Did professional attendance at home births improve early neonatal survival in Indonesia?
Did professional attendance at home births improve early neonatal survival in Indonesia?
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DOI：
10.1093/heapol/czp012
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发表时间：
2009-07-01
影响因子：
3.2
通讯作者：
Adisasmita, Asri
中科院分区：
文献类型：
--
作者：
Hatt, Laurel;Stanton, Cynthia;Adisasmita, Asri
方法：我们汇集了四个印尼人口和健康调查，并采用多元逻辑回归分析的第一天和早期新生儿死亡率的趋势。我们衡量的影响交付的背景下，包括地方和类型的供应商，并测试的变化趋势时，助产士在村里programme initiated.Results报道的第一天死亡率并没有显着下降，1986年至2002年，而早期新生儿死亡率下降了平均每年3.2%。无论是在1989年启动乡村助产士方案时，还是在专业护理增加后的任何一年，下降率都没有变化。在简单和多变量分析中，有或没有专业助产士的家庭分娩的第一天或早期新生儿死亡率没有显着差异。早期新生儿死亡率较高的公共设施，可能是由于选择。生物学决定因素（双胞胎，男性，短的生育间隔，以前早期新生儿损失）是重要的两个outcome.Conclusions新生儿死亡率下降在印度尼西亚是令人鼓舞的，但目前尚不清楚，这些下降与更多的摄取专业分娩护理在家里或在卫生设施。这可能意味着需要改进新生儿即时护理培训，加强紧急转诊，并继续支持计划生育政策。
Methods We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the Midwife in the Village programme was initiated.Results Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes.Conclusions Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies.