USA.
12
Department of Nutrition Exercise and Sports, University of Copenhagen,
Copenhagen, Denmark.
13
College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
14
Department of Pediatrics, University College of Medical Sciences, Delhi, India.
15
Nutrition and Child Health Unit, Department of Public Health, Prince Leopold
Institute of Tropical Medicine, Antwerp, Belgium; Faculty of Bio-science
engineering, Ghent University, Belgium.
16
Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and
Innovation, Ouagadougou, Burkina Faso.
17
School of Public Health and Family Medicine, University of Malawi College of
Medicine, Blantyre, Malawi.
18
Food and Agriculture Organization of the United Nations, Libreville, Gabon.
19
Department of Community Health, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania.
20
Department of Women's and Children's Health, International Maternal and Child
Health, Uppsala University, Uppsala, Sweden.
21
Hubert Department of Global Health, Rollins School of Public Health, Emory
University, Atlanta, USA.
22
Instituto Nacional de Salud Publica, Cuernavaca, Mexico.
23
Center of Excellence in Women and Child Health, The Aga Khan University,
Karachi, Pakistan.
24
Pediatric and Clinical Epidemiology Unit, Sitar am Bhartia Institute of Science and
Research, New Delhi, India.
25
UNICEF Regional Office for West and Central Africa, Dakar, Senegal.
26
Department of Epidemiology and Biostatistics, School of Public Health, Xi'an
Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China.
27
Health, Boston, MA, USA.
28
Health, Boston, MA, USA. Electronic address: csudfeld@hsph.harvard.edu.
Abstract
BACKGROUND:
Micronutrient deficiencies are common among women in low-income and middle-income

countries. Data from randomised trials suggest that maternal multiple micronutrient
supplementation decreases the risk of low birthweight and potentially improves other infant
health outcomes. However, heterogeneity across studies suggests influence from effect
modifiers. We aimed to identify individual-level modifiers of the effect of multiple
micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income
and middle-income countries.
METHODS:
This two-stage meta-analysis of individual patient included data from 17 randomised

controlled trials done in 14 low-income and middle-income countries, which compared
multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in
112 953 pregnant women. We generated study-specific estimates and pooled subgroup
estimates using fixed-effects models and assessed heterogeneity between subgroups with the
χ2 test for heterogeneity. We did sensitivity analyses using random-effects models,
stratifying by iron-folic acid dose, and exploring individual study effect.
FINDINGS:
Multiple micronutrient supplements containing iron-folic acid provided significantly greater

reductions in neonatal mortality for female neonates compared with male neonates than did
iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75-0·96 vs 1·06, 0·95-1·17; p
value for interaction 0·007). Multiple micronutrient supplements resulted in greater
reductions in low birthweight (RR 0·81, 95% CI 0·74-0·89; p value for interaction 0·049),
small-for-gestational-age births (0·92, 0·87-0·97; p=0·03), and 6-month mortality (0·71,
0·60-0·86; p=0·04) in anaemic pregnant women (haemoglobin <110g/L) as compared with
non-anaemic pregnant women. Multiple micronutrient supplements also had a greater effect
on preterm births among underweight pregnant women (BMI <18·5 kg/m2; RR 0·84, 95% CI
0·78-0·91; p=0·01). Initiation of multiple micronutrient supplements before 20 weeks
gestation provided greater reductions in preterm birth (RR 0·89, 95% CI 0·85-0·93; p=0·03).
Generally, the survival and birth outcome effects of multiple micronutrient supplementation
were greater with high adherence (≥95%) to supplementation. Multiple micronutrient
supplements did not significantly increase the risk of stillbirth or neonatal, 6-month, or infant
mortality, neither overall or in any of the 26 examined subgroups.
INTERPRETATION:
Antenatal multiple micronutrient supplements improved survival for female neonates and
provided greater birth-outcome benefits for infants born to undernourished and anaemic
pregnant women. Early initiation in pregnancy and high adherence to multiple micronutrient
supplements also provided greater overall benefits. Studies should now aim to elucidate the
mechanisms accounting for differences in the effect of antenatal multiple micronutrient
supplements on infant health by maternal nutrition status and sex.
FUNDING:
None.
Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article
under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Free Article
PMID: 29025632
Similar articles
14. Aust Health Rev. 2017 Oct 2. doi: 10.1071/AH17092. [Epub ahead of print]
Strengthening the primary care workforce to deliver

community case management for child health in rural
Indonesia.
Setiawan A, Dawson A.
Abstract
Objectives The aim of the present study was to report on the implementation of community
case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur,
Kalimantan Indonesia.Methods An interpretive qualitative methodology was used. In-depth
interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were
observed during a consultation with mothers to gain insight into the delivery of the new
protocol and workforce issues. The field notes and interview transcripts were analysed
thematically.Results PHCWs reported that their performance had improved as a result of
increased knowledge and confidence. The implementation of CCM had also reportedly
enhanced the PHCWs' clinical reasoning. However, the participants noted confusion
surrounding their role in prescribing medication.Conclusions CCM is viewed as a useful
model of care in terms of enhancing the capacity of rural PHCWs to provide child health
care and improve the uptake of life-saving interventions. However, work is needed to
strengthen the workforce and to fully integrate CCM into maternal and child health service
delivery across Indonesia.What is known about the topic? Indonesia has successfully
reduced infant mortality in the past 10 years. However, concerns remain regarding issues
related to disparities between districts. The number of infant deaths in rural areas tends to be
staggeringly high compared with that in the cities. One of the causes is inadequate access to
child health care.What does this paper add? CCM is a model of care that is designed to
address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to
deliver life-saving interventions to sick children in rural communities. In the present study,
CCM improved the capacity of PHCWs to treat childhood illnesses.What are the
implications for practitioners? CCM can be considered to strengthen PHCWs' competence
in addressing infant mortality in areas where access to child health care is challenging.
Policy regarding task shifting needs to be examined further so that CCM can be integrated
into current health service delivery in Indonesia.
PMID: 28965537
Similar articles
15. BMC Health Serv Res. 2017 Aug 7;17(1):541. doi: 10.1186/s12913-017-2490-y.
Barriers to utilization of postnatal care at village level in Klaten

district, central Java Province, Indonesia.
Probandari A1, Arcita A2,3, Kothijah K4, Pamungkasari EP5.
Author information:
1
Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir.
Sutami 36A, Surakarta, 57126, Indonesia. ari.probandari@staff.uns.ac.id.
2
Master Program of Public Health, Graduate School, Universitas Sebelas Maret,
Surakarta, Indonesia.
3
Bethesda Health Institute, Yogyakarta, Indonesia.
4
Vocational Program of Occupational Health and Safety, Faculty of Medicine,
Universitas Sebelas Maret, Surakarta, Indonesia.
5
Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir.
Sutami 36A, Surakarta, 57126, Indonesia.
Abstract
BACKGROUND:
Maternal health remains a persisting public health challenge in Indonesia. Postnatal

complications, in particular, are considered as maternal health problems priority that should
be addressed. Conducting adequate care for postnatal complications will improve the quality
of life of mothers and babies. With the universal health coverage implementation, the
Indonesian government provides free maternal and child health services close to clients at
the village level, which include postnatal care. Our study aimed to explore barriers to
utilization of postnatal care at the village level in Klaten district, Central Java Province,
Indonesia.
METHODS:
A qualitative study was conducted in March 2015 - June 2016 in Klaten district, Central
Java, Indonesia. We selected a total of 19 study participants, including eight mothers with
postnatal complications, six family members, and five village midwives for in-depth
interviews. We conducted a content analysis technique on verbatim transcripts of the
interviews using open code software.
RESULTS:
This study found three categories of barriers to postnatal care utilization in villages: mother
and family members' health literacy on postnatal care, sociocultural beliefs and practices,
and health service responses. Most mothers did not have adequate knowledge and skills
regarding postnatal care that reflected how they lacked awareness and practice of postnatal
care. Inter-generational norms and myths hindered mothers from utilizing postnatal care and
from having adequate nutritional intake during the postnatal period. Mothers and family
members conducted unsafe self-treatment to address perceived minor postnatal complication.
Furthermore, social power from extended family influenced the postnatal care health literacy
for mother and family members. Postnatal care in the village lacked patient-centered care
practices. Additionally, midwives' workloads and capacities to conduct postnatal
information, education and counseling were also issues.
CONCLUSIONS:
Despite the government's efforts to provide free postnatal care closer to mothers' homes,
other barriers to postnatal care utilization remained. Specifically, among mothers,
community, and health services. An innovative approach to increase the health literacy on
postnatal care is required. In particular, improving the capacity of midwives to conduct
patient-centered care. In addition, village midwives' tasks should be evaluated and
reoriented.

PMID: 28784169
Similar articles
16. Health Policy Plan. 2017 Oct 1;32(8):1203-1211. doi: 10.1093/heapol/czx073.
Suami SIAGA: male engagement in maternal health in

Indonesia.
Kurniati A1,2, Chen CM3, Efendi F4, Elizabeth Ku LJ5, Berliana SM6.
Author information:
1
Institute of Allied Health Sciences, College of Medicine, National Cheng Kung
University, Tainan, Taiwan.
2
Center for Planning and Management of Human Resources for Health, BPPSDMK,
Ministry of Health, Indonesia.
3
Department of Nursing, Institute of Gerontology, Institute of Allied Health Sciences,
College of Medicine, National Cheng Kung University, Tainan, Taiwan.
4
Department of Mental Health and Community Health Nursing, Faculty of Nursing,
Universitas Airlangga, Surabaya, Indonesia.
5
Department of Public Health, National Cheng Kung University Hospital, College of
Medicine, National Cheng Kung University, Tainan, Taiwan.
6
Institute of Statistics (STIS), BPS-Statistics of Indonesia, Jakarta, Indonesia.
Abstract
Suami SIAGA, which translates literally as the 'alert husband', is a national campaign that
was created in early 2000 to promote male participation in maternal and child health
program in Indonesia. The purpose of this study was to identify the proportion of men who
took part in Suami SIAGA and the factors associated with their participation using the 2012
Indonesia Demographic and Health Survey (IDHS). This study also examined the
relationship between Suami SIAGA and the following results related to the national
campaign: the presence of husbands at antenatal care (ANC) units and the place of delivery
at health facilities. Data on the characteristics of husbands and wives, as well as other related
factors, the perceived elements of Suami SIAGA, and the national campaign outcomes were
obtained from a total of 1256 eligible male subjects, drawn from the matched couples' data
set. The data was analysed using bivariate and multiple logistic regression to test the
associations. This study found that 86% of the respondents were categorised as SIAGA
husbands. After controlling all the variables, age and education of wife factors were
significantly associated with Suami SIAGA, especially in the group of women aged 41-
49 years old (OR = 2.4, 95% CI: 1.1-5.5) and women with a secondary level of education
(OR = 1.8, 95% CI: 1.2-2.7) and higher (OR = 2.8, 95% CI: 1.4-5.6). SIAGA husbands were
more likely to attend their wives' ANC (OR = 2.3; 95% CI: 1.4-3.7). This study provides
evidence on the benefit of husband involvement in maternal health, especially to improve
ANC attendance. Empowering women themselves should also be addressed in leveraging the
impact of Suami SIAGA.
PMID: 28666325
Similar articles
17. Glob Health Action. 2017;10(1):1339534. doi: 10.1080/16549716.2017.1339534.
Expanding the scope beyond mortality: burden and missed

opportunities in maternal morbidity in Indonesia.
Widyaningsih V1, Khotijah1, Balgis1.
Author information:
1
a Faculty of Medicine , Universitas Sebelas Maret , Surakarta , Indonesia.
Abstract
BACKGROUND:
Indonesia still faces challenges in maternal health. Specifically, the lack of information on
community-level maternal morbidity. The relatively high maternal healthcare non-utilization
in Indonesia intensifies this problem.
OBJECTIVE:
To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to

evaluate the extent and determinants of missed opportunities in women with maternal
morbidity.
METHODS:
We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS
2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were
estimated from 43,782 women. We analyzed missed opportunities in women who
experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects
logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012
(n = 6762).
RESULTS:
There were significant increases in the crude and adjusted proportion of maternal morbidity
from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal
morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these
morbidities happened during labor. There were significant decreases in non-utilization of
maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not
receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not
have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher
proportions of non-utilization happened in women who were younger, multiparous, of low
socioeconomic status (SES), and living in less-developed areas. In multilevel analyses,
missed opportunities in healthcare utilization were strongly related to low SES and low-
resource areas in Indonesia.
CONCLUSION:
The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor.
This condition is amplified by the concerning missed opportunities in maternal healthcare.
Efforts are needed to identify risk factors for maternal morbidity, as well as increasing
healthcare coverage for the vulnerable population.

PMID: 28649930
Similar articles
18. Anemia. 2017;2017:6935648. doi: 10.1155/2017/6935648. Epub 2017 May 29.
Low Hemoglobin among Pregnant Women in Midwives

Practice of Primary Health Care, Jatinangor, Indonesia: Iron
Deficiency Anemia or β-Thalassemia Trait?
Susanti AI1, Sahiratmadja E2, Winarno G3, Sugianli AK4, Susanto H3, Panigoro R2.
Author information:
1
Program Study of Midwifery, Division of Maternal and Child Health, Department of
Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
2
Department of Biochemistry and Molecular Biology, Faculty of Medicine,
Universitas Padjadjaran, Bandung, Indonesia.
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas
Padjadjaran and Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
4
Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran and
Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Abstract
Low hemoglobin (Hb) or anemia is common among pregnant women in developing
countries which may cause adverse pregnancy outcomes and maternal deaths. Our study
aimed to assess Hb level measured by midwives in primary health care facility at rural area
of Jatinangor, Indonesia, and to explore whether the anemia was due to iron deficiency
(IDA) or β-thalassemia trait (β-TT). Pregnant women (n = 105) had finger prick test for Hb
level during a regular antenatal care examination from October to November 2016. Hb level
by finger prick test was compared with venous blood, measured by complete blood count
(CBC). Indices including MCV and MCH and indices of Shine & Lal, Mentzer, Srivastava,
Engels & Frase, Ehsani, and Sirdah were analyzed to differentiate anemia due to IDA and
anemia due to suspect β-TT. HbA2 was measured to confirm β-TT. Anemic pregnant women
were found in 86.7% by finger prick test compared to 21.9% (n = 23) by CBC. The
prevalence of β-TT in our study was 5.7%. Hb measurement among pregnant women in low
resource area is highly important; however, finger prick test in this study showed a high
frequency of anemia which may lead to iron oversupplementation. A standard CBC is
encouraged; MCV and MCH would help midwives to identify β-TT.

PMID: 28634546
Similar articles
19. Asia Pac J Clin Nutr. 2017 Jun;26(Suppl 1):S19-S25. doi: 10.6133/apjcn.062017.s6.
Intergenerational effects of maternal birth weight, BMI, and

body composition during pregnancy on infant birth weight:
Tanjungsari Cohort Study, Indonesia.
Nugraha GI1, Herman H2, Alisjahbana A3.
Author information:
1
Department of Biochemistry and Biomolecular, Faculty of Medicine, Universitas
Padjadjaran, West Java, Indonesia. Email: gagairawan@gmail.com.
2
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas
Padjadjaran, West Java, Indonesia.
3
Frontiers for Health, West Java, Indonesia.
Abstract
BACKGROUND AND OBJECTIVES:

Infant birth weight might be partly contributed to by maternal nutritional status at birth and
maternal nutrition during pregnancy. The objective of this study was to analyze
intergenerational maternal birth weight, maternal BMI, weight change during pregnancy, and
maternal body composition (FM, FFM, and TBW) changes during pregnancy.
METHODS AND STUDY DESIGN:
We analyzed the associations between the maternal birth weight and body composition of 94
women and infant birth weight by using multiple regression adjusted for socioeconomic and
reproductive history.
RESULTS:
All associations with infant birth weight were positive. The association between infant birth
weight and maternal birth weight was 0.28 (95% CI: 0.02-0.54); that for the association
between infant birth weight and maternal body weight in the first, second, and third
trimesters was 15.1 (95% CI: 4.92-25.3), 13.7 (95% CI: 2.78-24.6), and 16.1 (95% CI: 5.22-
27.0), respectively. The association between infant birth weight and fat mass in the second
and third trimesters were 18.4 (95% CI: 3.38-33.5) and 16.1 (95% CI: 5.23-27.0),
respectively, and those for the association between infant birth weight and fat-free mass in
the first and third trimesters were 33.6 (6.38, 60.9) and 34.8 (95% CI: 3.47-66.1),
respectively.
CONCLUSIONS:
This study confirms previous findings that maternal birth weight and body composition
during pregnancy are associated with infant birth weight.
Free Article
PMID: 28625032 [Indexed for MEDLINE]
Similar articles
20. BMC Pregnancy Childbirth. 2017 May 22;17(1):149. doi: 10.1186/s12884-017-1326-4.
Maternal care quality in near miss and maternal mortality in an

academic public tertiary hospital in Yogyakarta, Indonesia: a
retrospective cohort study.
Mawarti Y1, Utarini A2, Hakimi M3.
Author information:
1
Public Health Graduate Program, Faculty of Medicine, Universitas Gadjah Mada,
Sekip, Yogyakarta, 55281, Indonesia. yulimawarti@gmail.com.
2
Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Sekip,
Yogyakarta, 55281, Indonesia.
3
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Gadjah
Mada, Sekip, Yogyakarta, 55281, Indonesia.
Abstract
BACKGROUND:
Reducing maternal mortality remains a major challenge for health care systems worldwide.
The factors related to maternal mortality were extensively researched, and maternal death
clusters around labour, delivery and the immediate postpartum period. Studies on the quality
of maternal care in academic medical centre settings in low income countries are uncommon.
METHODS:
A retrospective cohort study of maternal deaths was conducted in an academic public tertiary
hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained
from medical records from February 1, 2011 to September 30, 2012. Three groups of
variables were measured: (1) timeliness of care, (2) adherence to a standard of process
indicators, and (3) associated extraneous variables. Variables were analysed using logistic
regression to explore their effects on maternal mortality.
RESULTS:
The mean of triage response time and obstetric resident response time were longer in
maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses
(1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received
oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02-0.77). Magnesium
sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths
although insignificant statistically (OR 0.19; 95% CI 0.03-1.47). Prophylactic antibiotic was
also more frequently given in near misses than in maternal deaths though insignificant
statistically (OR 0.3; 95% CI 0.06-1.56). Extraneous variables, such as caesarean sections
were less performed in maternal deaths (OR 0.15; 95% CI 0.04-0.51), vaginal deliveries
were more frequent in maternal deaths (OR 3.47; 95% CI 1.05-11.54), and more women in
near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01-0.91).
CONCLUSIONS:
The near misses had relatively received better quality of care compared to the maternal
deaths. The near misses had received faster response time and better treatments. Timely
referral systems enabled benefits to prevent maternal death.

PMID: 28532393
Similar articles
21. J Glob Health. 2017 Jun;7(1):010406. doi: 10.7189/jogh.07.010406.
Maternal mortality as a Millennium Development Goal of the

United Nations: a systematic assessment and analysis of
available data in threshold countries using Indonesia as
example.
Reinke E1, Supriyatiningsih2, Haier J3.
Author information:
1
University Hospital Münster, Münster, Germany.
2
Medical Services of Asri Medical Center, Universitas Muhammadiyah Yogyakarta,
Yogyakarta, Indonesia.
3
Nordakademie University of Applied Sciences, Hamburg/Elmshorn, Germany.
Abstract
BACKGROUND:
In 2015 the proposed period ended for achieving the Millennium Development Goals
(MDG) of the United Nations targeting to lower maternal mortality worldwide by ~ 75%.
99% of these cases appear in developing and threshold countries; but reports mostly rely on
incomplete or unrepresentative data. Using Indonesia as example, currently available data
sets for maternal mortality were systematically reviewed.
METHODS:
Besides analysis of international and national data resources, a systematic review was carried
out according to Cochrane methodology to identify all data and assessments regarding
maternal mortality.
RESULTS:
Overall, primary data on maternal mortality differed significantly and were hardly
comparable. For 1990 results varied between 253/100 000 and 446/100 000. In 2013 data
appeared more conclusive (140-199/100 000). An annual reduction rate (ARR) of -2.8% can
be calculated.
CONCLUSION:
Reported data quality of maternal mortality in Indonesia is very limited regarding

comprehensive availability and methodology. This limitation appears to be of general
importance for the targeted countries of the MDG. Primary data are rare, not uniformly
obtained and not evaluated by comparable methods resulting in very limited comparability.
Continuous small data set registration should have high priority for analysis of maternal
health activities.

PMID: 28400953
Similar articles
22. Health Policy Plan. 2017 Apr 1;32(3):366-375. doi: 10.1093/heapol/czw135.
The impact of health insurance on maternal health care

utilization: evidence from Ghana, Indonesia and Rwanda.
Wang W1, Temsah G1, Mallick L2.
Author information:
1
International Health and Development Division, ICF International, Rockville, MD,
USA.
2
Avenir Health, Glastonbury, CT, USA.
Abstract
While research has assessed the impact of health insurance on health care utilization, few
studies have focused on the effects of health insurance on use of maternal health care.
Analyzing nationally representative data from the Demographic and Health Surveys (DHS),
this study estimates the impact of health insurance status on the use of maternal health
services in three countries with relatively high levels of health insurance coverage-Ghana,
Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection
bias in health insurance uptake and to assess the effect of health insurance on four
measurements of maternal health care utilization: making at least one antenatal care visit;
making four or more antenatal care visits; initiating antenatal care within the first trimester
and giving birth in a health facility. Although health insurance schemes in these three
countries are mostly designed to focus on the poor, coverage has been highly skewed toward
the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by
wealth status. The analysis found significant positive effects of health insurance coverage on
at least two of the four measures of maternal health care utilization in each of the three
countries. Indonesia stands out for the most systematic effect of health insurance across all
four measures. The positive impact of health insurance appears more consistent on use of
facility-based delivery than use of antenatal care. The analysis suggests that broadening
health insurance to include income-sensitive premiums or exemptions for the poor and low
or no copayments can increase use of maternal health care.

Similar articles
23. BMC Pregnancy Childbirth. 2017 Mar 28;17(1):100. doi: 10.1186/s12884-017-1280-1.
Maternal characteristics and obstetrical complications impact

neonatal outcomes in Indonesia: a prospective study.
Anggondowati T1,2, El-Mohandes AA3, Qomariyah SN1, Kiely M4, Ryon JJ5, Gipson RF6,
Zinner B7, Achadi A8, Wright LL9.
Author information:
1
Center for Family Welfare, Faculty of Public Health, University of Indonesia, Depok,
Indonesia.
2
School of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
3
CUNY Graduate School of Public Health and Health Policy, 55 West 125th St.,
Room 714, New York, NY, 10027, USA.
4
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.
5
(Formerly) John Snow, Inc., Arlington, VA, USA.
6
John Snow, Inc., Boston, MA, USA.
7
U.S. Agency for International Development, Washington, District of Columbia,
USA.
8
School of Public Health, University of Indonesia, Depok, Indonesia.
9
George Washington University School of Medicine and Health Science, Washington,
District of Columbia, USA.
Abstract
BACKGROUND:
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.
METHODS:
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.
RESULTS:
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].
CONCLUSIONS:
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.

PMID: 28351384
Similar articles
24. J Trop Pediatr. 2017 Mar 3. doi: 10.1093/tropej/fmx010. [Epub ahead of print]
Changing Knowledge and Practices of Mothers on Newborn

Care through Mother Class: An Intervention Study in
Indonesia.
by, Nasir NM1, Amran Y1, Nakamura Y2.
Author information:
1
Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic
University, Ciputat 15419, Indonesia.
2
Graduate School of Human Sciences, Osaka University, Suita, Osaka 565-0871,
Japan.
Abstract
Poor knowledge and practices of newborn care may contribute to high neonatal mortality.
This study aims to analyze the effect of prenatal education, namely 'mother class', on
knowledge and practices of newborn care among mothers in Tangerang Selatan District,
Indonesia. An intervention study with a quasi-experimental design was conducted. Using a
questionnaire, 427 mothers were interviewed: an intervention group (n = 214) that attended
mother class and a control group (n = 213) that had not. A home visit followed the
intervention to assess newborn care practices. Mother class used Maternal and Child Health
Handbook as the main reference material. Attending mother class significantly increased
knowledge of breastfeeding initiation and hepatitis B immunization (p < 0.05). Mothers in
the intervention group had the likelihood of practicing good newborn care compared with the
control group (odds ratio: 1.812; 95% confidence interval: 1.235-2.660). Mother class
improves knowledge and newborn care practices and strengthens interactions between
mothers and health care providers.
PMID: 28334898
Similar articles
25. BMJ Open. 2017 Feb 3;7(2):e013408. doi: 10.1136/bmjopen-2016-013408.

Regional differences in usage of antenatal care and safe
delivery services in Indonesia: findings from a nationally
representative survey.
Tripathi V1, Singh R2.
Author information:
1
Faculty of Science and Technology, Department of Mathematics and Statistics, The
University of the West Indies, St Augustine, Trinidad and Tobago.
2
Cardiology Research Centre, Heart Hospital, Hamad Medical Corporation (HMC),
Doha, Qatar.
Abstract
BACKGROUND:
Indonesia has shown a nominal increase in antenatal care (ANC) coverage from 93% to 96%
in the Indonesia Demographic Health Survey (IDHS)-2012. This is high but for a
comprehensive assessment of maternal health coverage in Indonesia, safe delivery services
need to be assessed in conjunction with ANC coverage.
MATERIALS AND METHODS:
The study uses survey data from the IDHS-2012 that was conducted among women aged 15-
49 years who gave birth during the past 3 years preceding the survey. Socioeconomic and
demographic factors affecting ANC coverage and safe delivery services are analysed by
segregating the data into 7 regions of Indonesia.
RESULTS:
Multivariate results show that besides wealth and education differentials, regional
differences significantly affect the usage of ANC and safe delivery services across the 7
regions. Univariate analyses show that Sulawesi, Maluku and Western New Guinea islands
are at a disadvantage in accessing ANC and safe delivery services.
CONCLUSIONS:
The study recommends that disaggregated regional targets be set in order to further reduce
maternal mortality rates in Indonesia.
Published by the BMJ Publishing Group Limited. For permission to use (where not already
granted under a licence) please go to http://www.bmj.com/company/products-services/rights-
and-licensing/.

Similar articles
Competing interests: None declared.

26. BMC Health Serv Res. 2017 Feb 2;17(1):105. doi: 10.1186/s12913-017-2028-3.
Health facility and skilled birth deliveries among poor women

with Jamkesmas health insurance in Indonesia: a mixed-
methods study.
Brooks MI1,2, Thabrany H3, Fox MP4,5, Wirtz VJ6,5, Feeley FG6,5, Sabin LL6,5.
Author information:
1
Pathfinder International, 9 Galen St, Suite 217, Watertown, 02472, MA, USA.
mib@bu.edu.
2
Department of Global Health, Boston University School of Public Health, 801
Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118, MA, USA. mib@bu.edu.
3
Center for Health Economics and Policy Studies, University of Indonesia School of
Public Health, Building G Room 311, Depok, 16424, West Java, Indonesia.
4
Department of Epidemiology, Boston University School of Public Health, 715
Albany Street, Talbot T2C, Boston, 02118, MA, USA.
5
Center for Global Health and Development, Boston University School of Public
Health, 801 Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118, MA, USA.
6
Department of Global Health, Boston University School of Public Health, 801
Massachusetts Avenue, Crosstown 3rd Fl, Boston, 02118, MA, USA.
Abstract
BACKGROUND:
The growing momentum for quality and affordable health care for all has given rise to the
recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to
achieve the goal of UHC, large investments have been made to increase health access for the
poor, resulting in the implementation of various health insurance schemes targeted towards
the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's
aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects
poor women. The objective of this study was to evaluate the association of health facility and
skilled birth deliveries among poor women with and without Jamkesmas and explore
perceived barriers to health insurance membership and maternal health service utilization.
METHODS:
We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic
and Health Survey (n = 45,607), secondary analysis using propensity score matching was
performed on key outcomes of interest: health facility delivery (HFD) and skilled birth
delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and
Banten among poor women, midwives, and government representatives. Thematic
framework analysis was performed on qualitative data to explore perceived barriers.
RESULTS:
In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor
women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and
17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without
insurance. Qualitative interviews highlighted key issues, including: lack of proper
documentation for health insurance registration; the preference of pregnant women to deliver
in their parents' village; the use of traditional birth attendants; distance to health facilities;
shortage of qualified health providers; overcrowded health facilities; and lack of health
facility accreditation.
CONCLUSIONS:
Poor women with Jamkesmas membership had a modest increase in HFD and SBD. These
findings are consistent with economic theory that health insurance coverage can reduce
financial barriers to care and increase service uptake. However, factors such as socio-cultural
beliefs, accessibility, and quality of care are important elements that need to be addressed as
part of the national UHC agenda to improve maternal health services in Indonesia.

Similar articles
27. Lancet Glob Health. 2017 Feb;5(2):e217-e228. doi: 10.1016/S2214-109X(16)30354-0.
Maternal multiple micronutrient supplementation and other

biomedical and socioenvironmental influences on children's
cognition at age 9-12 years in Indonesia: follow-up of the
SUMMIT randomised trial.
Prado EL1, Sebayang SK2, Apriatni M2, Adawiyah SR2, Hidayati N2, Islamiyah A2, Siddiq
S2, Harefa B2, Lum J3, Alcock KJ4, Ullman MT5, Muadz H6, Shankar AH7.
Author information:
1
Summit Institute of Development, Mataram, Nusa Tenggara Barat, Indonesia;
Department of Nutrition, University of California Davis, Davis, CA, USA.
2
Summit Institute of Development, Mataram, Nusa Tenggara Barat, Indonesia.
3
School of Psychology, Deakin University, Melbourne, VIC, Australia.
4
Psychology Department, Lancaster University, Bailrigg, Lancaster, UK.
5
Department of Neuroscience, Georgetown University, Washington, DC, USA.
6
Summit Institute of Development, Mataram, Nusa Tenggara Barat, Indonesia; Center
for Research on Language and Culture, University of Mataram, Mataram, Nusa
Tenggara Barat, Indonesia.
7
Summit Institute of Development, Mataram, Nusa Tenggara Barat, Indonesia;
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA,
USA. Electronic address: ashankar@hsph.harvard.edu.
Abstract
BACKGROUND:
Brain and cognitive development during the first 1000 days from conception are affected by
multiple biomedical and socioenvironmental determinants including nutrition, health,
nurturing, and stimulation. An improved understanding of the long-term influence of these
factors is needed to prioritise public health investments to optimise human development.
METHODS:
We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention

Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with
multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live
infants from birth to 3 months of age in 2001-04, we re-enrolled 19 274 (70%) children at
age 9-12 years, and randomly selected 2879 from the 18 230 who were attending school at a
known location. Of these, 574 children were oversampled from mothers who were anaemic
or malnourished at SUMMIT enrolment. We assessed the effects of MMN and associations
of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and
socioenvironmental determinants (ie, parental education, socioeconomic status, home
environment, and maternal depression) on general intellectual ability, declarative memory,
procedural memory, executive function, academic achievement, fine motor dexterity, and
socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616.
FINDINGS:
Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01-0·20,
p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in
scores with half a year of schooling. Children of anaemic mothers in the MMN group scored
0·18 SD (0·06-0·31, p=0·0047) higher in general intellectual ability, similar to the increase
with 1 year of schooling. Overall, 18 of 21 tests showed a positive coefficient of MMN
versus IFA (p=0·0431) with effect sizes from 0·00-0·18 SD. In multiple regression models,
socioenvironmental determinants had coefficients of 0·00-0·43 SD and 22 of 35 tests were
significant at the 95% CI level, whereas biomedical coefficients were 0·00-0·10 SD and
eight of 56 tests were significant, indicating larger and more consistent impact of
socioenvironmental factors (p<0·0001).
INTERPRETATION:
Maternal MMN had long-term benefits for child cognitive development at 9-12 years of age,
thereby supporting its role in early childhood development, and policy change toward MMN.
The stronger association of socioenvironmental determinants with improved cognition
suggests present reproductive, maternal, neonatal, and child health programmes focused on
biomedical determinants might not sufficiently enhance child cognition, and that
programmes addressing socioenvironmental determinants are essential to achieve thriving
populations.
FUNDING:
Grand Challenges Canada Saving Brains Program.
Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article
under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.
Free Article
Similar articles
28. J Epidemiol Glob Health. 2016 Dec;6(4):267-275. doi: 10.1016/j.jegh.2016.06.002. Epub
2016 Jun 30.
Predictors of Ramadan fasting during pregnancy.

van Bilsen LA1, Savitri AI2, Amelia D3, Baharuddin M3, Grobbee DE4, Uiterwaal CS4.
Author information:
1
Leiden University College The Hague, Faculty of Governance and Global Affairs,
Leiden University, The Hague, The Netherlands.
2
Julius Center for Health Sciences and Primary Care, Julius Global Health, University
Medical Center Utrecht, Utrecht, The Netherlands. Electronic address:
a.i.savitri@umcutrecht.nl.
3
Maternal and Child Care, Budi Kemuliaan Hospital, Jakarta, Indonesia.
4
Julius Center for Health Sciences and Primary Care, Julius Global Health, University
Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
Although the health effects of Ramadan fasting during pregnancy are still unclear, it is
important to identify the predictors and motivational factors involved in women's decision to
observe the fast. We investigated these factors in a cross sectional study of 187 pregnant
Muslim women who attended antenatal care visits in the Budi Kemuliaan Hospital, Jakarta,
Indonesia. The odds of adherence to fasting were reduced by 4% for every week increase in
gestational age during Ramadan [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.92,
1.00; p=0.06] and increased by 10% for every one unit increase of women's prepregnancy
body mass index (BMI) (OR 1.10; 95% CI 0.99, 1.23; p=0.08). Nonparticipation was
associated with opposition from husbands (OR 0.34; 95% CI 0.14, 0.82; p=0.02) and with
women's fear of possible adverse effects of fasting on their own or the baby's health (OR
0.47; 95% CI 0.22, 1.01; p=0.05 and OR 0.43; 95% CI 0.21, 0.89; p=0.02, respectively),
although they were attenuated in multivariable analysis. Neither age, income, education,
employment, parity, experience of morning sickness, nor fasting during pregnancy outside of
Ramadan determined fasting during pregnancy. Linear regression analysis within women
who fasted showed that the number of days fasted were inversely associated with women's
gestational age, fear of possible adverse effects of fasting on their own or the fetal health,
and with opposition from husbands. In conclusion, earlier gestational age during Ramadan,
husband's opinion and possibly higher prepregnancy BMI, influence women's adherence to
Ramadan fasting during pregnancy. Fear of adverse health effects of Ramadan fasting is
common in both fasting and non-fasting pregnant women.
Free Article
Similar articles
29. Asia Pac J Clin Nutr. 2016 Dec;25(Suppl 1):S43-S51. doi: 10.6133/apjcn.122016.s10.
Factors affecting breastfeeding intention and its continuation

among urban mothers in West Jakarta: a follow-up qualitative
study using critical point contact for breastfeeding.
Nuzrina R1,2,3, Roshita A3, Basuki DN4.
Author information:
1
Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta,
Indonesia. Email: rachmanida.nuzrina@esaunggul.ac.id.
2
Department of Nutrition, Faculty of Health Sciences, Universitas Esa Unggul,
Jakarta, Indonesia.
3
SEAMEO RECFON (South East Asia Ministers of Education Organization Regional
Center for Food and Nutrition), Jakarta, Indonesia.
4
Helen Keller Indonesia, Jakarta, Indonesia.
Abstract
BACKGROUND AND OBJECTIVES:
Although breastfeeding is recommended by WHO, the breastfeeding rate in Indonesia

remains low, because many women fail to maintain their breastfeeding intention during the
breastfeeding period. The decision whether to breastfeed or not, like any other nutritional
behaviour, may develop over a lifetime and is rooted in many aspects of life; however, many
factors may affect a mother's decision about whether to stop or continue breastfeeding during
the breastfeeding period. A critical time point of contact for breastfeeding is a time point
when the mother experiences difficulties and encounters influences that may affect
breastfeeding continuation.
METHODS AND STUDY DESIGN:
A qualitative approach was used to investigate the factors affecting breastfeeding intention
and continuation. A follow-up approach was used to assess actual experiences and problems
at each time point of contact. The interviewees in this study were pregnant women who lived
and worked in West Jakarta and were in at least Week 36 of their pregnancy. The key
interviewees for triangulation were 2 grandmothers and 2 healthcare providers.
RESULTS AND CONCLUSIONS:
Knowledge, beliefs, and support were the factors affecting the women's intentions. Perceived
obstacles; common beliefs; stigmas regarding breastfeeding; and support and influences
from husbands, mothers, family members, and relatives were the factors influencing
breastfeeding continuation within the first month postpartum.
Free Article
Similar articles
30. PLoS One. 2016 Dec 19;11(12):e0168405. doi: 10.1371/journal.pone.0168405. eCollection

2016.
Using the Three Delays Model to Examine Civil Registration

Barriers in Indonesia.
Bennouna C1, Feldman B2, Usman R1, Adiputra R1, Kusumaningrum S1, Stark L2.
Author information:
1
Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA),
School of Social and Political Sciences, Depok, Indonesia.
2
Program on Forced Migration and Health (PFMH), Mailman School of Public
Health, Columbia University, New York, NY, United States of America.
Abstract
The Three Delays Model has proven a useful framework for examining barriers to seeking
obstetric care and preventing maternal and child mortality. This article demonstrates the
applicability of the Three Delays Model to the case of civil registration in rural Indonesia
and examines ways that efforts to strengthen civil registration services can draw on lessons
from maternal and child health programming. Twenty focus group discussions were
conducted using a participatory ranking exercise in four Indonesian districts. Focus groups
were stratified into four groups: (1) government officials involved in civil registration, (2)
civil society organization members that assist communities in civil registration, and (3)
female and (4) male community members. Transcripts were analyzed using constant
comparative method and thematic analysis, revealing barriers that communities commonly
faced in accessing civil registration services. In examining the categories and themes related
to these barriers, the research team found a significant overlap with the factors and phases of
the Three Delays Model. Participants were delayed from seeking registration services by a
range of sociocultural factors and by the perceived inaccessibility and poor quality of
services. Once they decided to seek care, long distances to services and poor transportation
options delayed their access to registration offices. Finally, a series of bottlenecks in service
provision created extended delays once applicants reached registration offices. Ownership of
civil registration documents in Indonesia remains exceptionally low, with just over half of
children and youth possessing a birth certificate. To strengthen civil registration and health
systems more generally, it is important to understand the factors that enable and constrain
civil registration, how these factors relate to one another, and how they change over a child's
life.

Similar articles
The authors have declared that no competing interests exist.

31. BMC Pregnancy Childbirth. 2016 Nov 25;16(1):374.
Hyperemesis gravidarum and placental dysfunction disorders.

Koudijs HM1, Savitri AI2, Browne JL1, Amelia D3, Baharuddin M3, Grobbee DE1, Uiterwaal
CS1.
Author information:
1
Julius Center for Health Sciences and Primary Care, Global Health, University
Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht,
The Netherlands.
2
Julius Center for Health Sciences and Primary Care, Global Health, University
Medical Center Utrecht, Huispost Str. 6.131, PO Box 855500, 3508, GA, Utrecht,
The Netherlands. aryisavitri@gmail.com.
3
Budi Kemuliaan Hospital, Jakarta, Indonesia.
Abstract
BACKGROUND:
Evidence about the consequence of hyperemesis gravidarum (HG) on pregnancy outcomes is

still inconclusive. In this study, we evaluated if occurrence of hyperemesis gravidarum is
associated with placental dysfunction disorders and neonatal outcomes.
METHODS:
A prospective cohort study was conducted in a maternal and child health primary care
referral center, Budi Kemuliaan Hospital and its branch, in Jakarta, Indonesia. 2252 pregnant
women visiting the hospital for regular antenatal care visits from July 2012 until October
2014 were included at their first clinic visit. For women without, with mild and with severe
hyperemesis, placental dysfunction disorders (gestational hypertension, preeclampsia (PE),
stillbirth, miscarriage), neonatal outcomes (birth weight, small for gestational age (SGA),
low birth weight (LBW), Apgar score at 5 min, gestational age at delivery) and placental
outcomes (placental weight and placental-weight-to-birth-weight ratio (PW/BW ratio)) were
studied.
RESULTS:
Compared to newborns of women without hyperemesis, newborns of women with severe

hyperemesis had a 172 g lower birth weight in adjusted analysis (95%CI -333.26; -10.18;
p = 0.04). There were no statistically significant effects on placental dysfunction disorders or
other neonatal outcome measures.
CONCLUSIONS:
The results of our study suggest that hyperemesis gravidarum does not seem to induce
placental dysfunction disorders, but does, if severe lead to lower birth weight.

Similar articles
32. BMC Pediatr. 2016 Nov 21;16(1):188.
Reference curves of birth weight, length, and head

circumference for gestational ages in Yogyakarta, Indonesia.
Haksari EL1, Lafeber HN2, Hakimi M3, Pawirohartono EP4, Nyström L5.
Author information:
1
Department of Child Health, Faculty of Medicine, Gadjah Mada University, Sardjito
General Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55284, Indonesia.
ekahaksari@yahoo.com.
2
Department of Pediatrics, Vrije Universiteit Medical Center, P.O. Box 7057,
1007 MB, Amsterdam, The Netherlands.
3
Faculty of Medicine, Gadjah Mada University/Sardjito General Hospital, Jl.
Kesehatan No. 1, Yogyakarta, 55284, Indonesia.
4
Department of Child Health, Faculty of Medicine, Gadjah Mada University, Sardjito
General Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55284, Indonesia.
5
Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
Abstract
BACKGROUND:
The birth weight reference curve to estimate the newborns at risk in need of assessment and
monitoring has been established. The previous reference curves from Indonesia,
approximately 8 years ago, were based on the data collected from teaching hospitals only
with limited gestational ages. The aims of the study were to update the reference curves for
birth weight, supine length and head circumference for Indonesia, and to compare birth
weight curves of boys and girls, first child and later children, and the ones in the previous
studies.
METHODS:
Data were extracted from the Maternal-Perinatal database between 1998-2007. Only live
singletons with recorded gestational ages of 26 to 42 weeks and the exact time of admission
to the neonatal facilities delivered or referred within 24 h of age to Sardjito Hospital, five
district hospitals and five health centers in Yogyakarta Special Territory were included.
Newborns with severely ill conditions, congenital anomaly and chromosomal abnormality
were excluded. Smoothening of the curves was accomplished using a third-order polynomial
equation.
RESULTS:
Our study included 54,599 singleton live births. Growth curves were constructed for boys
(53.3%) and girls (46.7%) for birth weight, supine length, and head circumference. At term,
mean birth weight for each gestational age of boys was significantly higher than that of girls.
While mean birth weight for each gestational age of first-born-children, on the other hand
was significantly lower than that of later-born-children. The mean birth weight was lower
than that of Lubchenco's study. Compared with the previous Indonesian study by
Alisyahbana, no differences were observed for the aterm infants, but lower mean birth
weight was observed in preterm infants.
CONCLUSIONS:
Updated neonatal reference curves for birth weight, supine length and head circumference
are important to classify high risk newborns in specific area and to identify newborns
requiring attention.

Similar articles
33. Popul Stud (Camb). 2016 Nov;70(3):365-376. Epub 2016 Jun 16.
The effects of Indonesia's 'Midwife in the Village' programme

10 years post-launch.
Triyana M1.
Author information:
1
a Nanyang Technological University.
Abstract
Data from the Indonesian Family Life Survey (1993-2000) were used to examine whether
the effects of the Indonesian 'Midwife in the Village' programme persisted more than 10
years after its implementation. The study followed up earlier studies of the programme's
effects by estimating its effects on pregnancy outcomes, using propensity-score matching
applied to data collected after the 1997 Asian economic crisis. The results indicate that only
the programme's effect on the use of prenatal care services persisted, and that the loss of
village midwives during the crisis had no significant effect on pregnancy outcomes.
Similar articles
34. Indian J Public Health. 2016 Jul-Sep;60(3):195-202. doi: 10.4103/0019-557X.189013.

Comparison of satisfaction with maternal health-care services
using different health insurance schemes in aceh province,
Indonesia.
Kesuma ZM1, Chongsuvivatwong V2.
Author information:
1
Senior Lecturer, Department of Mathematics, Faculty of Mathematics and Natural
Sciences, Syiah Kuala University, Banda Aceh, Indonesia.
2
Professor, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University,
Hat Yai, Songkhla, Thailand.
Abstract
BACKGROUND:
An insurance scheme called Jaminan Kesehatan Aceh (JKA) was established by the local
government to achieve universal coverage for Aceh's population who were not registered
under the national insurance scheme for the poor (Jamkesmas).
OBJECTIVE:
This study was conducted to compare women's satisfaction before and after the
implementation of JKA and across different insurance schemes.
METHODS:
The study was conducted from July 2011 to July 2012 on satisfaction of maternal health
services among 1197, 15-49 years aged old women living in eight districts of Aceh Province,
Indonesia, and a cluster sampling technique was applied. Analysis of variance was used to
assess the effects of different insurance schemes, period, and type of services on satisfaction
with maternal health services.
RESULTS:
Women were mostly satisfied with birth delivery services (mean score: 2.69) followed by
postnatal care (mean score: 2.62) and antenatal care services (mean score: 2.37).
CONCLUSION:
Over the changing period, the average level of satisfaction in the JKA group increased
significantly.
Free Article
PMID: 27561398
Similar articles
35. Matern Child Health J. 2016 Nov;20(11):2254-2260.
Improving Access to Child Health Care in Indonesia Through

Community Case Management.
Setiawan A1, Dignam D2, Waters C2, Dawson A2.
Author information:
1
Faculty of Nursing, Universitas Indonesia, Jakarta, Indonesia.
agus.setiawan.ui@gmail.com.
2
Faculty of Health, University of Technology, Sydney, Australia.
Abstract
Objectives In order to reduce infant mortality in Indonesia, community case management

(CCM) was introduced. CCM is a community-based service delivery model to improve
children's wellness and longevity, involving the delivery of lifesaving, curative interventions
to address common childhood illnesses, particularly where there are limited facility-based
services. This paper reports the findings of a qualitative study that investigated the
implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the
perspective of mothers who received care. Methods Seven mothers and health workers were
observed during a consultation and these mothers were interviewed in their home weeks after
delivery. Field notes and the interview transcriptions were analysed thematically. Findings
Mothers reported that their access to care had improved, along with an increase in their
knowledge of infant danger signs and when to seek care. Family compliance with care plans
was also found to have improved. Mothers expressed satisfaction with the care provided
under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in
each village, preferably someone from that village. However two mothers did not wish their
children to receive health interventions as they did not believe these to be culturally
appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of
care in terms of increasing access to health care and the uptake of lifesaving interventions for
sick children. However there is a need to modify the program to demonstrate cultural
sensitivity and meet cultural needs of the target population. While CCM is a potentially
effective model of care, further integrative strategies are required to embed this model into
maternal and child health service delivery.
Similar articles
36. Soc Sci Med. 2016 Aug;163:10-20. doi: 10.1016/j.socscimed.2016.06.020. Epub 2016 Jun
15.
Can cash transfers improve determinants of maternal

mortality? Evidence from the household and community
programs in Indonesia.
Kusuma D1, Cohen J2, McConnell M2, Berman P2.
Author information:
1
Harvard T.H. Chan School of Public Health, Department of Global Health and
Population, 655 Huntington Avenue, Boston, MA 02115, USA; Center for Health
Economics and Policy Studies, Faculty of Public Health Universitas Indonesia,
Kampus Baru UI, Depok 16424, Indonesia. Electronic address:
dkusuma@mail.harvard.edu.
2
Harvard T.H. Chan School of Public Health, Department of Global Health and
Population, 655 Huntington Avenue, Boston, MA 02115, USA.
Abstract
Despite global efforts in maternal health, 303,000 maternal deaths still occurred globally in
2015. One explanation is a considerable inequality in maternal mortality and the sources
such as nutritional status and health utilization. One strategy to fight health inequality due to
poverty is conditional cash transfer (CCT). Taking advantage of two large clustered-
randomized trials in Indonesia from 2007 to 2009, this paper provides evidence on the
effects of household cash transfers (PKH) and community cash transfers (Generasi) on
determinants of maternal mortality. The sample sizes are 14,000 households for PKH and
12,000 households for Generasi. After two years of implementation, difference-in-
differences (DID) analyses show that the two programs can improve determinants of
maternal mortality with Generasi provides positive impact in some aspects of determinants,
but PKH does not. Generasi improves maternal health knowledge, reduces financial barriers
to accessing health services and improves utilization of health services, increases utilization
among higher-risk women, improves posyandu equipment, and increases nutritional intake.
As for PKH, evidence shows its strongest effects only on utilization of health services. Both
programs, however, are unlikely to have a large effect on maternal mortality due to design
and implementation issues that might significantly reduce program effectiveness. While the
programs improved utilization, they did so at community-based facilities not equipped with
emergency obstetric care. In the midst of popularity of household cash transfer, our results
show that community cash transfer offers a viable policy alternative to improve the
determinants of maternal mortality by allowing more flexibility in activities and at lower cost
by monitoring at community level.
Similar articles
37. BMC Public Health. 2016 Jun 8;16:486. doi: 10.1186/s12889-016-3155-1.
The effectiveness of nutrition education for overweight/obese

mothers with stunted children (NEO-MOM) in reducing the
double burden of malnutrition in Indonesia: study protocol for
a randomized controlled trial.
Mahmudiono T1,2, Nindya TS3, Andrias DR3, Megatsari H4, Rosenkranz RR5.
Author information:
1
Department of Nutrition - Faculty of Public Health, Universitas Airlangga, Jl.
Mulyorejo Kampus C, Surabaya, 60115, Indonesia. triasmahmudiono@gmail.com.
2
Department of Food, Nutrition, Dietetics & Health, Kansas State University,
Manhattan, KS, 66506, USA. triasmahmudiono@gmail.com.
3
Department of Nutrition - Faculty of Public Health, Universitas Airlangga, Jl.
Mulyorejo Kampus C, Surabaya, 60115, Indonesia.
4
Department of Health Promotion and Behavioral Education - Faculty of Public
Health, Universitas Airlangga, Jl. Mulyorejo Kampus C, Surabaya, 60115, Indonesia.
5
Department of Food, Nutrition, Dietetics & Health, Kansas State University,
Manhattan, KS, 66506, USA.
Abstract
BACKGROUND:
Nutrition transition in developing countries were induced by rapid changes in food patterns
and nutrient intake when populations adopt modern lifestyles during economic and social
development, urbanization and acculturation. Consequently, these countries suffer from the
double burden of malnutrition, consisting of unresolved undernutrition and the rise of
overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest
for moderate levels (third quintile) of socioeconomic status. Evidence suggests that
modifiable factors such as intra-household food distribution and dietary diversity are
associated with the double burden of malnutrition, given household food security. This
article describes the study protocol of a behaviorally based nutrition education intervention
for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double
burden of malnutrition.
METHODS:
NEO-MOM is a randomized controlled trial with a three-month behavioral intervention for

households involving pairs of 72 stunted children aged 2-5 years old and overweight/obese
mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either
an intervention group or to a comparison group that received usual care plus printed
educational materials. The intervention consisted of six classroom sessions on nutrition
education and home visits performed by trained community health workers using a
motivational interviewing approach. The primary outcomes of this study are the prevalence
of double burden of malnutrition as measured in SCOWT, child's height-for-age z-score
(HAZ) and maternal body mass index (BMI).
DISCUSSION:
Because previous studies are mainly observational in nature, this study advances
understanding of the double burden of malnutrition through a fully powered randomized
controlled trial. The intervention assists participants in self-administered goal setting to
improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy
may be enhanced through vicarious and active mastery of experiences gained during six
sessions of nutrition education and verbal persuasion during home visits.
TRIAL REGISTRATION:
The Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was
registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is
allocated the registration number: ACTRN12615001243505 on 12 November 2015.

Similar articles
38. Women Health. 2017 May-Jun;57(5):614-629. doi: 10.1080/03630242.2016.1181136. Epub

2016 May 26.
Determinants of utilization of antenatal care services among
adolescent girls and young women in Indonesia.
Efendi F1,2, Chen CM1,3, Kurniati A1,4, Berliana SM5.
Author information:
1
a Institute of Allied Health Sciences, College of Medicine , National Cheng Kung
University , Tainan , Taiwan , China.
2
b Faculty of Nursing , Airlangga University , Surabaya , Indonesia.
3
c Department of Nursing and Institute of Gerontology , National Cheng Kung
University , Tainan , Taiwan , China.
4
d Center for Planning and Management of Human Resources for Health , The Board
for Development and Empowerment of Human Resources for Health (BPPSDMK),
Ministry of Health , Jakarta, Indonesia.
5
e Institute of Statistics (STIS) , Statistics Indonesia (BPS) , Jakarta , Indonesia.
Abstract
Due to the high number of maternal deaths, provision of antenatal care services (ANC) in
Indonesia is one of the key aims of the post-Millennium Development Goals agenda. This
study aimed to assess the key factors determining use of ANC by adolescent girls and young
women in Indonesia. Data from the Indonesia Demographic and Health Survey 2012 were
used, with a focus on married adolescent girls (aged 15-19 years, n = 543) and young women
(20-24 years, n = 2,916) who were mothers. Bivariate and multiple logistic regression
analyses were performed to determine the factors associated with ANC use. The findings
indicated that adolescents were less likely to make ANC visits than young women. Richer
women were more likely to make four ANC visits in both groups compared to the poorer
women. Living in urban areas, higher educational attainment, and lower birth order were
also all associated with higher levels of receiving ANC among young women. The results
showed that socio-economic factors were related to the use of ANC among adolescent girls
and young women. Ongoing health-care interventions should thus put a priority on
adolescent mothers coming from poor socio-economic backgrounds.
Similar articles
39. Public Health Nutr. 2016 Oct;19(15):2818-28. doi: 10.1017/S1368980016001002. Epub

2016 May 16.
Role of family support and women's knowledge on pregnancy-
related risks in adherence to maternal iron-folic acid
supplementation in Indonesia.
Wiradnyani LA1, Khusun H1, Achadi EL2, Ocviyanti D3, Shankar AH4.
Author information:
1
1SEAMEO Regional Center for Food and Nutrition,Universitas Indonesia,SEAMEO
RECFON Building,Kampus Universitas Indonesia,Salemba Raya no. 6,Jakarta Pusat
10430,Indonesia.
2
3Department of Nutrition, Faculty of Public Health,Universitas
Indonesia,Jakarta,Indonesia.
3
4Department of Obstetrics and Gynecology, Faculty of Medicine,Universitas
Indonesia,Jakarta,Indonesia.
4
5Harvard T.H. Chan School of Public Health,Boston,MA,USA.
Abstract
OBJECTIVE:
To examine whether women's knowledge of pregnancy-related risks and family support

received during pregnancy are associated with adherence to maternal iron-folic acid (IFA)
supplementation.
DESIGN:
Secondary data analysis of the 2002-03, 2007 and 2012 Indonesia Demographic and Health
Survey. Analysis of the association between factors associated with adherence (consuming
≥90 IFA tablets), including the women's knowledge and family support, was performed
using multivariate logistic regression.
SETTING:
National household survey.
SUBJECTS:
Women (n 19 133) who had given birth within 2 years prior to the interview date.
RESULTS:
Knowledge of pregnancy-related risks was associated with increased adherence to IFA

supplementation (adjusted OR=1·8; 95 % CI 1·6, 2·0), as was full family (particularly
husband's) support (adjusted OR=1·9; 95 % CI 1·6, 2·3). Adequate antenatal care (ANC)
visits (i.e. four or more) was associated with increased adherence (adjusted OR=2·2; 95 %
CI 2·0, 2·4). However, ANC providers missed opportunities to distribute tablets and
information, as among women with adequate ANC visits, 15 % reported never having
received/bought any IFA tablets and 30 % had no knowledge of pregnancy-related risks. A
significant interaction was observed between family support and the women's educational
level in predicting adherence. Family support significantly increased the adherence among
women with <9 years of education.
CONCLUSIONS:
Improving women's knowledge of pregnancy-related risks and involving family members,

particularly the husband and importantly for less-educated women, improved adherence to
IFA supplementation. ANC visit opportunities must be optimized to provide women with
sufficient numbers of IFA tablets along with health information (especially on pregnancy-
related risks) and partner support counselling.
PMID: 27181394
Similar articles
40. J Biosoc Sci. 2017 Jan;49(1):123-146. Epub 2016 Apr 29.
LOCAL GOVERNMENT AND COMMUNITY LEADERS'

PERSPECTIVES ON CHILD HEALTH AND MORTALITY AND
INEQUITY ISSUES IN RURAL EASTERN INDONESIA.
Pardosi JF1, Parr N2, Muhidin S2.
Author information:
1
*School of Public Health and Community Medicine, Faculty of Medicine,University
of New South Wales,Sydney,Australia.
2
†Department of Marketing and Management, Faculty of Business and
Economics,Macquarie University,Sydney,Australia.
Abstract
Since 2001 a decentralization policy has increased the responsibility placed on local
government for improving child health in Indonesia. This paper explores local government
and community leaders' perspectives on child health in a rural district in Indonesia, using a
qualitative approach. Focus group discussions were held in May 2013. The issues probed
relate to health personnel skills and motivation, service availability, the influence of
traditional beliefs, and health care and gender inequity. The participants identify weak
leadership, inefficient health management and inadequate child health budgets as important
issues. The lack of health staff in rural areas is seen as the reason for promoting the use of
traditional birth attendants. Midwifery graduates and village midwives are perceived as
lacking motivation to work in rural areas. Some local traditions are seen as detrimental to
child health. Husbands provide little support to their wives. These results highlight the need
for a harmonization and alignment of the efforts of local government agencies and local
community leaders to address child health care and gender inequity issues.
Similar articles
41. Int J Environ Res Public Health. 2016 Mar 7;13(3). pii: E293. doi: 10.3390/ijerph13030293.
Association of Maternal and Child Health Center (Posyandu)

Availability with Child Weight Status in Indonesia: A National
Study.
Andriani H1, Liao CY2, Kuo HW3,4,5.
Author information:
1
International Health Program, Institute of Public Health, National Yang Ming
University, Taipei 112, Taiwan. helen_a9@yahoo.com.
2
Department of Early Childhood Educare, College of Health, Chung Chou University
of Science and Technology, Changhua 510, Taiwan. cyliao@dragon.ccut.edu.tw.
3
International Health Program, Institute of Public Health, National Yang Ming
University, Taipei 112, Taiwan. hwkuo@ym.edu.tw.
4
Institute of Environmental and Occupational Health Sciences, National Yang-Ming
University, Taipei 112, Taiwan. hwkuo@ym.edu.tw.
5
School of Public Health, National Defense Medical Center, Taipei 112, Taiwan.
hwkuo@ym.edu.tw.
Abstract
Little is known about the childhood obesity prevention and treatment practices of Maternal
and Child Health services (Posyandu) in Indonesia or in other countries. The present study
aims to assess the association of the availability of Posyandu with overweight and obesity in
children of different household wealth levels. This was a secondary analysis of data collected
in the 2013 Riskesdas (or Basic Health Research) survey, a cross-sectional study,
representative population-based data. Height and weight, the availability of Posyandu, and
basic characteristics of the study population were collected from parents with children aged 0
to 5 years (n = 63,237). Non-availability of Posyandu significantly raised the odds of being
obese (OR = 1.13, 95% CI: 1.06-1.21) and did not show a significant relationship in the odds
for overweight (OR = 0.99, 95% CI: 0.93-1.07). This relationship persisted after a full
adjustment (OR = 1.16, 95% CI: 1.07-1.25 and OR = 1.04, 95% CI: 0.96-1.13, respectively).
There was effect modification by household wealth, which was stronger for obese children.
The availability of Posyandu has a protective association with childhood obesity in
Indonesia. Posyandu services are well placed to play an important role in obesity prevention
and treatment in early life.

Similar articles
42 Glob Health Action. 2016 Feb 16;9:30445. doi: 10.3402/gha.v9.30445. eCollection 2016.
.
Risk factors associated with neonatal deaths: a matched case-
control study in Indonesia.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759830/pdf/G
HA-9-30445.pdf
Abdullah A1,2,3, Hort K2,4, Butu Y2, Simpson L2.
Author information:
1
Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.
2
Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang,
Indonesia.
3
Department of Epidemiology and Preventive Medicine, Monash University, Clayton,
Australia; Asnawi.Abdullah@fkm.unmuha.ac.id.
4
Nossal Institute for Global Health, University of Melbourne, Parkville, Australia.
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.
DESIGN:
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.
CONCLUSION:
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.
Similar articles
43. World Health Popul. 2015;16(2):16-23.
Case Study: Clinical Governance as an Approach to Improve

Maternal and Newborn Health in 22 Hospitals in Indonesia.
Amelia D1, Suhowatsky S2, Baharuddin M3, Tholandi M4, Hyre A5, Sethi R6.
Author information:
1
Clinical Team Lead, Lembaga Kesehatan Budi Kemuliaan, Jakarta, Indonesia.
2
Maternal Health Program Manager, Jhpiego, Kathmandu, Nepal.
3
Director of Budi Kemuliaan Hospital and Midwifery Academy, Lembaga Kesehatan
Budi Kemuliaan, Jakarta, Indonesia.
4
EMAS Monitoring and Evaluation Director, Jhpiego, Jakarta, Indonesia.
5
Chief of Party, Jhpiego, Jakarta, Indonesia.
6
Senior Monitoring and Evaluation Advisor, Jhpiego, Baltimore, MD, USA.
Abstract
Clinical governance is a concept used to improve management, accountability and the

provision of quality healthcare. An approach to strengthen clinical governance as a means to
improve the quality of maternal and newborn care in Indonesia was developed by the
Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents
findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-
peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts
resulted in improved hospital preparedness and significantly increased the odds of facility-
level coverage for three evidence-based maternal and newborn healthcare interventions.
PMID: 26860759
Similar articles
44. Bull World Health Organ. 2015 Sep 1;93(9):631-639A. doi: 10.2471/BLT.14.144899. Epub
2015 Aug 3.
Cost-effectiveness of community-based practitioner
programmes in Ethiopia, Indonesia and Kenya.
McPake B1, Edoka I2, Witter S2, Kielmann K2, Taegtmeyer M3, Dieleman M4, Vaughan K4,
Gama E3, Kok M4, Datiko D5, Otiso L6, Ahmed R3, Squires N7, Suraratdecha C8, Cometto
G9.
Author information:
1
Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia .
2
Institute for International Health & Development, Queen Margaret University, Queen
Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland .
3
Department of International Public Health, Liverpool School of Tropical Medicine,
Liverpool, England .
4
Royal Tropical Institute, Amsterdam, Netherlands .
5
REACHOUT, Hidase Hulentenawi Agelglot Yebego Adragot Mahber, Awassa,
Ethiopia .
6
REACHOUT, LVCT Health, Nairobi, Kenya .
7
Public Health England, North of England Region, England .
8
United States Agency for International Development, Washington, DC, United States
of America .
9
Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland
.
Abstract
OBJECTIVE:
To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia,

Indonesia and Kenya.
METHODS:
Incremental cost-effectiveness ratios for the three programmes were estimated from a
government perspective. Cost data were collected for 2012. Life years gained were estimated
based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia
and Kenya, estimates of coverage before and after the implementation of the programme
were obtained from empirical studies. For Indonesia, coverage of health service interventions
was estimated from routine data. We used the Lives Saved Tool to estimate the number of
lives saved from changes in reproductive, maternal, neonatal and child health-service
coverage. Gross domestic product per capita was used as the reference willingness-to-pay
threshold value.
FINDINGS:
The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya,
$999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in
the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis,
there was greater than 80% certainty that each programme was cost-effective.
CONCLUSION:
Community-based approaches are likely to be cost-effective for delivery of some essential

health interventions where community-based practitioners operate within an integrated team
supported by the health system. Community-based practitioners may be most appropriate in
rural poor communities that have limited access to more qualified health professionals.
Further research is required to understand which programmatic design features are critical to
effectiveness.

Similar articles
45. Nutrients. 2015 Oct 2;7(10):8376-91. doi: 10.3390/nu7105399.
Double Burden of Malnutrition in Rural West Java: Household-

Level Analysis for Father-Child and Mother-Child Pairs and the
Association with Dietary Intake.
Sekiyama M1, Jiang HW2, Gunawan B3, Dewanti L4, Honda R5, Shimizu-Furusawa H6,
Abdoellah OS7, Watanabe C8.
Author information:
1
Graduate Program in Sustainability Science-Global Leadership Initiative (GPSS-
GLI), Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5
Kashiwanoha, Kashiwa City 277-8563, Japan. sekiyama@k.u-tokyo.ac.jp.
2
Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku,
Kyoto 603-8047, Japan. jiang@chikyu.ac.jp.
3
Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I,
Bandung 40132, Indonesia. budhi_gunawan@unpad.ac.id.
4
Faculty of Medicine, Airlangga University, Jl. Mayjen. Prof. Dr. Moestopo 47,
Surabaya 60132, Indonesia. lindaperisdiono@yahoo.com.
5
RSET, Institute of Science and Engineering, Kanazawa University, Kakuma-machi,
Kanazawa 920-1192, Japan. rhonda@se.kanazawa-u.ac.jp.
6
Department of Human Ecology, School of International Health, The University of
Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. hana-
shimizu@umin.ac.jp.
7
Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I,
Bandung 40132, Indonesia. oekan.abdoellah54@gmail.com.
8
Department of Human Ecology, School of International Health, The University of
Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. chiho@humeco.m.u-
tokyo.ac.jp.
Abstract
Indonesia is facing household-level double burden malnutrition. This study aimed at

examining (1) household-level double burden for the mother-child and father-child pairs; (2)
risk of adiposity of double burden households; and (3) associated dietary factors. Subjects
were 5th and 6th grade elementary school children (n = 242), their mothers (n = 242), and
their fathers (n = 225) in five communities (1 = urban, 4 = rural) in the Bandung District.
Questionnaires on socioeconomic factors, blood hemoglobin measurements, and
anthropometric measurements were administered. For adults, body fat percentage (BF%)
was estimated by bioelectrical impedance (BF%-BI) and by converting skinfold thickness
(ST) data using Durnin and Womersley's (1974) formula (BF%-ST). Food frequency
questionnaires were also completed. Double burden was defined as coexistence of maternal
or paternal overweight (Body mass index (BMI) ≥ 23) and child stunting (height-for-age z-
score <-2) within households. Maternal-child double burden occurred in 30.6% of total
households, whereas paternal-child double burden was only in 8.4%. Mothers from double
burden households showed high adiposity; 87.3% with BF%-BI and 66.2% with BF%-ST
had BF% >35%, and 60.6% had waists >80 cm. The major dietary patterns identified were
"Modern" and "High-animal products". After controlling for confounding factors, children in
the highest quartile of the "High-animal products" dietary pattern had a lower risk of
maternal-child double burden (Adjusted OR: 0.46, 95% CI: 0.21-1.04) than those in the
lowest quartile. Given that the "High-animal products" dietary pattern was associated with
the decreased risk of maternal-child double burden through a strong negative correlation
with child stunting, improving child stunting through adequate intake of animal products is
critical to solve the problem of maternal-child double burden in Indonesia.

Similar articles
46. J Matern Fetal Neonatal Med. 2016;29(11):1736-40. doi: 10.3109/14767058.2015.1059815.

Epub 2015 Jul 27.
Expectant management of preterm preeclampsia in Indonesia

and the role of steroids.
Ernawati1, Gumilar E1, Kuntoro2, Soeroso J3, Dekker G1,4.
Author information:
1
a Department of Obstetric Gynecology , Medical Faculty Airlangga University ,
Surabaya , Indonesia .
2
b Department of Statistic , Public Health Faculty Airlangga University , Surabaya ,
Indonesia .
3
c Department of Internal Medicine , Medical Faculty Airlangga University , Surabaya
, Indonesia , and.
4
d Women's and Children's Division, Lyell McEwin Health Service, Medical School
North , University of Adelaide , Elizabeth Vale , Australia.
Abstract
OBJECTIVE:
To present the outcome of expectant management of preterm preeclampsia in Indonesia, and

the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal
outcome.
MATERIAL AND METHODS:
Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration

of dexamethasone for fetal lung maturation, patients were randomized to receive 25 mg MP
group IV for the first week, decreasing to 12.5 mg during 2nd week and continued till birth,
or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval
served as primary outcome measurement.
RESULTS:
The average time gained with expectant management was almost 14 days. However, there
was no difference of mean time interval between entry to delivery between the PL (13.8
days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not
improve maternal and/or perinatal outcome and might be associated with a higher risk for
severe maternal infections--in particular tuberculosis.
CONCLUSION:
Expectant management of preterm preeclampsia is a realistic option in a major Indonesian

perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be
used in the expectant management of preterm preeclampsia in Indonesia.
Similar articles
47. Rural Remote Health. 2015 Apr-Jun;15(2):2959. Epub 2015 Jun 8.
Antenatal care and women's birthing decisions in an

Indonesian setting: does location matter?
Ansariadi A1, Manderson L2.
Author information:
1
School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Caulfield East, Victoria, Australia.
ansariadi@gmail.com.
2
School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Caulfield East, Victoria, Australia.
lenore.manderson@wits.ac.za.
Abstract
INTRODUCTION:
Poor maternal health outcome, still a major health problem in developing countries, is
influenced by both women's personal characteristics and the characteristics of the place
where they live. Identifying the spatial distribution and clusters of poor maternal health
outcomes can assist in developing geographically specific interventions. This article
examines the influence of urban and rural settings on antenatal care and birthing decisions in
South Sulawesi, a province in Indonesia, and investigates the existence of geographical
clusters of women's decision regarding antenatal care and birth assistance.
METHODS:
Data were derived from a survey of 485 women who recently gave birth. Household
coordinates, midwives' location and hospital location were recorded using a handheld global
positioning system (GPS). Logistic regression was used to examine the influence of place of
residence on antenatal care and women's birthing decisions. SaTScan software was used to
identify the location of geographical clusters. ArcGIS v9.3 was used to visualize and
interpret the distribution of facilities and clusters.
RESULTS:
Area of residence determines the likelihood of a woman presenting for antenatal care--care
that pregnant women receive from skilled birth attendants. The likelihood of hospital
delivery or delivery at home with the support of a skilled birth attendant (SBA), however,
was not determined by residential area. Distance to nearest SBA, working as a village
midwife, was associated with the likelihood to be assisted by her at home. Attendance of
SBA at home, or delivery at a hospital, were clustered in urban areas at different
geographical locations, but no similar clustering occurred in rural areas. In contrast, women
with low numbers of antenatal care visits and a traditional birthing assistant (TBA) at home
were clustered in particular rural areas, but low antenatal care visits and use of TBA were not
clustered in urban areas.
CONCLUSIONS:
Although area of residence did not appear to influence the likelihood of women delivering at
hospital or with SBA at home, clusters of women follow particular patterns of behaviour in
different geographic settings. This clustering highlights the heterogeneity of both urban and
rural areas.
Free Article
Similar articles
48. BMC Nurs. 2015 Apr 22;14:22. doi: 10.1186/s12912-015-0072-z. eCollection 2015.
Students' understanding of "Women-Centred Care
Philosophy" in midwifery care through Continuity of Care
(CoC) learning model: a quasi-experimental study.
Yanti Y1, Claramita M2, Emilia O3, Hakimi M4.
Author information:
1
Undergraduate Program of Midwifery Education, Estu Utomo Boyolali School of
Health Science, Tentara Pelajar Street no. 12, Mudal, Boyolali 57351 Indonesia.
2
Department of Medical Education and Family Medicine Graduate Program, Faculty
of Medicine, Gadjah Mada University, Radiopoetro Building 6th floor, Farmako
Street no. 1, Sekip Utara, Jogjakarta 55281 Indonesia.
3
Department of Ob-Gyn and Department of Medical Education, Faculty of Medicine,
Gadjah Mada University, Farmako Street no. 1, Sekip Utara, Jogjakarta 55281
Indonesia.
4
Department Ob-Gyn Faculty of Medicine, Gadjah Mada University, Jogjakarta,
Indonesia.
Abstract
BACKGROUND:
The philosophy of midwifery education is based on the 'Women-centred care' model, which
provides holistic care to women. Continuity of care (CoC) is integral to the concept of
holistic women-centred care and fundamental to midwifery practice. The objective of this
study was to determine any differences in students' understanding of midwifery care
philosophy between students who underwent the CoC learning model and those who
underwent the fragmented care learning model.
METHOD:
We used a quasi-experiment design. This study was conducted by all final year midwifery
students at two schools of midwifery in Indonesia. Fifty four students from one school
attended 6 months of clinical training using the CoC learning model. The control group was
comprised of 52 students from the other school. These students used the conventional
clinical training model (the fragmented care learning model). The independent T-test using
SPSS was used to analyse the differences between the two groups of students in terms of
understanding midwifey care philosophy in five aspects (personalized, holistic, partnership,
collaborative, and evidence-based care).
RESULTS:
There were no significant differences between the groups before interventon. There were
significant differences between the two groups after clinical training (p < 0.01). The mean
post-clinical score of students using all five aspects of the CoC clinical learning model
(15.96) was higher than that of the students in the control group (10.65). The CoC clinical
learning model was shown to be a unique learning opportunity for students to understand the
philosophy of midwifery. Being aligned with midwifery patients and developing effective
relationships with them offered the students a unique view of midwifery practice. This also
promoted an increased understanding of the philosophy of women-centred care. Zero
maternal mortality rate was found in the experiment group.
CONCLUSION:
The results of this study suggest that clinical trainingwith a CoC learning model is more
likely to increase students' understanding of midwifery care philosophy. This in turn
improves the quality ofclinical care, thereby enhancing overall health benefits for women.

PMID: 25937819
Similar articles
49. Public Health. 2015 May;129(5):582-6. doi: 10.1016/j.puhe.2015.01.001. Epub 2015 Mar 9.
Factors affecting the utilisation of maternal, newborn, and

child health services in Indonesia: the role of the Maternal and
Child Health Handbook.
Osaki K1, Kosen S2, Indriasih E3, Pritasari K4, Hattori T5.
Author information:
1
Japan International Cooperation Agency, Tokyo, Japan. Electronic address:
Osaki.Keiko@jica.go.jp.
2
Ministry of Health, Republic of Indonesia, Jakarta, Indonesia. Electronic address:
soewarta.kosen7@gmail.com.
3
e_indriasih@yahoo.com.
4
kirana72012@gmail.com.
5
Health and Development Service, Tokyo, Japan. Electronic address:
ryoma.intl@gmail.com.
Similar articles
50. Asia Pac J Clin Nutr. 2015;24(1):162-76. doi: 10.6133/apjcn.2015.24.1.10.
Factors associated with not using antenatal iron/folic acid

supplements in Indonesia: the 2002/2003 and 2007 Indonesia
Demographic and Health Survey.
Titaley CR1, Dibley MJ2.
Author information:
1
Center for Health Research Universitas Indonesia. Faculty of Public Health, G
Building, Room 211. Universitas Indonesia Kampus UI, Depok 16424 West Java,
Indonesia. Email: christiana_rialine@yahoo.com.
2
The University of Sydney, NSW, 2006 Australia.
Abstract
BACKGROUND:
This analysis examined factors associated with non-use of antenatal iron/folic acid
supplements in Indonesia.
METHODS:
Data from the 2002/2003 and 2007 Indonesia Demographic and Health Surveys (IDHS)
were used, providing survival information for 26,591 most recent deliveries over the five-
year period prior to each survey. The main outcome variable was non-use of iron/folic acid
supplements. Using logistic regression, we examined the role of external environment,
predisposing, enabling, need factors, and previous utilization of other maternal care services
in non-use of antenatal iron/folic acid supplements.
RESULTS:
Mothers from outer Java- Bali Region and rural areas (OR=1.73, 95% CI: 1.48-2.03) had
increased odds for not using antenatal iron/folic acid supplements. The likelihood for not
using the supplements increased with the reduction of household wealth index and parental
education. The odds increased amongst mothers with low autonomy on her own health care
(OR=1.24, 95% CI: 1.04-1.49), high birth-rank infants, mothers with low knowledge of
obstetric complications and low exposure to mass media. Enabling factors associated with
increased odds for non-use of iron/folic acid supplements included mothers reporting money
to pay health services (OR=1.28, 95% CI: 1.13- 1.44) and distance to health services
(OR=1.20, 95% CI: 1.02-1.40) were major problems. Our study demonstrated the
importance of antenatal care as a distribution channel of the supplements.
CONCLUSIONS:
Increasing community awareness, coverage and access to health services along with
strengthening counselling sessions during antenatal care and community participation in
health programs are necessary to improve the uptake of iron/folic acid supplements, to
increase infant survival in Indonesia.
Free Article
Similar articles
51. Am J Clin Nutr. 2015 Mar;101(3):455-61. doi: 10.3945/ajcn.114.087775. Epub 2014 Dec
24.
Effectiveness in improving knowledge, practices, and intakes

of "key problem nutrients" of a complementary feeding
intervention developed by using linear programming:
experience in Lombok, Indonesia.
Fahmida U1, Kolopaking R1, Santika O1, Sriani S1, Umar J1, Htet MK1, Ferguson E1.
Author information:
1
From the Southeast Asian Ministers of Education Organization Regional Center for
Food and Nutrition, Universitas Indonesia, Jakarta, Indonesia (UF, OS, and SS); the
Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta,
Indonesia (RK and JU); the Center of Community Health and Population Studies,
The Research Institute, Trisakti University, Jakarta, Indonesia (MKH); and the
London School of Hygiene and Tropical Medicine, London, United Kingdom (EF).
Abstract
BACKGROUND:
Complementary feeding recommendations (CFRs) with the use of locally available foods can
be developed by using linear programming (LP). Although its potential has been shown for
planning phases of food-based interventions, the effectiveness in the community setting has
not been tested to our knowledge.
OBJECTIVE:
We aimed to assess effectiveness of promoting optimized CFRs for improving maternal

knowledge, feeding practices, and child intakes of key problem nutrients (calcium, iron,
niacin, and zinc).
DESIGN:
A community-intervention trial with a quasi-experimental design was conducted in East

Lombok, West Nusa Tenggara Province, Indonesia, on children aged 9-16 mo at baseline. A
CFR group (n = 240) was compared with a non-CFR group (n = 215). The CFRs, which
were developed using LP, were promoted in an intervention that included monthly cooking
sessions and weekly home visits. The mother's nutrition knowledge and her child's feeding
practices and the child's nutrient intakes were measured before and after the 6-mo
intervention by using a structured interview, 24-h recall, and 1-wk food-frequency
questionnaire.
RESULTS:
The CFR intervention improved mothers' knowledge and children's feeding practices and
improved children's intakes of calcium, iron, and zinc. At the end line, median (IQR) nutrient
densities were significantly higher in the CFR group than in the non-CFR group for iron [i.e.,
0.6 mg/100 kcal (0.4-0.8 mg/100 kcal) compared with 0.5 mg/100 kcal (0.4-0.7 mg/100
kcal)] and niacin [i.e., 0.8 mg/100 kcal (0.5-1.0 mg/100 kcal) compared with 0.6 mg/100
kcal (0.4-0.8 mg/100 kcal)]. However, median nutrient densities for calcium, iron, niacin,
and zinc in the CFR group (23, 0.6, 0.7, and 0.5 mg/100 kcal, respectively) were still below
desired densities (63, 1.0, 0.9, and 0.6 mg/100 kcal, respectively).
CONCLUSIONS:
The CFRs significantly increased intakes of calcium, iron, niacin, and zinc, but nutrient
densities were still below desired nutrient densities. When the adoption of optimized CFRs is
constrained by economic access for or acceptability of nutrient-dense foods, other strategies
need to be incorporated into interventions to ensure adequate intakes of these nutrients.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT02078271.
© 2015 American Society for Nutrition.

Similar articles
52. Matern Child Health J. 2015 Jul;19(7):1624-33. doi: 10.1007/s10995-015-1673-6.
Maternal characteristics and clinical diagnoses influence

obstetrical outcomes in Indonesia.
Adisasmita A1, Smith CV, El-Mohandes AA, Deviany PE, Ryon JJ, Kiely M, Rogers-Bloch
Q, Gipson RF.
Author information:
1
Department of Epidemiology, Faculty of Public Health, University of Indonesia,
Depok, West Java, Indonesia.
Abstract
This Indonesian study evaluates associations between near-miss status/death with maternal
demographic, health care characteristics, and obstetrical complications, comparing results
using retrospective and prospective data. The main outcome measures were obstetric
conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric
admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East
Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic
status, access to care and referral patterns. Reduced logistic models were constructed, and
multivariate analyses used to assess association of risk variables to outcome. Using
multivariate analysis, variables associated with risk of near-miss/death include postpartum
hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI
5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57;
prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for
antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and
prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital
(AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia
are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital
are significant risk factors. Prompt recognition of complications, timely referrals,
standardized care protocols, prompt hospital triage, and structured provider education may
reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective
data provided valuable information about barriers to care and referral patterns.
Similar articles
53. J Biosoc Sci. 2015 Nov;47(6):780-802. doi: 10.1017/S0021932014000522. Epub 2014 Dec
15.
INEQUITY ISSUES AND MOTHERS' PREGNANCY, DELIVERY

AND EARLY-AGE SURVIVAL EXPERIENCES IN ENDE
DISTRICT, INDONESIA.
Pardosi JF1, Parr N1, Muhidin S1.
Author information:
1
Department of Marketing and Management, Faculty of Business and
Economics,Macquarie University,Sydney,Australia.
Abstract
Indonesia's infant mortality rates are among the highest in South-East Asia, and there are
substantial variations between its sub-national regions. This qualitative study aims to explore
early mortality-related health service provision and gender inequity issues based on mothers'
pregnancy, delivery and early-age survival experience in Ende district, Nusa Tenggara Timur
province. Thirty-two mothers aged 18-45 years with at least one birth in the previous five
years were interviewed in depth in May 2013. The results show most mothers have little
knowledge about the danger signs for a child's illness. Mothers with early-age deaths
generally did not know the cause of death. Very few mothers had received adequate
information on maternal and child health during their antenatal and postnatal visits to the
health facility. Some mothers expressed a preference for using a traditional birth attendant,
because of their ready availability and the more extensive range of support services they
provide, compared with local midwives. Unprofessional attitudes displayed by midwives
were reported by several mothers. As elsewhere in Indonesia, the power of health decision-
making lies with the husband. Policies aimed at elevating mothers' roles in health care
decision-making are discussed as measures that would help to improve early-age survival
outcomes. Widening the public health insurance distribution, especially among poorer
mothers, and equalizing the geographical distribution of midwives and health facilities are
recommended to tackle geographical inequities and to increase early-age survival in Ende
district.
Similar articles
54. Matern Child Health J. 2015 Jul;19(7):1515-25. doi: 10.1007/s10995-014-1656-z.
What works to improve duration of exclusive breastfeeding:

lessons from the exclusive breastfeeding promotion program
in rural Indonesia.
Susiloretni KA1, Hadi H, Prabandari YS, Soenarto YS, Wilopo SA.
Author information:
1
Department of Nutrition, Semarang Health Polytechnic MoH RI, Jl. Wolter
Monginsidi 115, Semarang, 52192, Indonesia, aristiati@yahoo.com.
Abstract
The aim of the study was to identify determinants of exclusive breastfeeding (EBF) at the
individual, family, community, and organizational level. This study was a secondary analysis
of data from a multilevel promotion of EBF program in two rural public health centers
(PHCs) in the Demak district, Central Java, Indonesia. The program was a quasi-
experimental study with a pretest-posttest control group. A total of 599 participants were
enrolled, consisting of 163 mother infant pairs, 163 fathers, 163 grandmothers, 82
community leaders, and 28 midwives. EBF duration and its determinants were measured and
analyzed using Cox proportional-hazard model. Mothers with a high level of breastfeeding
knowledge had the greatest EBF duration. Mothers who had a knowledge score >80 had a 73
% (HR 0.27, 95 % CI 0.15, 0.48) greater chance of EBF compared to mothers who had a
knowledge score of <60. Factors which shortened EBF duration were grandmother's lack of
support for EBF (HR 2.04, 95 % CI 1.33, 3.14), received formula samples at discharge (HR
1.99, 95 % CI 1.25, 3.16), and maternal experience of breast engorgement (HR 1.97, 95 %
CI 1.32, 2.94). High maternal breastfeeding knowledge was the only factor associated with
longer duration of EBF. Barriers to EBF were breast engorgement, receiving formula
samples at discharge, and a grandmother's lack of support for EBF.
Similar articles
55 BMC Pregnancy Childbirth. 2014 Sep 30;14:342. doi: 10.1186/1471-2393-14-342.

.
Does cultural practice affects neonatal survival- a case control
study among low birth weight babies in Aceh Province,
Indonesia.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.
1186/1471-2393-14-342
Sutan R1, Berkat S.
Author information:
1
Community Health Department, Universiti kebangsaan Malaysia Medical Centre,
Jalan Yaakob Latif, Bandar Tun Razak Cheras, 56000 Kuala Lumpur, Malaysia.
rosnah_sutan@yahoo.com.
Abstract
BACKGROUND:
Cultural practice have often overlooked when providing maternal and child health care
services. Low birth weight is the second cause of neonatal mortality in the world but it is a
major factor in a developing country such as Indonesia. The purpose of this study is to
predict the neonatal mortality among low birth weight babies in Aceh Province Indonesia.
METHODS:
Unmatched case control study was conducted using data from year 2010 to 2012 in 8 selected
districts of Aceh Province Indonesia. A total of 500 samples were obtained. There were 250
of the samples died in neonatal period (case group) and 250 who were alive (control group).
There were 26 variables studied and were grouped into 4 factors: neonatal factor, maternal
factor, maternal and child health services and neonatal care practices. The data was analysed
using bivariate logistic regression and multivariate logistic regression.
RESULTS:
There were 13 out of 26 variables found as determinant factors of neonatal mortality among
low birth weight babies in Aceh Province. The predictors found in this study were: boy
(aOR1.80, 95% CI: 1.09-2.96), moderate low birth weight (aOR17.84, 95% CI: 6.20-51.35),
preterm (aOR1.84, 95% CI: 1.07- 3.17), presence of maternal illnesses (aOR1.87, 95% CI:
1.06-3.30), too short or too long birth interval (aOR1.80, 95% CI: 1.20-2.91), inappropriate
antenatal care (aOR2.29, 95% CI: 1.34-3.91), inappropriate neonatal visit (aOR7.04, 95% CI:
3.67-13.49), not practicing kangaroo mother care (aOR15.32, 95% CI: 2.85-82.56), not using
warm bottle padding (aOR20.70, 95% CI: 6.32-67.80), not practicing 'didaring' (aOR4.33,
95% CI: 1.83-10.19), late initiation of breastfeeding (aOR2.03, 95% CI: 1.09-3.80), discard
colostrums (aOR3.53, 95% CI: 1.93-6.43) and not practicing exclusive breastfeeding
(aOR5.58, 95% CI: 2.89-10.77).
CONCLUSIONS:
Cultural practices are strongly seen among Acehnese. Inappropriate antenatal care and
neonatal care, late initiation of breastfeeding, discarding colostrums and not practicing
exclusive breastfeeding were related to cultural practices. Improving knowledge heat
preservation to prevent hypothermia using Kangaroo mother care, warm bottle padding and
'didaring' were proven methods to reduce neonatal mortality. Strengthening of health services
in screening for high risk cases and anticipate intervention tailored to cultural practices are
important to decrease neonatal mortality among low birth weight.

Similar articles
56. BJOG. 2014 Sep;121 Suppl 4:67-70. doi: 10.1111/1471-0528.13001.
Maternal death review in selected countries of South East Asia

Region.
Mathur A1, Awin N, Adisasmita A, Jayaratne K, Francis S, Sharma S, Myint T.
Author information:
1
Department of Family Health and Research, WHO South East Asia Regional Office
(SEARO), New Delhi, India.
Abstract
Understanding the underlying factors that led to maternal deaths through a maternal death
review (MDR) throws light on the causes, characteristics and circumstances of the death. We
reviewed and report on the implementation of MDR in India, Indonesia, Myanmar, Nepal
and Sri Lanka, capturing the experiences of MDR initiatives, follow-up actions and lessons
learnet. Overall, while the findings from MDRs have been used to design or change policies
and strategies for improvement of services provided, there are still challenges in scaling up
these initiatives, particularly in the larger countries.
Free Article
Similar articles
57. Matern Child Health J. 2015 May;19(5):1033-46. doi: 10.1007/s10995-014-1603-z.

Maternal agency influences the prevalence of diarrhea and
acute respiratory tract infections among young Indonesian
children.
Agustina R1, Shankar AV, Ayuningtyas A, Achadi EL, Shankar AH.
Author information:
1
SEAMEO RECFON (Southeast Asian Ministers of Education Organization Regional
Center for Food and Nutrition), University of Indonesia, P.O. Box 3852, Jakarta,
10038, Indonesia, dr.rinaagustina@gmail.com.
Abstract
To examine the relationship between measures of mother's caretaking, practice and

individual agency on acute diarrhea and respiratory tract infections (ARTIs) of Indonesian
children. Using population-based household data from the Indonesian Demographic Health
Surveys for 2002-2003 (n = 9,151 children) and 2007 (n = 9,714 children), we selected 28
indicators related to mother' caretaking, and applied principal component analysis to derive
indices for access to care, practice and experience, and agency. The association between
index quartiles (level 1-4) and the prevalence of diarrhea and ARTIs in the youngest child <5
years of age was assessed with multivariate logistic regression adjusting for socioeconomic
status, residence type, mother's age and education, family size, child's age and sex,
immunization status and received vitamin A supplementation. Moderate levels (level 3) of
practice and experience were associated with decreased diarrheal risk (adjusted OR 0.86, 95
% CI 0.75-0.98), but not for ARTIs. Children of mothers with higher levels (level 4) of
agency were protected against both diarrhea (adjusted OR 0.68, 95 % CI 0.60-0.77) and
ARTIs (adjusted OR 0.77, 95 % CI 0.66-0.91). Stratified analyses with child's age and
mother's education, and tests of interaction, showed that agency had a stronger effect on
diarrhea and ARTIs prevalence in children <2 years of age. Maternal caretaking, especially
agency, is strongly associated with lower prevalence of diarrhea and ARTIs in younger
children. Interventions specifically designed to promote maternal autonomy and decision-
making may lead to improved child health.
Similar articles
58 PLoS One. 2014 Jul 25;9(7):e103597. doi: 10.1371/journal.pone.0103597. eCollection 2014.

.
Location matters: trends in inequalities in child mortality in
Indonesia. Evidence from repeated cross-sectional surveys.
http://journals.plos.org/plosone/article?id=10.1371/journal.pon
e.0103597
Hodge A1, Firth S1, Marthias T2, Jimenez-Soto E1.
Author information:
1
School of Population Health, The University of Queensland, Brisbane, Queensland,
Australia.
2
Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada
University, Yogyakarta, Indonesia.
Abstract
BACKGROUND:
Considerable improvements in life expectancy and other human development indicators in

Indonesia are thought to mask considerable disparities between populations in the country.
We examine the existence and extent of these disparities by measuring trends and inequalities
in the under-five mortality rate and neonatal mortality rate across wealth, education and
geography.
METHODOLOGY:
Using data from seven waves of the Indonesian Demographic and Health Surveys, direct
estimates of under-five and neonatal mortality rates were generated for 1980-2011. Absolute
and relative inequalities were measured by rate differences and ratios, and where possible,
slope and relative indices of inequality. Disparities were assessed by levels of rural/urban
location, island groups, maternal education and household wealth.
FINDINGS:
Declines in national rates of under-five and neonatal mortality have accorded with reductions
of absolute inequalities in clusters stratified by wealth, maternal education and rural/urban
location. Across these groups, relative inequalities have generally stabilised, with possible
increases with respect to mortality across wealth subpopulations. Both relative and absolute
inequalities in rates of under-five and neonatal mortality stratified by island divisions have
widened.
CONCLUSION:
Indonesia has made considerable gains in reducing under-five and neonatal mortality at a
national level, with the largest reductions happening before the Asian financial crisis (1997-
98) and decentralisation (2000). Hasty implementation of decentralisation reforms may have
contributed to a slowdown in mortality rate reduction thereafter. Widening inequities
between the most developed provinces of Java-Bali and those of other island groupings
should be of particular concern for a country embarking on an ambitious plan for universal
health coverage by 2019. A focus on addressing the key supply side barriers to accessing
health care and on the social determinants of health in remote and disadvantaged regions will
be essential for this plan to be realised.

Similar articles
59. Lancet. 2014 Sep 27;384(9949):1215-25. doi: 10.1016/S0140-6736(14)60919-3. Epub 2014

Jun 22.
Country experience with strengthening of health systems and

deployment of midwives in countries with high maternal
mortality.
Van Lerberghe W1, Matthews Z2, Achadi E3, Ancona C4, Campbell J5, Channon A6, de
Bernis L7, De Brouwere V8, Fauveau V9, Fogstad H10, Koblinsky M11, Liljestrand J12,
Mechbal A13, Murray SF14, Rathavay T15, Rehr H16, Richard F17, ten Hoope-Bender P5,
Turkmani S18.
Author information:
1
WHO Regional Office for Europe, Athens, Greece. Electronic address:
wvl@euro.who.int.
2
Evidence for Action, University of Southampton, Southampton UK.
3
Center for Family Welfare, Faculty of Public Health University of Indonesia, Depok,
West Java, Indonesia.
4
Brussels, Belgium.
5
Instituto de Cooperación Social Integrare, Barcelona, Spain.
6
Department of Social Statistics and Demography, University of Southampton,
Southampton, UK.
7
UN Population Fund, Geneva, Switzerland.
8
Woman & Child Health Research Centre, Institute of Tropical Medicine, Antwerp,
Belgium.
9
Holistic Santé, Montpellier, France.
10
Norad Oslo, Norway.
11
US Agency for International Development, Washington DC, USA.
12
Lund University, Sweden.
13
Rabat, Morocco.
14
International Development Institute, King's College London, London, UK.
15
National Reproductive Health Program, Phnom Penh, Cambodia.
16
Evidence for Action, London, UK.
17
Institute of Tropical Medicine, Antwerp, Belgium.
18
Afghan Midwives Association, Jhpiego, Kabul, Afghanistan.
Abstract
This paper complements the other papers in the Lancet Series on midwifery by documenting
the experience of low-income and middle-income countries that deployed midwives as one
of the core constituents of their strategy to improve maternal and newborn health. It
examines the constellation of various diverse health-system strengthening interventions
deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up
of the pre-service education of midwives was only one element. Efforts in health system
strengthening in these countries have been characterised by: expansion of the network of
health facilities with increased uptake of facility birthing, scaling up of the production of
midwives, reduction of financial barriers, and late attention for improving the quality of care.
Overmedicalisation and respectful woman-centred care have received little or no attention.
Similar articles
60. BMC Int Health Hum Rights. 2014 May 5;14:14. doi: 10.1186/1472-698X-14-14.
Factors associated with non-utilisation of health service for
childbirth in Timor-Leste: evidence from the 2009-2010
Demographic and Health Survey.
Khanal V1, Lee AH, da Cruz JL, Karkee R.
Author information:
1
Sanjeevani College of Medical Sciences, Butwal, Rupandehi, Nepal.
khanal.vishnu@gmail.com.
Abstract
BACKGROUND:
Timor-Leste is a young developing country in Asia. Most of its infrastructure was destroyed
after a long armed conflict for independence. Despite recent expansion of health facilities
and investment in healthcare, maternal mortality remains high with most mothers still giving
birth at home. This study investigated factors affecting the non-utilisation of health service
for childbirth in the aftermath of the independence conflict.
METHODS:
The Timor-Leste Demographic and Health Survey 2009-2010 was the latest two-stage
national survey, which used validated questionnaires to obtain information from 26 clusters
derived from 13 districts of the country. Factors influencing non-utilisation of health facility
for childbirth were investigated using univariate and multivariable logistic regression
analyses, accounting for the cluster sampling and sample weight of the survey.
RESULTS:
Of the total 5986 participants included in the study, 4472 (74.8%) did not deliver their last
child at a health facility. Lack of education for the mother (adjusted odds ratio (OR): 2.04;
95% confidence interval (CI) 1.56 to 2.66) and her partner (OR: 1.45; 95% CI 1.14 to 1.84),
low household wealth status (OR: 5.20; 95% CI 3.93 to 6.90), and rural residence (OR: 2.83;
95% CI 2.22 to 3.66), were associated with increased likelihood of non-utilisation of health
facility for childbirth. Working mothers (OR: 1.55; 95% CI 1.32 to 1.81), who had high
parity (OR: 1.78; 95% CI 1.36 to 2.32) and did not attend antenatal care service (OR: 4.68;
95% CI 2.65 to 8.28) were also vulnerable for not delivering at a health facility. Conversely,
the prevalence of non-utilisation of health facility for childbirth reduced with increasing
number of service components received during antenatal care visits (OR: 0.72; 95% CI 0.64
to 0.80).
CONCLUSIONS:
Only a quarter of Timorese women delivered at a health facility. In order to reduce maternal
mortality, future interventions should target disadvantaged mothers from poor families, those
residing in rural areas, have higher parity but no education, and who seldom attend antenatal
care service, by improving their utilisation of health facility for childbirth.

Similar articles
61. BMC Pregnancy Childbirth. 2014 May 7;14:163. doi: 10.1186/1471-2393-14-163.
A randomised controlled trial on the Four Pillars Approach in

managing pregnant women with anaemia in Yogyakarta-
Indonesia: a study protocol.
Widyawati W1, Jans S, Bor H, Siswishanto R, van Dillen J, Lagro-Janssen AL.
Author information:
1
School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta,
Indonesia. A.Widyawati@radboudumc.nl.
Abstract
BACKGROUND:
Anaemia is a common health problem among pregnant women and a contributing factor with
a major influence on maternal mortality in Indonesia. The Four Pillars Approach is a new
approach to anaemia in pregnancy, combining four strategies to improve antenatal and
delivery care. The primary objective of this study is to measure the effectiveness of the Four
Pillars Approach. The barriers, the facilitators, and the patients' as well as the midwives'
satisfaction with the Four Pillars Approach will also be measured.
METHODS/DESIGN:
This study will use a cluster randomised controlled trial. This intervention study will be
conducted in the Public Health Centres with basic emergency obstetric care in Yogyakarta
Special Province and in Central Java Province. We will involve all the Public Health Centres
(24) with emergency obstetric care in Yogyakarta Special Province. Another 24 Public
Health Centres with emergency obstetric care in Central Java Province which have
similarities in their demographic, population characteristics, and facilities will also be
involved. Each Public Health Centre will be asked to choose two or three nurse-midwives to
participate in this study. For the intervention group, the Public Health Centres in Yogyakarta
Special Province, training on the Four Pillars Approach will be held prior to the model's
implementation. Consecutively, we will recruit 360 pregnant women with anaemia to take
part in part in the study to measure the effectiveness of the intervention. The outcome
measurements are the differences in haemoglobin levels between the intervention and control
groups in the third trimester of pregnancy, the frequency of antenatal care attendance, and
the presence of a nurse-midwife during labour. Qualitative data will be used to investigate
the barriers and facilitating factors, as to nurse-midwives' satisfaction with the
implementation of the Four Pillars Approach.
DISCUSSION:
If the Four Pillars Approach is effective in improving the outcome for pregnant women with
anaemia, this approach could be implemented nationwide and be taken into consideration to
improve the outcome for other conditions in pregnancy, after further research.
TRIAL REGISTRATION:
Current Controlled Trials ISRCTN35822126.

Similar articles
62. Pediatr Int. 2014 Oct;56(5):720-5. doi: 10.1111/ped.12333. Epub 2014 Sep 17.
Environment as a risk factor in delayed development in

premature, low-birthweight and mild asphyxia children.
Yanuarti HP1, Rusmil K, Effendi SH.
Author information:
1
Department of Child Health, Medical School, Padjadjaran University, Bandung,
Indonesia.
Abstract
BACKGROUND:
Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of
language and visual-motor development. Environmental risk factors contributing to the delay
include parents' education, family income, number of children in the family, exclusive
breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature,
LBW and mild asphyxia children minimizes information to parents on the importance of an
optimal environment. The aim of this study was to observe the role of the environment as a
risk factor for delay in language and visual-motor development.
METHODS:
A cross-sectional study was carried out from June to December 2011 of 12-24-month-old
children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City,
and Muhammadiyah Hospitals. Language and visual-motor development were measured by
Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic
regression analysis.
RESULTS:
Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related
to the delay were low parental education, low family income, non-exclusive breast-feeding
(P < 0.001) and full-time maternal parenting (P < 0.05). On multivariate analysis non-
exclusive breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756;
95% confidence interval [CI]: 10.407-2934.516, P < 0.001), and low family income, a 0.042-
fold risk (PR 0.042; 95%CI: 0.005-0.321, P < 0.05).
CONCLUSION:
Low family income and non-exclusive breast-feeding are risk factors for delay in language
and visual-motor development in 12-24-month-old children born premature, with LBW and
mild asphyxia.
© 2014 Japan Pediatric Society.

Similar articles
63. Asia Pac J Public Health. 2015 Apr;27(3):348-59. doi: 10.1177/1010539514524818. Epub
2014 Feb 24.
Utilization of the Local Government Health Insurance Scheme

(JKA) for Maternal Health Services Among Women Living in
Underdeveloped Areas of Aceh Province, Indonesia.
Kesuma ZM1, Chongsuvivatwong V2.
Author information:
1
Syiah Kuala University, Banda Aceh, Indonesia kesumaku@yahoo.com.
2
Prince of Songkla University, Hatyai, Songkhla, Thailand.
Abstract
Aceh province of Indonesia created its own health coverage scheme called Jaminan
Kesehatan Aceh (JKA) to cover Aceh's populations who were not registered under insurance
for the poor (Jamkesmas). This study aims to compare the utilization rate of maternal health
care (MHC) services and contraceptive prevalence rate (CPR) before JKA, during the
transition period, and after JKA had been established. A cross-sectional household survey
was conducted from June 2011 to July 2012. Utilization of MHC services and CPR during
the 3 periods was assessed using a questionnaire. The Mantel-Haenszel χ(2) test was used to
examine the association between period and coverage. Generalized estimating equations
(GEEs) were used to examine utilization and type of service, period of service, and type of
scheme. Coverage of utilization of skilled birth attendants significantly improved among the
JKA holders (odds ratio = 1.84; 95% confidence interval = 1.18-2.89). JKA, thus, has shown
its positive impact.
Similar articles
64. Asia Pac J Clin Nutr. 2014;23(1):91-104. doi: 10.6133/apjcn.2014.23.1.18.
Socio-economic factors and use of maternal health services

are associated with delayed initiation and non-exclusive
breastfeeding in Indonesia: secondary analysis of Indonesia
Demographic and Health Surveys 2002/2003 and 2007.
Titaley CR1, Loh PC, Prasetyo S, Ariawan I, Shankar AH.
Author information:
1
Center for Health Research Universitas Indonesia (CHR-UI), Faculty of Public
Health, Universitas Indonesia, Depok, Indonesia Tel: +62 21 727 0154; Fax: +62 21
727 0153 Email: christiana_rialine@yahoo.com.
Abstract
This analysis aims to examine factors associated with delayed initiation and non-exclusive
breastfeeding in Indonesia. Data were derived from the 2002/2003 and 2007 Indonesia
Demographic and Health Survey. Information from 12,191 singleton live-born infants aged
0-23 months was used to examine factors associated with delayed initiation of breastfeeding.
Furthermore, information from 3,187 singleton live-born infants aged 0-5 months was used
to identify factors associated with non-exclusive breastfeeding. Associations between
potential predictors and study outcomes were examined using logistic regression. Our study
found that infants from high household wealth-index had significantly increased odds of both
delayed initiation and non-exclusive breastfeeding. Other factors associated with an
increased odds of delayed initiation of breastfeeding included infants from Sumatera region
(OR=1.64, 95% CI: 1.38-1.95), Caesarean-section deliveries (OR=1.84, 95% CI: 1.39-2.44)
and deliveries in government-owned (OR=1.38, 95% CI: 1.08-1.76) and non-health facility
(OR=1.20, 95% CI: 1.00-1.43). Other factors associated with an increased odds for non-
exclusive breastfeeding included parents who were in the workforce (OR=1.37, 95% CI:
1.06-1.78) and mothers with obstetric complication at childbirth (OR=1.35, 95% CI: 1.05-
1.74). However, the odds reduced for infants from Eastern Indonesia (OR=0.64, 95% CI:
0.49-0.85). Poor breastfeeding practices are associated with environmental, socio-economic,
pregnancy-birthing characteristics and maternal health services factors. Efforts to promote
breastfeeding practices should be conducted comprehensively to target population at risk for
poor breastfeeding practices.
Free Article
Similar articles
65. BMC Pregnancy Childbirth. 2014 Jan 22;14:39. doi: 10.1186/1471-2393-14-39.
Maternal deaths in eastern Indonesia: 20 years and still

walking: an ethnographic study.
Belton S1, Myers B, Ngana FR.
Author information:
1
Menzies School of Health Research, Casuarina, Darwin, NT, Australia.
suzanne.belton@menzies.edu.au.
Abstract
BACKGROUND:
The delays in receiving adequate emergency maternal care described by Thaddeus and
Maine twenty years ago are still occurring, as exemplified in this study of cases of maternal
deaths in a subdistrict in rural eastern Indonesia.
METHODS:
An ethnographic design was conducted, recruiting eleven families who reported on cases of
maternal deaths in one sub-district of Indonesia, as well as assessing the geographical and
cultural context of the villages. Traditional birth attendants and village leaders provided
information to the research team which was thematically and contextually analysed.
RESULTS:
Two stages to the first and second delays have been differentiated in this study. First, delays
in the decision to seek care comprised time taken to recognise (if at all) that an emergency
situation existed, followed by time taken to reach a decision to request care. The decision to
request care resided variously with the family or cadre. Second, delays in reaching care
comprised time taken to deliver the request for help and then time for help to arrive. A phone
was not available to request care in many cases and so the request was delivered by walking
or motorbike. In two cases where the decision to seek care and the delivery of the request
happened in a timely way, help was delayed because the midwife and ambulance
respectively were unavailable.
CONCLUSIONS:
This study, although a small sample, confirmed that either a single delay or a sequence of
delays can prove fatal. Delays were determined by both social and geographic factors, any of
which alone could be limiting. Initiatives to improve maternal health outcomes need to
address multiple factors: increased awareness of equitable access to maternal health care,
village preparedness for emergency response, improved access to telecommunications and
geographic access.

Similar articles
66. Stud Fam Plann. 2013 Dec;44(4):389-409. doi: 10.1111/j.1728-4465.2013.00366.x.
Effect of village midwife program on contraceptive prevalence

and method choice in Indonesia.
Weaver EH1, Frankenberg E, Fried BJ, Thomas D, Wheeler SB, Paul JE.
Author information:
1
Fogarty Global Health Fellow, School of Medicine, University of North Carolina at
Chapel Hill, 130 Mason Farm Road, Campus Box 7030, Chapel Hill, NC, 27599.
emweaver@email.unc.edu.
Abstract
Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal
mortality. The program's goals were to address gaps in access to reproductive health care for
rural women, increase access to and use of family planning services, and broaden the mix of
available contraceptive methods. In this study, we use longitudinal data from the Indonesia
Family Life Survey to examine the program's effect on contraceptive practice. We find that
the program did not affect overall contraceptive prevalence but did affect method choice.
Over time, for women using contraceptives, midwives were associated with increased odds
of injectable contraceptive use and decreased odds of oral contraceptive and implant use.
Although the Indonesian government had hoped that the Village Midwife Program would
channel women into using longer-lasting methods, the women's "switching behavior"
indicates that the program succeeded in providing additional outlets for and promoting the
use of injectable contraceptives.

Similar articles
6 Int J Vitam Nutr Res. 2013;83(1):14-25. doi: 10.1024/0300-9831/a000141.

7.
The impact of prenatal vitamin A and zinc supplementation on
birth size and neonatal survival - a double-blind, randomized
controlled trial in a rural area of Indonesia.
https://www.tandfonline.com/doi/abs/10.3109/14767058.2015.10
79615?journalCode=ijmf20
Prawirohartono EP1, Nyström L, Nurdiati DS, Hakimi M, Lind T.
Author information:
1
Department of Child Health, Medical School, Gadjah Mada University, Yogyakarta,
Indonesia.
Abstract
BACKGROUND:
Prenatal supplementation with micronutrients may increase birth weight and thus improve
infant health and survival in settings where infants and children are at risk of micronutrient
deficiencies.
OBJECTIVE:
To assess whether vitamin A and/or zinc supplementation given during pregnancy can
improve birth weight, birth length, neonatal morbidity, or infant mortality.
METHODS:
A double-blind, randomized controlled trial supplementing women (n = 2173) in Central

Java, Indonesia throughout pregnancy with vitamin A, zinc, combined vitamin A+zinc, or
placebo.
RESULTS:
Out of 2173 supplemented pregnant women, 1956 neonates could be evaluated. Overall, zinc
supplementation improved birth length compared to placebo or combined vitamin A+zinc
(48.8 vs. 48.5 cm, p = 0.04); vitamin A supplementation improved birth length compared to
placebo or combined vitamin A+zinc (48.7 vs. 48.2 cm, p = 0.04). These effects remained
after adjusting for maternal height, pre-pregnancy weight, and parity. There was no effect of
supplementation on birth weight, the proportion of low birth weight, neonatal morbidity, or
mortality.
CONCLUSIONS:
Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on

birth length, but supplementation with zinc, vitamin A or a combination of zinc and vitamin
A, have no effect on birth weight, neonatal morbidity, or mortality.
Similar articles
68. Trop Med Int Health. 2013 Oct;18(10):1193-201. doi: 10.1111/tmi.12175. Epub 2013 Aug
23.
Maternal mortality, birth with a health professional and
distance to obstetric care in Indonesia and Bangladesh.
Scott S1, Chowdhury ME, Pambudi ES, Qomariyah SN, Ronsmans C.
Author information:
1
London School of Hygiene and Tropical Medicine, London, UK.
Abstract
OBJECTIVE:
To examine the relationship between distance to a health facility, consulting a health

professional and maternal mortality.
METHODS:
Retrospective cohort study in Matlab, Bangladesh (1987-2005), to collect data on all

pregnancies, births and deaths. In Java, Indonesia (2004-2005), an informant-based approach
identified maternal deaths and a population-based survey sampled women who survived
birth. Logistic regression was used to examine the influence of distance to a health facility
and uptake of a health professional on odds of dying.
RESULTS:
Maternal mortality was 320 per 100 000 births (95% CI: 290, 353) in Indonesia and 318 per
100 000 (95% CI: 272, 369) in Bangladesh. Women who lived further from health centres in
both countries were less likely to have their births attended by health professionals than
those who lived closer. For women who were assisted by a health professional, the odds of
dying increased with increasing distance from a health centre [odds ratio per km; Indonesia:
1.07 (95% CI: 1.02-1.11), Bangladesh: 1.47 (95% CI: 1.22-1.78)]. There was no evidence for
an association between distance to a health centre and maternal death for women who were
not assisted by a health professional.
CONCLUSIONS:
Even in settings where health services are relatively close to women's homes, distance to a
health facility affects maternal mortality for women giving birth with a health professional.
Women may only seek professional care in an emergency and may be unable to reach timely
care when living far away from a health centre.
© 2013 John Wiley & Sons Ltd.

Free Article
Similar articles
69. Glob Health Action. 2013 May 6;6:1-12. doi: 10.3402/gha.v6i0.20429.
The role of home-based records in the establishment of a

continuum of care for mothers, newborns, and children in
Indonesia.
Osaki K1, Hattori T, Kosen S.
Author information:
1
Human Development Department, Japan International Cooperation Agency, Tokyo,
Japan. Osaki.Keiko@jica.go.jp
Abstract
BACKGROUND:
The provision of appropriate care along the continuum of maternal, newborn, and child
health (MNCH) service delivery is a challenge in developing countries. To improve this, in
the 1990s, Indonesia introduced the maternal and child health (MCH) handbook, as an
integrated form of parallel home-based records.
OBJECTIVE:
This study aimed to identify the roles of home-based records both before and after childbirth,
especially in provinces where the MCH handbook (MCHHB) was extensively promoted, by
examining their association with MNCH service uptake.
DESIGN:
This was a cross-sectional study using nationally representative data sets, the Indonesia
Demographic and Health Surveys (IDHSs) from 1997, 2002-2003, and 2007. The IDHS
identifies respondents' ownership of home-based records before and after childbirth.
Multivariate logistic regression was used to examine associations between record ownership
and service utilisation in national data and data from two provinces, West Sumatra and North
Sulawesi, where ownership of pre- and post-natal records served as a proxy for MCHHB
ownership.
RESULTS:
Pre- and post-natal record ownership increased from 1997 to 2007. Provincial data from
2007 showed that handbook ownership was associated with having delivery assisted by
trained personnel [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.05-4.25],
receiving maternal care (aOR: 3.92, 95% CI: 2.35-6.52), completing 12 doses of child
immunisation for seven diseases (aOR: 4.86, 95% CI: 2.37-9.95), and having immunisation
before and after childbirth (aOR: 5.40, 95% CI: 2.28-12.76), whereas national data showed
that service utilisation was associated with ownership of both records compared with owning
a single record or none.
CONCLUSION:
Our results suggest that pre- and post-natal home-based record use may be effective for
ensuring service utilisation. In addition, since the handbook is an efficient home-based
record for use throughout children's life courses, it could be an effective tool for promoting
the continuum of MNCH care in Indonesia.

Similar articles
70. Health Policy Plan. 2014 Jul;29(4):409-20. doi: 10.1093/heapol/czt027. Epub 2013 May 6.
'Desa SIAGA', the 'Alert Village': the evolution of an iconic

brand in Indonesian public health strategies.
Hill PS1, Goeman L2, Sofiarini R3, Djara MM2.
Author information:
1
Australian Centre for International and Tropical Health, The University of
Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and
Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels,
Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19,
Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis
and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International
Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia peter.hill@sph.uq.edu.au.
2
Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia.
3
Zusammenarbeit (GIZ) GmbH, Mataram 83121, IndonesiaAustralian Centre for
International and Tropical Health, The University of Queensland, Herston Road,
Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian
Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS
Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia
and Consolidation Programme Health/Policy Analysis and Formulation in the Health
Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH,
Mataram 83121, Indonesia.
Abstract
In 1999, the Ministry of Women's Empowerment in Indonesia worked with advertisers in

Jakarta and international technical advisors to develop the concept of 'Suami SIAGA', the
'Alert Husband', confronting Indonesian males with their responsibilities to be aware of their
wives' needs and ensure early access if needed to trained obstetrics care. The model was
rapidly expanded to apply to the 'Desa SIAGA', the 'Alert Village', with communities
assuming the responsibility for awareness of the risks of pregnancy and childbirth, and
supporting registered pregnant mothers with funding and transportation for emergency
obstetric assistance, and identified blood donors. Based on the participant observation,
interviews and documentary analysis, this article uses a systems perspective to trace the
evolution of that iconic 'brand' as new national and international actors further developed the
concept and its application in provincial and national programmes. In 2010, it underwent a
further transformation to become 'Desa Siaga Aktif', a national programme with
responsibilities expanded to include the provision of basic health services at village level,
and the surveillance of communicable disease, monitoring of lifestyle activities and disaster
preparedness, in addition to the management of obstetric emergencies. By tracking the use of
this single 'brand', the study provides insights into the complex adaptive system of policy and
programme development with its rich interactions between multiple international, national,
provincial and sectoral stakeholders, the unpredictable responses to feedback from these
actors and their activities and the resultant emergence of new policy elements, new
programmes and new levels of operation within the system.
Similar articles
71. CMAJ. 2013 Feb 5;185(2):E95-6. doi: 10.1503/cmaj.109-4347. Epub 2013 Jan 7.
Indonesia: the midwife and maternal mortality miasma.

Webster PC.
Similar articles

Indonesia Maternal Health Articles - Abstracts - Neonatal

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Indonesia Maternal Health Articles - Abstracts - Neonatal

Încărcat de

Drepturi de autor:

Formate disponibile

Indonesia and Maternal Health – 2.

Trends and inequities in use of maternal health care services in

Ongoing pro-poor health-financing strategies should be strengthened with introduction of

PMCID: PMC5749568 Free PMC Article

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention

3. J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):48. doi: 10.1186/s41043-017-0126-9.

Summary findings from a mixed methods study on identifying

There is a lack of systematic information documenting recognition of potentially life-

PMCID: PMC5764052 Free PMC Article

4. J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):51. doi: 10.1186/s41043-017-0119-8.

Methodology for a mixed-methods multi-country study to

PMCID: PMC5764055 Free PMC Article

Sustainability of a Community-Based CHOICE Program to

6. Lancet. 2018 Jan 30. pii: S0140-6736(18)30183-1. doi: 10.1016/S0140-6736(18)30183-1.

Status and drivers of maternal, newborn, child and adolescent

Copyright © 2018 Elsevier Ltd. All rights reserved.

7. J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):44. doi: 10.1186/s41043-017-0122-0.

Recognition of and care-seeking for maternal and newborn

PMCID: PMC5764054 Free PMC Article

8. Compr Child Adolesc Nurs. 2017;40(sup1):145-151. doi: 10.1080/24694193.2017.1386983.

Maternal Self-Efficacy of Pregnant Indonesian Teens:

The Development of an Interactive Health Education Model

10. BMC Womens Health. 2017 Nov 9;17(1):102. doi: 10.1186/s12905-017-0455-2.

PMCID: PMC5679340 Free PMC Article

11. Eval Program Plann. 2018 Feb;66:102-110. doi: 10.1016/j.evalprogplan.2017.10.011. Epub

Use of most significant change (MSC) technique to evaluate

Maternal health promotion is a defined activity in the community integrated posts

Factors influencing Indonesian women's use of maternal

13. Lancet Glob Health. 2017 Nov;5(11):e1090-e1100. doi: 10.1016/S2214-109X(17)30371-6.

Modifiers of the effect of maternal multiple micronutrient

Micronutrient deficiencies are common among women in low-income and middle-income

This two-stage meta-analysis of individual patient included data from 17 randomised

Multiple micronutrient supplements containing iron-folic acid provided significantly greater

Strengthening the primary care workforce to deliver

Barriers to utilization of postnatal care at village level in Klaten

Maternal health remains a persisting public health challenge in Indonesia. Postnatal

PMCID: PMC5547562 Free PMC Article

16. Health Policy Plan. 2017 Oct 1;32(8):1203-1211. doi: 10.1093/heapol/czx073.

Suami SIAGA: male engagement in maternal health in

Expanding the scope beyond mortality: burden and missed

To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to

PMCID: PMC5496086 Free PMC Article

18. Anemia. 2017;2017:6935648. doi: 10.1155/2017/6935648. Epub 2017 May 29.

Low Hemoglobin among Pregnant Women in Midwives

PMCID: PMC5467296 Free PMC Article

Intergenerational effects of maternal birth weight, BMI, and

BACKGROUND AND OBJECTIVES:

METHODS AND STUDY DESIGN:

20. BMC Pregnancy Childbirth. 2017 May 22;17(1):149. doi: 10.1186/s12884-017-1326-4.

Maternal care quality in near miss and maternal mortality in an

PMCID: PMC5440944 Free PMC Article

21. J Glob Health. 2017 Jun;7(1):010406. doi: 10.7189/jogh.07.010406.

Maternal mortality as a Millennium Development Goal of the

Reported data quality of maternal mortality in Indonesia is very limited regarding

PMCID: PMC5370209 Free PMC Article

22. Health Policy Plan. 2017 Apr 1;32(3):366-375. doi: 10.1093/heapol/czw135.

The impact of health insurance on maternal health care

PMCID: PMC5400062 Free PMC Article

23. BMC Pregnancy Childbirth. 2017 Mar 28;17(1):100. doi: 10.1186/s12884-017-1280-1.

Maternal characteristics and obstetrical complications impact

We investigated associations between maternal characteristics, access to care, and obstetrical