Expanding Maternal and Neonatal Survival Opportunities in Indonesia

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This supplement of the International Journal of Gynecology and Obstetrics includes a series of nine papers that describe the achievements of the USAID-funded Expanding Maternal and Neonatal Survival (EMAS) Program in Indonesia from September 2011 to March 2017. The EMAS program impacted quality of emergency obstetric and neonatal care and efficiency and effectiveness of referrals, and increased accountability through mentoring in six Indonesian provinces. The culmination of the program’s approaches led to impressive results, including:

  • The obstetric case fatality rate (CFR) from any maternal complications decreased significantly by 50% at EMAS intervention hospitals. On average, the CFR decreased from 5.4 to 2.6 deaths per 1,000 cases of obstetric complications admitted.
  • The very early neonatal mortality rate (deaths within 24 hours of birth) decreased by 21%.
  • In a comparison of the mean differences in quality scores between EMAS intervention hospitals and comparison sites, EMAS sites showed significantly better performance: 14 points higher for labor monitoring, 38 points higher for newborn resuscitation readiness, and 33 points higher for infection prevention practices.
  • Monitoring data demonstrated improvements in intervention areas for stabilization of pre-eclampsia/eclampsia (24% vs. 61%) and treatment of newborns with suspected severe infection (30% vs. 54%).
  • EMAS intervention facilities were associated with significantly higher levels of communication, advanced notification, back referral, and hospital emergency readiness and staff preparedness than the comparison arm.

View the press release here.

Contents: Volume 144, Issue S1, (2019)

Editorial: Challenges of reducing maternal and neonatal mortality in Indonesia: Ways forward

Commentary: Innovative approaches to enhancing maternal and newborn survival: Indonesia’s experience in an era of global commitments to reducing mortality

Paper 1: Expanding Maternal and Neonatal Survival in Indonesia: A program overview

Paper 2: Changes in obstetric case fatality and early newborn mortality rates in hospitals after the implementation of the Expanding Maternal and Neonatal Survival program in Indonesia: Results from a health information system

Paper 3: The effect of Expanding Maternal and Neonatal Survival interventions on improving the coverage of labor monitoring and complication prevention practices in hospitals in Indonesia: A difference‐in‐difference analysis

Paper 4: Assessing the effect of the Expanding Maternal and Neonatal Survival program on improving stabilization and referral for maternal and newborn complications in Indonesia

Paper 5: Presence of doctors and obstetrician/gynecologists for patients with maternal complications in hospitals in six provinces of Indonesia

Paper 6: Assessment of knowledge of evidence‐based maternal and newborn care practices among midwives and nurses in six provinces in Indonesia

Paper 7: Maternal death reviews: A retrospective case series of 90 hospital‐based maternal deaths in 11 hospitals in Indonesia


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