Neonatal mortality in two districts in Indonesia: Findings from Neonatal Verbal and Social Autopsy (VASA)

Background The Government of Indonesia is determined to follow global commitments to reduce the neonatal mortality rate. Yet, there is a paucity of information on contributing factors and causes of neonatal deaths, particularly at the sub-national level. This study describes care-seeking during neonates’ fatal illnesses and their causes of death. Methods We conducted a cross-sectional community-based study to identify all neonatal deaths in Serang and Jember Districts, Indonesia. Follow-up interviews were conducted with the families of deceased neonates using an adapted verbal and social autopsy instrument. Cause of death was determined using the InSilicoVA algorithm. Results The main causes of death of 259 neonates were prematurity (44%) and intrapartum-related events (IPRE)-mainly birth asphyxia (39%). About 83% and 74% of the 259 neonates were born and died at a health facility, respectively; 79% died within the first week after birth. Of 70 neonates whose fatal illness began at home, 59 (84%) sought care during the fatal illness. Forty-eight of those 59 neonates went to a formal care provider; 36 of those 48 neonates (75%) were moderately or severely ill when the family decided to seek care. One hundred fifteen of 189 neonates (61%) whose fatal illnesses began at health facilities were born at a hospital. Among those 115, only 24 (21%) left the hospital alive–of whom 16 (67%) were referred by the hospital. Conclusions The high proportion of deaths due to prematurity and IPRE suggests the need for improved management of small and asphyxiated newborns. The moderate to severe condition of neonates at the time when care was sought from home highlights the importance of early illness recognition and appropriate management for sick neonates. Among deceased neonates whose fatal illness began at their delivery hospital, the high proportion of referrals may indicate issues with hospital capability, capacity, and/or cost

Gambaran Pengetahuan, Sikap, dan Perilaku Kader Palang Merah Remaja (PMR) di SMAN 2 Lamongan Terhadap Program Suplementasi Tablet Tambah Darah

Latar Belakang: penanggulangan anemia dengan pemberian Tablet Tambah Darah (TTD) dengan sasaran remaja putri menjadi fokus pemerintah saat ini. Walaupun sudah mulai berjalan, seringkali ditemukan beberapa kendala dalam pelaksanaan program, diantaranya ketidakpatuhan konsumsi TTD. Di sisi lain, sekolah memiliki potensi sumberdaya untuk meningkatkan optimalisasi program TTD, salah satunya adalah Palang Merah Remaja (PMR) yang dapat menjadi pendidik sebaya tentang masalah kesehatan termasuk anemia bagi siswi lainnya. Tujuan: Penelitian ini bertujuan melihat gambaran pengetahuan, sikap, dan perilaku kader PMR di SMA Negeri 2 Lamongan terhadap program pemberian TTD Metode: Penelitian ini merupakan menggunakan desain cross sectional. Populasi penelitian ini adalah anggota ekstrakurikuler Palang Merah Remaja (PMR) SMAN 2 Lamongan sejumlah 100 orang. Sampel dari penelitian ini adalah 60 siswa anggota PMR yang dipilih dengan metode simple random sampling dan memenuhi kriteria inklusi yaitu merupakan anggota aktif PMR dan bersedia mengikuti penelitian. Pengumpulan data dilakukan dengan menggunakan self-administered questionnaires dengan menggunakan aplikasi kuesioner online yang terdiri dari 20 pertanyaan untuk mengukur pengetahuan; 20 pertanyaan untuk mengukur sikap; dan 13 pertanyaan untuk mengukur perilaku. Data dikategorikan dan dianalisis menggunakan uji deskriptif. Hasil: Sebagian besar responden masih memiliki pengetahuan yang kurang terkait program TTD (56,7%) dan manfaatnya (56,7%). Sebesar 66% kader PMR memiliki sikap yang positif terhadap TTD, namun tidak 100% kader PMR mengonsumsi tablet tambah darah secara rutin. Kesimpulan: Perlu penguatan terhadap pengetahuan serta sikap terhadap TTD untuk meningkatkan kepatuhan konsumsi TTD di kalangan anggota PMR agar nantinya kader PMR dapat menjadi pendidik sebaya bagi siswi lainnya