Determinants of Neonatal Mortality in Indonesia

Nur Asiah

, Yulia Setianingsih

, Ahman Sya

, Izza Suraya

Faculty of Health Sciences, Universitas Muhammadiyah Prof. DR. HAMKA (UHAMKA), Jakarta, Indonesia

Program Study Population and environmental education, Universitas Negeri Jakarta, Jakarta, Indonesia

Keywords: Neonatal Mortality, Low Birth Weight, Antenatal Care, Parity.

Abstract: The results of the SDKI 2017 study show that the infant mortality rate aged 0-28 days was 15/1,000 live births,

meaning that out of 67 babies, 1 infant died in the first month of life. This shows that the Infant Mortality

Rate aged 0-28 days, although the number has decreased, the figure is still above the SDG's target of 12/1,000

live births. This study aims to determine the factors associated with infant mortality 0-28 days in Indonesia.

This type of research is quantitative with a cross-sectional study design. The data source in this study is the

SDKI 2017. The sample includes infants who meet the criteria for the last child and were born single. Data

were analysed by Bivariate analysis with chi-square test. The sampling Method in this study uses total

sampling. Bivariate results show variables related to infant mortality, namely mother's work status, Mother's

age at delivery, and parity with P <0.05. Based on the results of the study, it is suggested that there is a need

for increased vigilance and preparation for women of childbearing age starting from the preparation period

for pregnancy to delivery.

1 INTRODUCTION

The Infant Mortality Rate (IMR) is an important

indicator to determine health status in measuring the

level of progress of a country in terms of services and

development in the health sector. Based on data SDKI

from 2002-2003, 2007, and 2012, the Neonatal

Mortality Rate (NMR) is 20/1000 live births, 19/1,000

live births, and 19/1000 live births (SDKI, 2017).

These data show that the infant mortality rate did not

show a significant decrease. The data shows that the

neonatal mortality rate has decreased by 15/1,000 live

birth, but this figure has not been able to reach the

SDG's target of 12/1,000 live births.

One of the goals of the SDGs is to ensure a healthy

life and promote well-being for all people of all ages

as stated in point 3 of the SDGs. In these goals, there

are 13 targets, one of which is ending preventable

infant and under-five mortality, by trying to reduce the

Neonatal Mortality Rate (NMR) to at least 12/1,000

live births and the under-five mortality rate of

25/1,000 live births by 2030 (Ministry of Health,

2015).

Globally, neonatal mortality accounts for 47% of

all under-five deaths. Several previous studies on

neonatal and perinatal mortality show that the factors

associated with neonatal mortality were low birth

weight (Abdullah, Naiem, & Mahmud, 2012),

pregnancy complications (Suraya, 2017), birth

spacing (Simbolon, 2012), maternal age (Titaley,

Christiana R; Dibley, Michael J; Roberts, Kingsley

Christine L; Hall, John, 2008), maternal education

(Mahcepat, et al, 2011), birth attendant (Noorhalimah,

2015), antenatal visits (Tyas & Notobroto, 2014),

antenatal care (Yani, 2013), parity (Sugiharto, et al,

2010), place of delivery (Suraya, et al, 2017).

Some of the obstacles in efforts to reduce the

Infant Mortality Rate (IMR) are the poor quality of

antenatal, delivery, and postnatal health services

(UNICEF, 2012). Based on the description of the

problems above, the researchers conducted a study on

Determinants of Neonatal Death in Indonesia.

2 METHODS

This type of research is quantitative analysis using a

cross-sectional design. The data used is the SDKI

2017 data, which was conducted from 24 July to 30

September 2017 and throughout Indonesia covering

34 provinces. The population in this study were all

live births of the last child of women aged 15-49 years

who were ever married, in the period 2013-2017 in

Indonesia based on SDKI 2017 sample. Selection of

210

Asiah, N., Setianingsih, Y., Sya, A. and Suraya, I.

Determinants of Neonatal Mortality in Indonesia.

DOI: 10.5220/0010760200003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 210-213

ISBN: 978-989-758-542-5

samples from cleaning data Women aged 15-49 years

with ever-married status who successfully

interviewed and gave birth to their last child (live

birth) in the period 2013 – 2017 as many as 10,238

samples. The sampling method in this study is total

sampling, where all members of the population are

sampled.

Bivariate analysis was carried out using the chi-

square statistical test to test the research hypothesis,

namely the relationship between the independent

variable and the research dependent variable, namely

infant mortality.

3 RESULTS

The univariate analysis in this study included

descriptive analysis of data on neonatal mortality,

maternal education level, maternal employment

status, maternal age at delivery, and parity.

3.1 Univariate Analysis

Table 1: Recapitulation of univariate test of neonatal

mortality in Indonesia 2013-2017.

Variable Cate

oric n %

Neonatal Death Yes 108 1.1

No 10,130 98.9

Mothers Education

Level

Low 3,190 31.2

High 7,048 68.8

Mother’s Work

Status

Worke

5,023 49.1

Didn’t Wor

5,215 50.9

Mother’s Age at

Delivery

At-Risk (<20 or

>35 years)

2,616 25.6

No-Risk

(

20-35

)

7,622 74.4

Parity At-Risk

(

)

2,519 24.6

No-Risk

(

1-3

)

7,719 75.4

3.2 Bivariate Analysis

Table 2. Recapitulation of Bivariate analysis of neonatal

mortality in Indonesia 2013-2017.

Variable PR

(

95% CI

)

Pvalue Results

Mothers

education

level

1.300

(0.881-1.916)

0.185 No

Significant

Relationshi

Mother's

wor

status

1.631

(1.110-2.397)

0.012 Significant

Relationship

Mother's Age

at deliver

1.927

(1.315-2.826)

0.001 Significant

Relationship

Parity 1.875

(

1.275-2.759

)

0.001 Significant

Relationshi

3.2.1 Education

Respondents with a low level of maternal education

experienced more neonatal deaths, namely 1.3% than

respondents with a high level of maternal

education, namely 1.0%. The results of the Chi-

Square test showed that there was no relationship

between maternal education level and neonatal

mortality (P-value = 0.185). The results of the

calculation of the Prevalence Ratio (PR) show a value

of 1.3 (95% CI: 0.881-1.916), meaning that

respondents with a low level of maternal education

have a 1.3 times chance of experiencing neonatal

death than respondents with a high level of maternal

education.

3.2.2 Mother’s Work Status

Respondents with working mothers experienced

more neonatal deaths, namely 1.3% than mothers who

did not work, namely 0.8%. The results of the Chi-

Square test show that there was a relationship

between

maternal work status and neonatal mortality

(P-value =

0.012). The results of the Prevalence Ratio (PR)

calculation show a value of 1.631 (95% CI: 1.110-

2.397), meaning that respondents with working

mothers have a 1.613 times chance of experiencing

neonatal death than respondents with mothers who do

not work.

3.2.3 Mother's Age at Delivery

Maternal age at risk of giving birth (<20 or >35

years) experienced more neonatal deaths, namely

1.6% compared to the age of mother at risk of giving

birth (20-35 years) which was 0.9%. The results of

the Chi-Square test showed that there was a

relationship between maternal age at delivery and

neonatal mortality (P-value = 0.001). The results of

the calculation of the Prevalence Ratio (PR) showed

a value of 1.927 (95% CI: 1.315-2.826) maternal age

at risk (<20 or >35 years) 1.9 times experienced

neonatal death than respondents with maternal age at

delivery, not at risk (20 -35 years old).

3.2.4 Parity

Respondents with parity at risk (1 or 4 times)

experienced more neonatal deaths, namely 1.6% than

respondents with parity at no risk (2 – 3 times) which

was 0.9%. The results of the Chi-Square test showed

that there was a relationship between maternal age at

delivery and neonatal mortality (P- value = 0.001).

The results of the Prevalence Ratio (PR) calculation

show a value of 1.875 (95% CI: 1.275-2.759),

Determinants of Neonatal Mortality in Indonesia

211

meaning that respondents with parity at risk (1 or 4

times) have a 1.875 times chance of experiencing

neonatal death than respondents with parity at risk (2

– 3 times).

4 DISCUSSION

Mosley and Chen's theory explains that mortality and

child survival is influenced by sociodemographic

factors but are not able to directly affect child survival,

but require direct intermediaries called proxy

variables. The proxy variables consist of maternal

factors, environmental factors, malnutrition,

accidents, and personal illness control.

4.1 Education of Mothers with

Neonatal Mortality

Based on the results of the study, there were more

mothers with higher education (68.8%) than mothers

with lower education (31.2%).

Bivariate analysis using the Chi-Square test

obtained

a P-value of 0.185, which means that there is

no significant relationship between maternal

education level and neonatal mortality. With a

Prevalence Ratio (PR) value of 1.300 (95% CI: 0.881

– 1.916) this means that mothers with low education

are 1.3 times more likely to experience neonatal

death than mothers with higher education.

These results are in line with research conducted

by Sari and Syarif, (2016), Simbolon (2012), and

research conducted by Raharni (2011) which also

states that there is no significant difference between

reducing infant mortality.

Education is an effort to improve abilities and

develop a personality for life so that they can make

household decisions so that they can face various

problems including health problems to reduce the

risk of infant and toddler mortality. The level of

maternal education is closely related to the level of

understanding of health care, hygiene, the need for

prenatal care. (Septiana Dwi Susanti Aisyan et al,

2010).

4.2 Mothers Work Status with

Neonatal Mortality

The results of the univariate test show that there were

more working mothers (50.9%) than mothers who did

not work (49.1%).

The results of bivariate analysis using the Chi-

Square test obtained a P-value of 0.012, meaning that

there is a significant relationship between maternal

employment status and neonatal mortality. With a

Prevalence Ratio (PR) value of 1.631 (95% CI 1.110-

2.397), this means that working mothers are 1.6 times

more likely to experience neonatal death compared to

mothers who do not work.

This result is in line with the results of a study

conducted by Suparmi et al (2016) which shows that

children of working mothers had an 81% higher risk

of neonatal death when compared to neonatal death at

non-working mothers.

Working mothers tend to have less rest, less time

to take care of themselves, imbalance in eating, work

stress, tension due to fatigue. The severity of the

mother's work will affect the condition of the body

and ultimately affect the health status of the mother

which affects infant mortality. (Khomsan, 2010).

4.3 Mother's Age at Delivery with

Neonatal Death

The results of the bivariate analysis using the Chi-

Square test obtained a P-value of 0.001 which means

that there is a relationship between maternal age at

delivery and neonatal mortality. The results of the

Prevalence Ratio calculation obtained a value of 1.927

(95% CI 1.315 – 2.826) indicating that mothers who

gave birth at an age at risk had a 1.9 times chance of

experiencing neonatal death than mothers who gave

birth at an age, not at risk.

This is reinforced by research conducted by

Masitoh, et al (2014), Suparmi, etc (2016), and Sari &

Syarif (2016) showing that there is a significant

relationship between maternal age and neonatal

mortality.

Maternal age at delivery is one of the risk factors

for neonatal death. At the age that is considered safe,

namely 20-35 years, the mother is more physically and

psychologically prepared so that the risk of pregnancy

and childbirth disorders is relatively very low. At the

age of the motherless than 20 years, the risk of infant

mortality is higher because the mother has not finished

experiencing growth and development. The pelvis and

uterus are immature so there is a risk of jamming in

the birth canal resulting in prolonged labor and other

disorders. The risk of recurrence increases when the

mother's age is above

35 years, due to a decrease in

maternal health and the

process of changing

reproductive organs (Simbolon, 2012).

Education is an effort to improve abilities and

develop a personality for life so that they can make

household decisions so that they can face various

problems including health problems to reduce the risk

of infant and toddler mortality. The level of maternal

ICSDH 2021 - International Conference on Social Determinants of Health

212

education is closely related to the level of

understanding of health care, hygiene, the need for

prenatal care. (Septiana Dwi Susanti Aisyan et al,

2010).

4.4 Parity with Neonatal Mortality

Univariate results show that mothers with parity were

not at risk (75.4%) more than mothers with parity at

risk (24.6%).

The results of the bivariate analysis show a

significant relationship between parity and neonatal

mortality. Mothers with parity at risk are 1.875 times

more likely to experience neonatal death than

mothers with parity at risk. This is also reinforced by

previous research conducted by Masitoh, et al (2014),

Maheasy, et al (2011), Kurniawan and Melaniani

(2018) showing a relationship between parity and

infant mortality (P-value 0.000). Mothers who have

given birth to more than two children are 0.09 times

more likely to experience infant death in subsequent

births than mothers who have given birth to a second

child or less than two children. A positive relationship

with death status makes the higher the parity value or

the more children born, the higher the risk of the

mother giving birth to a dead baby. Parity is a variable

that has a relationship with infant mortality.

Health problems in pregnant women and childbirth

appear in mothers with parity at risk, namely giving

birth to more than 2 children. It is can make the uterine

broken and lead to abnormalities in the mother's

womb. This has an impact on the condition of the

location of the fetus or placenta in the mother which

can interfere with fetal growth. Disruption of fetal

growth in the mother's womb makes the mother give

birth to an unhealthy baby (Wiknjosastro, 2007).

5 CONCLUSION

Mothers with low education are more likely to

experience neonatal deaths than mothers with higher

education. Mothers who work experience more

neonatal deaths than mothers who do not work.

Mothers who gave birth at the age of <20 and >35

experienced more neonatal deaths than mothers who

gave birth at the age of 20-35. Mothers with parity at

risk had more chances of experiencing neonatal

deaths than mothers with non-risk parity. To reduce

the neonatal mortality rate, it is necessary to conduct

education or health promotion by related parties to

prospective mothers, especially teenagers, so that

they get married at the right age and plan their

pregnancy at an age that is not at risk. Women of

childbearing age are also advised to plan the number

of children they have. For working mothers who are

pregnant, pay attention to the type and workload they

do.

REFERENCES

Abdullah, A. Z., Naiem, M. F., & Mahmud, N. U. (2012).

Faktor Resiko Kematian Neonatal Dini di Rumah Sakit

Bersalin. Jurnal Kesehatan Masyarakat Nasional, Vol.

6 No. 6, 283 - 288.

Kemenkes R.I. (2015). Kesehatan Dalam Kerangka

Sustainable Development Goals (SDGs). Jakarta:

Kementerian Kesehatan RI.

Masitoh, S., EVK, T., & Karningsih. (2014). Asfiksia

Faktor Dominan Penyebab Kematian Neonatal. Jurnal

Ilmu dan Teknologi Kesehatan, Vol. 1 No. 2, 163 - 168.

Mekonnen, Y. (2013). Neonatal Mortality in Ethiopia:

Trends and Determinants. BMC Public Health.

Noorhalimah. (2015). Faktor-Faktor yang Berhubungan

dengan Kematian Neonatal di Kabupaten Tapin. Jurnal

Publikasi Kesehatan Masyarakat Idonesia, Vol. 2 No.

2, 64 - 71.

Raharni, Isakh, B. M., & Diana, I. (2011). Profil Kematian

Neonatal Berdasarkan Sosio Demografi dan Kondisi

Ibu saat Hamil di Indonesia. Buletin Penelitian Sistem

Kesehatan, Vol 14 no 4, 391 - 398.

Sari, T. W., & Syarif, S. (2016). Hubungan Prematuritas

dengan kematian Neonatal di Indonesia Tahun 2010

(Analisis Data Riskesdas 2010). Jurnal Epidemiologi

Kesehatan Indonesia, Vol 1 no 1, 9 - 14.

SDKI. (2017). Survei Demografi dan Kesehatan Indonesia

2017. Indonesia: Badan Kependudukan dan Keluarga

Berencana Indonesia.

Sugiharto, M., & Kusumawati, L. (2010, Oktober 4).

Analisis Perbedaan antar Paritas Ibu. Buletin Penelitian

Sistem Kesehatan, pp. 321-325.

Suraya, Izza. (2017). Determinan Kematian Neonatal Pada

Bayi Lahir Rendah di Indonesia (Analisis Data SDKI

2002-2003 dan 2007). ARKESMAS, Vol. 2 No.1, 126-

134.

Titaley, Christiana R; Dibley, Michael J; Roberts, Kingsley

Christine L; Hall, John. (2008). Determinants of

Neonatal Mortality in Indonesia. BMC Public Health,

8:232, 1-15.

Tyas, S. C., & Notobroto, H. B. (2014). Analisis Hubungan

Kunjungan Neonatal, Asfiksia dan BBLR dengan

Kematian Neonatal. Jurnal Biometrika dan

Kependudukan, Vol. 3, 168-174.

UNICEF. (2012). Ringkasan Kajian Kesehatan Ibu &

Anak. Indonesia: UNICEF Indonesia.

World Health Organization. (2006). Neonatal and

Perinatal Mortality. Prancis: WHO.

Wiknjosastro,H. 2007. Ilmu Kebidanan. Jakarta: Yayasan

Bina Pustaka

Yani, D. F., & Duarsa, A. B. (2013). Pelayanan Kesehatan

Ibu dan Kematian Neonatal. Jurnal Kesehatan

MAsyarakat Nasional.

Determinants of Neonatal Mortality in Indonesia

213