Modified Pathway to Survival highlights importance of rapid access to quality institutional delivery care to decrease...

Area of Science:

• Perinatal Medicine
• Public Health
• Neonatal Care

Background:

• High neonatal mortality persists in Indonesia despite increased institutional delivery rates.
• The Pathway to Survival (P-to-S) framework traditionally focuses on caregiver actions for sick neonates.
• A modified framework is needed to address maternal complications' role in neonatal survival within institutional settings.

Purpose of the Study:

• To investigate the association between maternal complications and neonatal deaths occurring in health facilities.
• To adapt the P-to-S framework for institutional delivery contexts in low- and middle-income countries.

Main Methods:

• Retrospective cross-sectional study of neonatal deaths in two districts of Java, Indonesia (June-December 2018).
• Utilized verbal and social autopsy methods to gather data on care-seeking, delivery place, and timing of illness/death.
• Examined the relationship between maternal complications and neonatal outcomes in health facilities.

Main Results:

• 73% of neonatal deaths occurred in a delivery facility (DF), with 60% of these dying before discharge.
• Neonatal illness onset in a DF was strongly associated with maternal complications (OR=6.5 for hospitals, OR=2.0 for lower-level DFs).
• Mothers with labour and delivery (L/D) complications faced delays in reaching their DF, impacting timely care.

Conclusions:

• Maternal complications are significantly linked to neonatal deaths that begin in delivery facilities.
• Early hospital-based care for mothers with complications could potentially prevent some neonatal deaths.
• A modified P-to-S framework emphasizing rapid access to quality institutional care is crucial for improving neonatal survival.