NEONATAL DEATH PREDICTION MODELS IN THE YEAR 2017 KENDARI

Sri Nuralami Meldayanti Samuddin,1 Stang,2 Arif tiro,3

1
Department of Biostatistics, Faculty of Public Health, Hasanuddin University, (email:
srinuralamimeldayantisamuddin@gmail.com )
2
Department of Biostatistics, School of Public Health, Hasanuddin University, (Email:
stangbios@gmail.com )
3
Department of Statistics, Faculty of Mathematics and Natural Sciences, Makassar
University, (Email: arif_tiro@yahoo.com )

Correspondence address:

Sri Nuralami Meldayanti Samuddin

Faculty of Public Health
Hasanuddin University
Makassar, 90245
Phone: 0822-9123-4098
Email: srinuralamimeldayantisamuddin@gmail.com
Abstract

In the program of SDGs, the national health system targets a reduction in neonatal mortality rate of at least 12
per 1000 live births. Whereas in 2017 in the city of Kendari number of neonatal mortality at 18 cases per 1,000
live births so that they do not meet the target of SDGs. This study aims to determine the predictive models of
neonatal mortality in Kendari Year 2017. The research was conducted in the city of Kendari, the study type used
in the study was observational with case control study design with a sample of 18 cases and 36 controls. The
control population of research is all mothers who gave birth to babies born alive until after 28 days in Kendari by
using simple random sampling, whereas sampling is not the case because the observations were made in the total
population.The data obtained were processed using computer applications for statistical and performed
univariate, bivariate and multivariate analyzes.The results of this research can be in the know that there is
influence between birth complications against neonatal mortality (OR = 10.298), asphyxia on neonatal mortality
(OR = 13.113), and LBW to neonatal mortality (OR = 12.545). Asphyxia are variables that influence on neonatal
death.Pregnant women are expected to consult and consult a pregnancy with routine in health facilities that are
not too late in recognizing early detection of complications during delivery and the baby suffered asphyxia risk.
Mother is expected to increase and maintain the nutritional intake while pregnancy,

Keywords : neonatal mortality, complications of labor, asphyxia, low birth weight, and maternal
INTRODUCTION
According to the Ministry of Health of Indonesia in the SDGs program that targets a
national health system that is on purpose to 3 explained that in 2030 all over the country
trying to reduce neonatal mortality rate at least 12 per 1000 live births. Neonatal deaths are
deaths in the period when the baby is born alive up to 28 days old baby (WHO, 2006).
In 2000, 3 million infants (23 per 1000 birth) died in the early neonatal period in
Europe and North America. Early neonatal mortality rate is higher obtained from the African
continent, which is 31 per 1,000 babies born. While early neonatal deaths in Asia (except
Japan) of 24 per 1000 babies born and in Southeast Asia at 15 per 1,000 babies born (Suraya
et al., 2016).
Based on data from Kendari City Health Department, in 2013 accounting for 19
(3:15%) and neonatal mortality in 2014 dropped to 17 cases (2.73%) per 1,000 live births. In
2015 and 2016 remained decreased to 12 cases (1.9%). Meanwhile, in 2017 increased the
number of neonatal deaths by 18 cases (2.2%) per 1,000 live births so that they do not meet
the SDGs targets to reduce neonatal mortality rate at least 12 per 1,000 live births (Dinkes
Prov Sultra, 2017).
Variety of factors can cause neonatal mortality as biological factors, namely infant
birth weight and gender also affect neonatal mortality. In addition, the neonatal mortality was
also influenced by the biological mother (age, history of abortion, and complications during
pregnancy) (Suraya et al., 2016)
Research conducted by Debelew et al (2014) states that the factors affecting neonatal
mortality is parity, the frequency of visits Antenatal Care (ANC), the place of delivery,
gestational age at delivery, premature rupture of membranes, multiple births, the size of the
neonate at birth and neonatal care practices. The purpose of this study was to determine the
prediction model of Neonatal mortality in Kendari City based on the influence of maternal
age, ANC service standards, low birth weight, asphyxia, parity, and labor complications.

METHOD
Location and Design Research
This research was conducted in Kendari conducted in February and March 2019. The
type was an observational study using case control design.
Population and Sample
The control population of research is all mothers who gave birth to babies born alive
until after 28 days in Kendari by using simple random sampling, whereas sampling is not the
case because the observations were made in the total population.
Method of collecting data
This study uses secondary data obtained from Kendari City Health Department and the
medical records of nine health centers in the city of Kendari 2017 puskesmas eye, kandai
health centers, community health centers Benu-continent, puuwatu health centers, community
health centers highway teak, blooming health centers, community health centers lepo- Lepo,
Poasia health centers and community health centers that provide data Abeli associated with
the variables to be studied.
Data analysis
Analysis of the data used is a univariate analysis were done to get a general overview
of the research problem. To see the effect of each independent variable on the dependent used
bivariate analysis using Chi-square test (2). Then multivariate analyzes were performed to
analyze the influence of several variables on other variables at the same time and to establish
a model using multiple logistic regression.

RESULTS
Table 1 shows the results of chi-square test to determine the association between
maternal age, ANC service standard, parity, complications of labor, asphyxia, low birth
weight and the incidence of mortality to incidence of neonatal death. At the age of the mother
shows the results of chi-square test for value Odds Ratio (OR) is 2.212, with p = 0.284. mean
age of mothers giving their risk by 2.212 times the incidence of neonatal death but there is no
relationship between maternal age with the incidence of neonatal mortality because the value
of p> 0.05.
Table 1 In the standard variable ANC shows the results of chi-square test for value Odds
Ratio (OR) is 1.750, with p = 0.499. standard means ANC gives the risk by 1.750 times the
incidence of neonatal death but there is no relationship between the ANC and the service
standards of neonatal mortality events since the value of p> 0.05. In the parity variables show
ch-square test results for grades Odds Ratio (OR) is 4.086, with p = 0.043. means that the
number of children one mother and more than 3 gives a risk four times greater than the
amount of his mother 2-3 and showed that there were significant relationship between parity
with the incidence of neonatal mortality as p <0.05.
 Table 1 In the variable delivery complications show ch-square test results for grades
Odds Ratio (OR) is 4.714, with p = 0.022. means parity gave their risk by 4,714 times the
incidence of neonatal death and showed there is a significant association between birth
complications with neonatal mortality events since the value of p <0.05. Variable asphyxia
show ch-square test results for grades Odds Ratio (OR) is 7.857, with p = 0.003. means
asphyxia gave their risk by 7.857 times the incidence of neonatal death and showed there is a
significant correlation between the incidence of asphyxia with neonatal mortality since the
value of p <0.05. Variable LBW show ch-square test results for grades Odds Ratio (OR) is
7.000, with p = 0.005. means LBW given 7,000 times the risk of the incidence of neonatal
death and showed that there were significant correlation between LBW by incidence of
neonatal mortality as p <0.05.
Table 2 shows the results of multiple logistic regression test using the enter key to
answer the hypothesis. Variable maternal age, parity standard ANC and has a p-value
respectively 0.610, 0.409 and 0.199 greater than 0.05. Then H0 is accepted, meaning variables
maternal age, parity standard ANC and no effect on the incidence of neonatal death. While
variable delivery complications, asphyxia and LBW has p values are respectively 0.017, 0.004
and 0.029 less than 0.05. Then the variable complications of delivery, asphyxia and LBW
have an influence on the incidence of neonatal death.
Table 3 shows the results of multiple logistic regression to model predictions, the first
phase shows the parity variables have the greatest value of p is p = 0.135. In the second stage
there are no more variables are excluded because of all the variables have a value of p <0.05.

DISCUSSION
In this research shows that there are several factors that significantly affect the
incidence of neonatal mortality are childbirth complications, the incidence asfikisa and LBW.
Pregnant women less than 20 years may be detrimental to the health of mothers and
fetal growth and development due to immaturity of the reproductive organs to become
pregnant. Complications in pregnancy adolescents (<20 years) was higher than healthy
reproductive period between 20-30 years. The situation will be more difficult when coupled
with the pressure (stress) psychological, social, economic, making it easier for miscarriage
(Manuaba et al., 2007). In this study indicate that maternal age had no effect on neonatal
mortality.
This study is in line with Bangun et al (2019) stating there is no influence of maternal
age incidence of neonatal mortality premises. However, it is not in line with research Oktarina
(2017) stating no influence between the mother's age with the incidence of neonatal mortality.
 ANC is an important way to monitor and support the health of pregnant women and
detecting normal women with normal pregnancies. Pregnant women should be encouraged to
visit a midwife or doctor as early as possible since she felt she was pregnant to get the ANC.
Pregnant women who do not get the ANC is not adequate at risk of experiencing perinatal
death. The ANC is very important because they will receive health education about healthy
behaviors to prevent the incidence of babies with low birth weight (Nelson et al., 2000). In
this study showed that the ANC service standard has no effect on neonatal mortality.
This study is in line with Raharni et al (2011) saying no influence between the ANC
and the incidence of neonatal mortality. However, it is not in line with research Bangun et al
(2019) stating that there is influence between the ANC and the incidence of neonatal
mortality.
The risk of early neonatal deaths are in infants born to mothers with parity one caused
by pelvic tissue stiffness as well as knowledge about pregnancy and childbirth care is low. In
women with parity> 3, early neonatal death can be caused by deterioration elasticity of tissue
which has been repeatedly contracted at delivery limiting the ability bleeding. It can cause
severe bleeding during delivery and carries the risk of infant mortality , In this study showed
that parity had no effect on neonatal mortality. This research is in line with research
Rachmania et al (2018) stating there is no influence of parity with the incidence of neonatal
mortality. However, not sejalanan with Bangun et al (2019) stating that there is influence
between parity with the incidence of neonatal mortality.
Maternal complications can occur as a direct result of pregnancy, or because of other
factors associated with the state of health of the mother. Maternal complications during
pregnancy and childbirth affect the state of babies born (Musrifa et al., 2014).
In this study showed that complications of labor influence on neonatal death. This
study is in line with Budiati (2016) stating no effect between birth complications with the
incidence of neonatal mortality.
Neonatorium asphyxia resulting biochemical changes in the baby's blood, causing
death or permanent damage to the central nervous system resulting in deformed babies
lifetime (Supriatiningsih, 2009). In this study indicate that there is the influence of asphyxia
on neonatal mortality in Kendari.
This study is in line with Tyas et al (2014) stating that there is influence of asphyxia
with neonatal mortality events. This study is also in line with Halim et al (2016) that states of
all deaths occur within the first seven days of life, asphyxia is the main cause of death (43%)
in Bangladesh.
In the study Supriatiningsih (2009), States that the cause of infant mortality due to
LBW 15-20% ranks third after infection. LBW died due to the highly problematic skin that is
fat and less brown fat, as well as the ability of low metabolism, so that the baby is heat loss
and hypothermia occur that can cause death in infants. In this study indicate that there is the
influence of LBW to neonatal death. This study is in line with Simbolon (2012) stating that
there is an influence on the incidence of LBW neonatal mortality. But not in line with Masni
et al (2016) stating that there was no effect on the incidence of LBW neonatal mortality.

CONCLUSIONS AND SUGESTION

It can be concluded that the variables associated with neonatal mortality are
complications of delivery, asphyxia and LBW and variables that do not affect neonatal
mortality are maternal age, and parity ANC service standard. Suggestion Check and consult a
pregnancy with routine in health facilities, especially in pregnant women with a high risk that
not too late in recognizing early detection of complications during delivery and the risk of a
baby has asphyxia, Mother is expected to increase and maintain the nutritional intake while
pregnant.
BIBLIOGRAPHY

Bangun I.F., Abdiana A. & Edison E. (2019). Faktor Risiko Kematian Neonatal di Kabupaten
Kepulauan Mentawai. Jurnal Endurance: Kajian Ilmiah Problema Kesehatan,
4(1):26-33.
Budiati I. (2016). Faktor-Faktor yang Berhubungan Dengan Kematian Neonatal Dini Usia 0
Sampai 7 Hari (Studi Kasus Di 4 Puskesmas Kabupaten Banjarnegara ). Universitas
Negeri Semarang, 1(4):14-16.
Cohen W.M., Nelson R.R. & Walsh J.P. (2000). Reviews their Protecting intellectual assets:
report uses conditions and why US manufacturing firms patent (or not), the National
Bureau of Economic Research, 1(2):18-19.
Debelew G.T., Afework M.F. & Yalew A.W. (2014). Determinants and causes of neonatal
mortality in Jimma zone, the southwest Ethiopia: a multilevel analysis of prospective
follow-up study. Plos One, 4(3):48-61.
Dinkes Prov Sultra ( Dinas Kesehatan Provinsi Sulawesi Tenggara). (2017). Profil Kesehatan
Sulawesi Tenggara. Kendari: Dinas Kesehatan Provinsi Sulawesi Tenggara.
Efriza E. (2007). Determinan Kematian Neonatal Dini di RSUD Dr. Achmad Mochtar
Bukittinggi. Kesmas: National Public Health Journal, 2(1):99-105.
Halim A., Dewez J.E., Biswas A., Rahman F., White S. & Van D.B.N. (2016). When, where,
and why are babies dying? Surveillance and review of neonatal death in Bangladesh.
Plos one, 3(2):18-20.
Masni. & Risma S. (2016). Faktor Risiko Kematian Neonatal Di Kabupaten Morowali
Propinsi Sulawesi Tengah. Journal Of Health, 1(2):20-29.
Manuaba I.B.G., Manuaba I.C. & Manuaba I. (2007). Penyakit Kandungan dan KB. Jakarta:
EGC.
Musrifa M., Wulandari L.P.L. & Wirawan D.N. (2014). Paparan Asap Rokok sebagai Faktor
Risiko Kematian Neonatal Dini di Kota Mataram Provinsi Nusa Tenggara Barat.
Publich Health and Preventive Medicine Archive, 2(1):14-19.
Oktarina S., Dawn N.A. & Yeni Y. (2017). Model Prediksi Kejadian Kematian Neonatal Di
Kecamatan Purbolinggo Kabupaten Lampung Timur Provinsi Lampung. Jurnal Ilmu
Kesehatan Masyarakat, 8(2):11-19.
Rachmania W. & Octaviani F. (2018). Faktor–Faktor Yang Mempengaruhi Kematian Neonatal
Di Kabupaten Bogor Tahun 2015 (Analisis Data Sekunder Otopsi Verbal Kematian
Perinatal–Neonatal Tahun 2015). PROMOTER, 1(2):148-161.
Raharni R., Isakh B.M. & Diana I. (2011). Profil Kematian Neonatal Berdasarkan Sosio
Demografi Dan Kondisi Ibu Saat Hamil Di Indonesia. Buletin Penelitian Sistem
Kesehatan, 14(4):1-9.
Simbolon D. (2012). Berat lahir dan kelangsungan hidup neonatal di Indonesia. Kesmas:
National Public Health Journal, 7(1):8-15.
Supriatiningsih. (2009). Faktor – faktor yang Berhubungan dengan Kematian Neonatus di
Kota Metro Tahun 2009. Jurnal Kesehatan, 2(1):6-10.
Suraya I., Meilani M. & Mariance O. (2016). Hubungan Akses Pelayanan Kesehatan Dengan
Kematian Neonatal Dini. ARKESMAS, 1(2):17-22.
Tyas S.C. & Notobroto H.B. (2014). Analisis Hubungan Kunjungan Neonatal, Asfiksia dan
BBLR dengan Kematian Neonatal. Jurnal Biometrika Dan Kependudukan, 3(2): 168-
174.
WHO. (2006). "Country, regional and global estimates." Geneva, Switzerland: World Health
Organization.
ATTACHMENT

Table 1. The Relationship Between Maternal Age, ANC Service Standard, Parity,
Complications Of Labor, Asphyxia, And LBW By Incidence Of Neonatal
Mortality

Variables OR Ll-Ul (95% Ci) p-value

Age Of Mother 2,212 0.699 To 6.998 .284
Standard ANC 1,750 0.559 To 5.481 0.499
Parity 4.086 1.194 To 13.978 0.043
Childbirth 4,714 1.404 To 15.829 0,022
Complications
Asphyxia 7.857 2.161 To 28.568 0,003
Lbw 7,000 1.890 To 25.932 0,005

Table 2. Effect of Maternal Age, ANC Service Standard, Parity, Complications of

Labor, Asphyxia, and LBW By Incidence of Neonatal Mortality

CI 95%
Coeffi
Variables SE Wald Df p-value OR Lower Upper
cient
Age of mother 0.504 .988 0,260 1 .610 1,655 0.239 11,466
Standard ANC -0.840 1,017 0.682 1 .409 0.432 0.059 3,168
Parity 1,145 0892 1,646 1 0,199 3,143 0.547 18.069
childbirth 2,196 0.919 5.711 1 0,017 8.991 1,484 54.456
complications
asphyxia 2,776 0.961 8.337 1 0,004 16.053 2,439 105.656
LBW 2,556 1,167 4,795 1 0,029 12.883 1.307 126.944
constants -4615 1,241 13.836 1 0,001 0,010

Table 3. The Final Model Of Multiple Logistic Regression Between Variables Parity,
Complications Of Delivery, Asphyxia And LBW On The Incidence Of Neonatal
Death

Variables Coefficient SE Wald Df p-value OR

Parity 1.292 0.865 2,230 1 0.135 3.638
Childbirth 2,197 0.899 5.968 1 0,015 9,000
Complications
Asphyxia 2,591 0.908 8.143 1 0,004 13.340
LBW 2,284 .923 6.117 1 0,013 9.813
Constants -4671 1.216 14.767 1 0,001 0.009