Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia.

PURPOSE: Kangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital. METHODS: Data collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted. RESULTS: This study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC. CONCLUSION: Efforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.

Kangaroo mother care knowledge, attitude, and practice among nursing staff in a hospital in Jakarta, Indonesia.

BACKGROUND: Kangaroo mother care (KMC) has been proven to decrease rates of morbidity and mortality among premature and low-birth-weight infants. Thus, this study aimed to obtain baseline data regarding KMC knowledge, attitudes, and practices (KAP) among nursing staff caring for mothers and newborns in a hospital in Indonesia. METHODS: This cross-sectional study included 65 participants from three hospital wards at Koja District Hospital, North Jakarta. Participants included 29 perinatal ward nurses, 21 postnatal ward nurses and midwives, and 15 labor ward midwives. Data on KAP of KMC were collected using a self-administered questionnaire with closed-ended questions. Each questionnaire can be completed in approximately 1 hour. RESULTS: Among the included nursing staff, 12.3% (8/65) were determined to have received specific training on KMC, whereas 21.5% (14/65) had received more general training that included KMC content. About 46.2% of the nursing staff had good knowledge concerning KMC, 98.5% had good knowledge of KMC benefits, and 100% had a positive attitude toward KMC. All perinatal ward nurses had some experience assisting and implementing KMC. Some KAP that were observed among the nursing staff included lack of knowledge about the eligible infant weight for KMC and weight gain of infants receiving KMC, lack of education/training about KMC, and concerns regarding necessary equipment in KMC wards. CONCLUSIONS: This study identified several issues that need to be addressed, including knowledge of feeding and weight gain, workload, incubator use, and the need for well-equipped KMC wards. We recommend that hospitals improve their nursing staff's knowledge of KMC and establish well-equipped KMC wards.

No one data source captures all: A nested case-control study of the completeness of maternal death reporting in Banten Province, Indonesia.

BACKGROUND: Indonesia's national health information systems collect data on maternal deaths but the completeness of reporting is questionable, making it difficult to design appropriate interventions. This study examines the completeness of maternal death reporting by the district health office (DHO) system in Banten Province. METHOD: We used a nested-control study design to compare data on maternal deaths in 2016 from the DHO reporting system and the MADE-IN/MADE-FOR method in two districts and one municipality in Banten Province, with the aim of identifying and characterizing missed deaths in the DHO reporting system. The capture-recapture method was used to assess the magnitude of underreporting of maternal deaths by both systems. RESULTS: A total of 169 maternal deaths were reported in the MADE-IN/MADE-FOR study for calendar year 2016 in the three study areas. The DHO system reported 105 maternal deaths for the same period, of which 90 cases were found in both data sources. Capture-recapture analyses suggest that the MADE-IN/MADE-FOR approach identified 92% (95% CI: 87%-95%) of all maternal deaths, while the DHO system captured 57% (95% CI: 50%-64%) of all maternal deaths. Deaths of women who resided in urban areas had four times higher odds (OR 4.3, 95% CI: 1.52-12.3) of being missed by the DHO system compared to deaths among women who lived in rural or remote areas after adjusting for other covariates. CONCLUSION: The DHO reporting system missed approximately half of the maternal deaths in the 3 study areas, suggesting that the DHO system is likely to grossly underestimate the maternal mortality ratio. The DHO reporting system needs to be improved to capture and characterize all maternal deaths.

Assessing quality of care provided by Indonesian village midwives with a confidential enquiry.

OBJECTIVE: to conduct a confidential enquiry to assess the quality of care provided by Indonesian village midwives and to identify opportunities for improvement. METHODS: local health-care practitioners assessed village-based care in obstetric emergencies in 13 cases of maternal death and near-miss from rural villages in West Java. The study focused on clinical quality of care, but also investigated the influence of the health system and social factors. The reviews were based on transcripts of interviews with health-care providers, family and community members involved in the cases. Both favourable and adverse factors were identified in order to recognise positive contributions, where they occurred. At the end of a series of case reviews, recommendations for practice were generated and disseminated. FINDINGS: in the cases reviewed, midwives facilitated referral effectively, reducing delays in reaching health facilities. Midwives' emergency diagnostic skills were accurate but they were less capable in the clinical management of complications. Coverage was poor; in some locations, midwives were responsible for up to five villages. Village midwives were also perceived as unacceptable to women and their families. Families and communities did not prepare for emergencies with finances or transport, partly due to a poorly understood health insurance system. The enquiry had learning effects for those involved. KEY CONCLUSIONS: village midwives should: receive appropriate support for the management of obstetric emergencies; engage with communities to promote birth preparedness; and work in partnership with formal and informal providers in the community. The enquiry was a diagnostic tool to identify opportunities for improving care. Practitioners had a unique insight into factors that contribute to quality care and how feasible interventions might be made.

Confidential inquiries into maternal deaths: modifications and adaptations in Ghana and Indonesia.

OBJECTIVE: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia. METHODS: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected. RESULTS: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours. CONCLUSION: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners.

Midwifery provision in two districts in Indonesia: how well are rural areas served?

Attention has focused recently on the importance of adequate and equitable provision of health personnel to raise levels of skilled attendance at delivery and thereby reduce maternal mortality. Indonesia has a village-based midwife programme that was intended to increase the rate of professional delivery care and redress the urban/rural imbalance in service provision by posting a trained midwife in every village in the country. We present findings on the distribution of midwifery provision in our study area: 10% of villages do not have a midwife but a nurse as a midwifery provider; there is a deficit in midwife density in remote villages compared with urban areas; those assigned to remote areas are less experienced; midwives manage few births and this may compromise their capacity to maintain professional skills; over 90% of non-hospital deliveries take place in the woman's (64%) or the midwife's (28%) home; three-quarters of midwives did not make regular use of the fee exemption scheme; midwives who live in their assigned village spend more days per month on clinical work there. We conclude that adequate provider density is an important factor in effective health care and that efforts should be made to redress the imbalance in provision, but that this can only contribute to reducing maternal mortality in the context of a supportive professional environment and timely access to emergency obstetric care.