Risk factors of early neonatal death in East Nusa Tenggara, Indonesia: a case-control study

  • Irene K.L.A. Davidz Airlangga University
  • Kuntoro Kuntoro Airlangga University
  • Hermanto T. Joewono Airlangga University
  • Irwanto Irwanto Airlangga University
Keywords: early neonatal death; risk factors


Background The neonatal mortality in East Nusa Tenggara is still high, contributes up to 75% of all neonatal death and more than 70% of early neonatal death which occurred less than 7 days after birth..

Objective This study aimed to analyze the risk factors of early neonatal death in East Nusa Tenggara.

Methods This case control study was conducted in 18 districts of East Nusa Tenggara, Indonesia. The case was newborn death, while the control was alive newborn during the early neonatal period. The data was obtained from the maternal and neonatal medical record that was kept in provincial health office and each health district office. An interview with mothers was performed if needed. The observed variables were the early neonatal death as a dependent variable and various independent variables.

Results The early neonatal death was associated with maternal age under 20 or over 35 years old (OR=1.8; 95%CI 1.1 to 3.1; P=0.032), the history of stillbirth (OR=27.5; 95%CI 11.6 to 64.5; P=0.000), mother with tuberculosis (OR=15.3; 95%CI 1.7 to 137.3; P=0.015), mother with hyperthyroid (OR=15.5; 95%CI 2.2 to 107; P=0.006), the risk for premature labor (OR= 4.5; 95%CI 2.3 to 8.7; P=0.000), prolonged labor (OR=2.3; 95%CI 1.2 to 4.8; P=0.020), the delivery not in a health facility (OR=18.6; 95%CI= 6.5 to 52.7; P=0.000), low birth weight infants (OR=5.6; 95%CI 3 to 10.3; P=0.000), and asphyxia (OR=25.2; 95%CI 95% 9.9 to 64.5; P=0.000).

Conclusions Increased early neonatal death is associated with maternal age, history of stillbirth, mother with hyperthyroid or tuberculosis, prolonged or risk for premature labor, delivery not in a health facility, low birth weight infants, and asphyxia.

Author Biographies

Hermanto T. Joewono, Airlangga University

Department of Obstetrics and Gynecology, Faculty of Medicine

Irwanto Irwanto, Airlangga University

Department of Child Health, Faculty of Medicine


1. WHO (World Health Organization). WHO recommendations on interventions to improve preterm birth outcomes. Geneva; WHO; 2015. ISBN: 978 92 4 150898 8
2. UNICEF (United Nations Children’s Fund). Level and trends in child mortality. Report 2018. New York: UNICEF; 2018. ISBN: 978-92-806-5321-2.
3. UNICEF (United Nations Children’s Fund). Country profiles. Indonesia. [cited 2021 May 1]. Available from: https://data.unicef.org/country/idn/.
4. Bidang Kesmas NTT. Laporan Program KIA. Kupang: Dinas Kesehatan Nusa Tenggara Timur; 2018.
5. Abdullah A, Hort K, Butu Y, Simpson L. Risk Factor Associated with Neonatal Death: A Matched Case Control Study in Indonesia. Glob Health Action. 2015;9:0445. DOI: https://doi.org/10.3402/gha.v9.30445
6. Sulistyoningsih N. Gizi untuk Kesehatan Ibu dan Anak. Yogyakarta: Graha Ilmu; 2011.
7. Jolly MC, Sebire N, Harris J, Robinson S, Regan L. Obstetric risks of pregnancy in women less than 18 years old. Obstet Gynecol. 2000;96:962-6. DOI: https://doi.org/10.1016/s0029-7844(00)01075-9
8. Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum. Reprod. 2000;15:2433–2437. DOI: https://doi.org/10.1093/humrep/15.11.2433
9. Ouyang F, Zhang J, Betrán AP, Yang Z, Souza JP, Merialdi M. Recurrence of adverse perinatal outcomes in developing countries. Bull World Health Organ. 2013;91:357-67. DOI: https://doi.org/10.2471/BLT.12.111021
10. Sun L, Yue H, Sun B, Han L, Tian Z, Qi M. Estimation of high risk pregnancy contributing to perinatal morbidity and mortality from a birth population-based regional survey in 2010 in China. BMC Pregnancy Childbirth. 2014;14:338. DOI: https://doi.org/10.1186/1471-2393-14-338
11. Ezeh KE, Agho KE, Dibley MJ, Hall J, Page AN. Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey. BMC Public Health. 2014;14:1471–2458. DOI: https://doi.org/10.1186/1471-2458-14-521
12. Akinyemi JO, Bamgboye EA, Ayeni O. Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics. BMC Pediatr. 2015;15:36. DOI: https://doi.org/10.1186/s12887-015-0349-0
13. Mendes KG, Olinto MTA, da Costa JS. Case-control study on infant mortality in Southern Brazil. Rev Saúde Pública. 2006;40:240–8. DOI: https://doi.org/10.1590/s0034-89102006000200009
14. Provincial Health Office East Nusa Tenggara WHO (World Health Organization). Stillbirth. Geneva: WHO; 2019.
15. Weiner R, Ronsmans C, Dorman E, Jilo H, Muhoro A, Shulman C. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya. Bull World Health Organ. 2003;81:561-566.
16. Hatt, L, Stanton C, Ronsmans C, Makowiecka K, Adisasmita A. Did professional attendance at home births improve early neonatal survival in Indonesia?. Health Policy Plan. 2009;24:270–8. DOI: https://doi.org/10.1093/heapol/czp012
17. Batieha AM, Khader YS, Berdzuli N, Chua-Oon C, Badran EF, Al-sheyab NA. Level, Causes and Risk Factors of Neonatal Mortality, in Jordan: Results of a National Prospective Study. Matern Child Health J. 2015;20:1061-1071. DOI: https://doi.org/10.1007/s10995-015-1892-x
18. Demitto M, Gravena AAF, Dell’Agnolo CM, Antunes MB, Pelloso SM. High risk pregnancies and factors associated with neonatal death. Rev Esc Enferm. USP. 2017;51:e03208. DOI: https://doi.org/10.1590/s1980-220x2016127103208
19. Black M, Shetty A, Bhattacharya S. Obstetric outcomes subsequent to intrauterine death in the first pregnancy. BJOG. 2008;115:269–74. DOI: https://doi.org/10.1111/j.1471-0528.2007.01562.x
20. Jain S, Anand S, Aherwar R. High risk scoring for prediction of pregnancy outcome: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2014;3:516–22.
21. Kolluru V, Reddy A. Study of high risk scoring in pregnancy and perinatal outcome. Indian J Obstet Gynecol Res. 2016;3:407–9.
22. Kusiako T, Ronsmans C, Van der Paal L. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh. Bull World Health Organ. 2000;78:621-627.
23. Bayou G, Berhan Y. Perinatal Mortality and Associated Risk Factors: A Case Control Study. Ethiop J Health Sci. 2012;22:153-62.
24. Nakimuli A, Mbalinda SN, Nabirye RC, Kakaire O, Nakubulwa S, Osinde MO. Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda. BMC Pediatr. 2015;15:1-8. DOI: https://doi.org/10.1186/s12887-015-0362-3
25. Gotsch F, Romero R, Erez O, Vaisbuch E, Kusanovic JP. The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth. J Matern Fetal Neonatal Med. 2009;22:5-23. DOI: https://doi.org/10.1080/14767050902860690
26. Anggondowati T, El-Mohandes AAE, Qomariyah SN, Kiely M, Ryon JJ, Gipson RF, Zinner B, Achadi A, Wright LL. Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study. BMC Pregnancy Childbirth. 2017;17:100. DOI: https://doi.org/10.1186/s12884-017-1280-1
27. Jonge de A, Goes van der B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG. 2009;116:1177–84. DOI: https://doi.org/10.1111/j.1471-0528.2009.02175.x
28. Bale JR, Stoll BJ, Lucas AO. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: National Academy Press; 2003.DOI: https://doi.org/10.17226/10841
29. WHO (World Health Organization). Preterm birth. [cited 2021 May 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth.
30. Gomella LG, Cunningham MD, Eyal FG. Neonatology Management, Procedures, On-call Problems, Disease, and Drugs, 7th ed. New York: McGraw-Hill; 2013.
How to Cite
Davidz I, Kuntoro K, Joewono H, Irwanto I. Risk factors of early neonatal death in East Nusa Tenggara, Indonesia: a case-control study. PI [Internet]. 26Aug.2022 [cited 25Jul.2024];62(4):282-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2655
Received 2021-05-04
Accepted 2022-08-26
Published 2022-08-26