Determinants of neonatal mortality in Indonesia

<p>Abstract</p> <p>Background</p> <p>Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002.</p> <p>Methods</p> <p>The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants.</p> <p>Results</p> <p>At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00), and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03) compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00) and for infants born to father who were unemployed (OR = 2.99, p = 0.02). The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00), male infants (OR = 1.49, p = 0.01), smaller than average-sized infants (OR = 2.80, p = 0.00), and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00). Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03).</p> <p>Conclusion</p> <p>Public health interventions directed at reducing neonatal death should address community, household and individual level factors which significantly influence neonatal mortality in Indonesia. Low birth weight and short birth interval infants as well as perinatal health services factors, such as the availability of skilled birth attendance and postnatal care utilization should be taken into account when planning the interventions to reduce neonatal mortality in Indonesia.</p

Flight Test of the F/A-18 Active Aeroelastic Wing Airplane

Successful flight-testing of the Active Aeroelastic Wing airplane was completed in March 2005. This program, which started in 1996, was a joint activity sponsored by NASA, Air Force Research Laboratory, and industry contractors. The test program contained two flight test phases conducted in early 2003 and early 2005. During the first phase of flight test, aerodynamic models and load models of the wing control surfaces and wing structure were developed. Design teams built new research control laws for the Active Aeroelastic Wing airplane using these flight-validated models; and throughout the final phase of flight test, these new control laws were demonstrated. The control laws were designed to optimize strategies for moving the wing control surfaces to maximize roll rates in the transonic and supersonic flight regimes. Control surface hinge moments and wing loads were constrained to remain within hydraulic and load limits. This paper describes briefly the flight control system architecture as well as the design approach used by Active Aeroelastic Wing project engineers to develop flight control system gains. Additionally, this paper presents flight test techniques and comparison between flight test results and predictions

Development and Testing of Control Laws for the Active Aeroelastic Wing Program

The Active Aeroelastic Wing research program was a joint program between the U.S. Air Force Research Laboratory and NASA established to investigate the characteristics of an aeroelastic wing and the technique of using wing twist for roll control. The flight test program employed the use of an F/A-18 aircraft modified by reducing the wing torsional stiffness and adding a custom research flight control system. The research flight control system was optimized to maximize roll rate using only wing surfaces to twist the wing while simultaneously maintaining design load limits, stability margins, and handling qualities. NASA Dryden Flight Research Center developed control laws using the software design tool called CONDUIT, which employs a multi-objective function optimization to tune selected control system design parameters. Modifications were made to the Active Aeroelastic Wing implementation in this new software design tool to incorporate the NASA Dryden Flight Research Center nonlinear F/A-18 simulation for time history analysis. This paper describes the design process, including how the control law requirements were incorporated into constraints for the optimization of this specific software design tool. Predicted performance is also compared to results from flight

An integrated framework utilising software agent reasoning and ontology models for sensor based building monitoring

Smart building monitoring demands a new software infrastructure that can elaborate building domain knowledge in order to provide advanced and intelligent functionalities. Conventional facility management (FM) software tools lack semantically rich components, and that limits the capability of supporting software for automatic information sharing, resource negotiation and to assist in timely decision making. Recent hardware innovation on compact ZigBee sensor devices, software developments on ontology and intelligent software agent paradigms provide a good opportunity to develop tools that can further improve current FM practices. This paper introduces an integrated framework which includes a ZigBee based sensor network and underlying multi-agent software (MAS) components. Several different types of sensors were integrated with the ZigBee host devices to produce compact multi-functional sensor units. The MAS framework incorporates the belief-desire-intention (BDI) abstraction with ontology support (provided via explicit knowledge bases). The different software agent types have been developed to work with sensor hardware to conduct resource negotiation, to optimize battery utilization, to monitor building space in a non-intrusive way and to reason about its usage through real time ontology model queries. The deployed sensor network shows promising intelligent characteristics, and it has been applied in several on-going research projects as an underlying decision making service. More applications and larger deployments have been planned for future work

Evaluation of a Package of Behaviour Change Interventions (Baduta Program) to Improve Maternal and Child Nutrition in East Java, Indonesia: Protocol for an Impact Study.

BACKGROUND: Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. OBJECTIVE: This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. METHODS: The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. RESULTS: In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. CONCLUSIONS: The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/18521

Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia.

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project's effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2-5.5) and 2.79 (95% CI: 1.7-4.4) for DDS and 3.49 (95% CI: 2.2-5.5) and 2.74 (95% CI: 1.8-5.2) for MAD in the 9-11 month and 16-18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age

Shonjibon cash and counselling : a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh

Background: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. Method: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. Discussion: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. Trial registration: The study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280)

Towards a synchronized semantic model to support aspects of building management

To improve the performance of building facility management tools and optimize operational costs, a semantic model is being developed that is synchronized in almost real time with a range of sensors throughout the building. The semantic aspect of the model will be comprised of novel ontological perspectives with identified scopes and restricted domain theories that will simplify the modeling representations to deliver easier knowledge maintenance and continued integrity of the overall system. Specialized ontologies are linked to shared higher level abstract ontologies (to facilitate interoperation), and target a wide range of domains including those to capture physical processes and product mode