1. Assessing the effect of the Expanding Maternal and Neonatal Survival program on improving stabilization and referral for maternal and newborn complications in Indonesia
- Author
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Reena Sethi, Maya Tholandi, Bambang Wijayanto, Dwirani Amelia, Ali Zazri, Alisa Pedrana, Saifuddin Ahmed, Sudirman Sudirman, Mandri Apriatni, Mark R. Emerson, Trisnawaty Gandawidjaja, and Siti Nurul Qomariyah
- Subjects
Adult ,medicine.medical_specialty ,Maternal-Child Health Services ,Non-Randomized Controlled Trials as Topic ,Referral ,Rate ratio ,Infant, Newborn, Diseases ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Pregnancy ,Infant Mortality ,medicine ,Humans ,Poisson Distribution ,030212 general & internal medicine ,Poisson regression ,Referral and Consultation ,030219 obstetrics & reproductive medicine ,Eclampsia ,business.industry ,Neonatal survival ,Infant, Newborn ,Infant ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Quality Improvement ,Confidence interval ,Obstetric Labor Complications ,Maternal Mortality ,Indonesia ,Preparedness ,Monitoring data ,Emergency medicine ,symbols ,Female ,business ,Program Evaluation - Abstract
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.
- Published
- 2019