Expanding Maternal and Neonatal Survival in Indonesia: A program overview

et al. 2019

Objectives Case fatality rates (CFRs) are often used as the key indicator for the measurement of quality of care at hospitals. We examine the trends of obstetric CFRs and very early neonatal mortality rates at hospitals in selected districts of Indonesia after implementation of a facility‐based maternal and neonatal health intervention—the Expanding Maternal and Neonatal Survival (EMAS) program. Methods Random‐effects Poisson regression models were fitted to routine facility data collected from 101 hospitals over approximately 4 years. Predicted incidence rates from the models were used for ascertaining the changes in CFRs and very early neonatal mortality rates during the EMAS intervention period. Results The obstetric CFR from any maternal complications decreased significantly by 50% (adjusted incidence rate ratio [IRR] 0.50; 95% confidence interval [CI] 0.42–0.61) at hospitals after the implementation of the EMAS program. On average, the CFR decreased from 5.4 to 2.6 deaths per 1000 cases of obstetric complications admitted during the program period. The very early neonatal mortality rate (deaths within 24 hours of birth) decreased by 21% (IRR 0.79; 95% CI, 0.65–0.96). Conclusion Our study suggests that overall obstetric case fatality and very early neonatal mortality rates—two indicators for tracking the quality of emergency obstetric care—decreased significantly at hospitals after the implementation of the EMAS intervention program in Indonesia.

Section: Methodsmentioning

confidence: 99%

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

Ahmed

Tholandi²,

et al. 2019

“…Expanding Maternal and Neonatal Survival approaches targeted improvements in facility self‐monitoring and accountability (clinical governance) as a means to strengthen practices related to the prevention of obstetric and newborn complications. Interventions targeting health facility service strengthening included peer‐to‐peer mentoring in clinical governance, improving routine data collection practices to monitor coverage of high‐impact interventions, use of relevant data to inform decision making, and quarterly assessments of facility readiness against optimal performance standards . EMAS was not designed to strengthen all childbirth practices; the program targeted selected practices to increase the coverage of high‐impact interventions and to prevent complications that contribute significantly to maternal and newborn mortality in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

“…The United States Agency for International Development (USAID) funded the Expanding Maternal and Neonatal Survival (EMAS) program, which was implemented by Jhpiego from September 2011 to March 2017, to support the Government of Indonesia in reducing maternal and newborn mortality. The EMAS program is described in the overview paper in this Supplement …”

Section: Introductionmentioning

confidence: 99%

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

Tholandi¹,

Sethi²,

et al. 2019

Self Cite

Objective To assess whether the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved care provided during hospital‐based childbirth. Methods A quasi‐experimental study with two rounds of data collection examined whether EMAS interventions improved facility‐based labor and childbirth care. Direct clinical observations were conducted for 1208 deliveries across 13 hospitals in 12 districts. Primary outcome measures included implementation of standard practices to reduce the risk of complications during labor and childbirth for both women and newborns. Results Adjusted difference‐in‐difference analysis compared the mean difference in quality scores between EMAS intervention hospitals and comparison sites and consistently found significantly better performance in EMAS sites: 14 points higher for labor monitoring (β‐coefficient 14.1; 95% confidence interval [CI], 7.1–21.0); 38 points higher for newborn resuscitation readiness (β‐coefficient 38.1; 95% CI, 31.1–45.2); and 33 points higher for infection prevention practices (β‐coefficient 32.6; 95% CI, 28.5–36.8). Conclusion EMAS approaches emphasizing facility readiness and adherence to performance standards significantly improved labor monitoring and complication prevention practices during childbirth.

“…The United States Agency for International Development (USAID) funded the Expanding Maternal and Neonatal Survival (EMAS) program (September 2011 to March 2017) to support the government of Indonesia in reducing maternal and newborn mortality by strengthening the quality of care provided in puskesmas and hospitals and in strengthening district‐level referral pathways. The EMAS program is fully described in the overview paper published in this Supplement …”

Section: Introductionmentioning

confidence: 99%

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

Qomariyah²,

Tholandi³

et al. 2019

Self Cite

Objective To determine if the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved effectiveness of the referral system in Indonesia to facilitate timely and effective management of complications experienced by women and newborns. Methods Poisson regression using longitudinal monitoring data was used to assess the impact of the EMAS program on stabilization practices prior to referral. Data from a nonrandomized quasi‐experimental pre‐post evaluation study were used to assess the impact of the EMAS program along the referral pathway using χ2 analysis. Results Monitoring data demonstrated improvements in intervention areas for stabilization of pre‐eclampsia/eclampsia (24% vs 61%, incidence rate ratio [IRR] 2.4; 95% confidence interval [CI], 2.3–2.6) and treatment of newborns with suspected severe infection (30% vs 54%, IRR 2.0; 95% CI, 1.6–2.4) prior to referral. The EMAS program was associated with significantly higher levels of communication, advanced notification, back referral, and hospital emergency readiness and staff preparedness compared with the comparison arm. Conclusion The EMAS program contributed to improvements in the management of obstetric and newborn complications, including communication, transportation, and preparation of pregnant mothers in need of referral and hospital emergency readiness and staff preparedness.