IJGO Supplement: Expanding Maternal and Neonatal Survival Opportunities in Indonesia

Journal Article
(Published February, 2019)
Ahmed, S. (Editor),
Fullerton, J. (Editor),
Johnson, T (Editor)
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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.