Asri C. Adisasmita

Bio: Asri C. Adisasmita is an academic researcher from University of Indonesia. The author has contributed to research in topics: Medicine & Population. The author has an hindex of 9, co-authored 31 publications receiving 457 citations.

Obstetric near miss and deaths in public and private hospitals in Indonesia.

Abstract: Falling numbers of maternal deaths have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The purpose of this study was to document the frequency and causes of near miss and maternal deaths in four hospitals in West Java, Indonesia. Cross sectional study in four hospitals in two districts in Banten province, Indonesia. We reviewed registers and case notes to identify the numbers and causes of near miss and death between November 2003 and October 2004. Near miss cases were defined based on organ dysfunction, clinical and management criteria. Near miss were categorized by whether or not the woman was at a critical state at admission by reviewing the final signs at admission. The prevalence of near miss was much greater in public than in private hospitals (17.3% versus 4.2%, p = 0.000). Hemorrhage and hypertensive diseases were the most common diagnoses associated with near miss, and vascular dysfunction was the most common criterion of organ dysfunction. The occurrence of maternal deaths was 1.6%, with non-obstetric complications as the leading cause. The majority (70.7%) of near miss in public hospitals were in a critical state at admission but this proportion was much lower in private hospitals (31.9%). This is the first study to document near miss in public and private hospitals in Indonesia. Close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals. Even though the private sector takes an increasingly larger share of facility-based births in Indonesia, managing obstetric emergencies remains the domain of the public sector.

Did the strategy of skilled attendance at birth reach the poor in Indonesia

Abstract: Objective To assess whether the strategy of “a midwife in every village” in Indonesia achieved its aim of increasing professional delivery care for the poorest women. Methods Using pooled Demographic and Health Surveys (DHS) data from 1986–2002, we examined trends in the percentage of births attended by a health professional and deliveries via caesarean section. We tested for effects of the economic crisis of 1997, which had a negative impact on Indonesia’s health system. We used logistic regression, allowing for time-trend interactions with wealth quintile and urban/rural residence. Findings There was no change in rates of professional attendance or caesarean section before the programme’s full implementation (1986–1991). After 1991, the greatest increases in professional attendance occurred among the poorest two quintiles – 11% per year compared with 6% per year for women in the middle quintile (P = 0.02). These patterns persisted after the economic crisis had ended. In contrast, most of the increase in rates of caesarean section occurred among women in the wealthiest quintile. Rates of caesarean deliveries remained at less than 1% for the poorest two-fifths of the population, but rose to 10% for the wealthiest fifth. Conclusion The Indonesian village midwife programme dramatically reduced socioeconomic inequalities in professional attendance at birth, but the gap in access to potentially life-saving emergency obstetric care widened. This underscores the importance of understanding the barriers to accessing emergency obstetric care and of the ways to overcome them, especially among the poor. Bulletin of the World Health Organization 2007;85:774–782.

Did professional attendance at home births improve early neonatal survival in Indonesia

Abstract: BACKGROUND Early neonatal mortality has been persistently high in developing countries. Indonesia, with its national policy of home-based, midwife-assisted birth, is an apt context for assessing the effect of home-based professional birth attendance on early neonatal survival. METHODS We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the 'Midwife in the Village' programme was initiated. RESULTS Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes. CONCLUSIONS Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies.

Prevalence and predictors of undiagnosed diabetes mellitus in Indonesia.

Abstract: AIM To find the prevalence and prediction factors of undiagnosed diabetes mellitus in an Indonesian adult population. By recognizing the prediction factors, we can make epidemiological modeling and scoring system of undiagnosed diabetes mellitus in Indonesia which can be used as a screening tool in primary health care and health care with minimal diagnostic facility. METHODS Cross-sectional design was conducted on subjects from National Health Survey, Ministry of Health Republic of Indonesia 2007. Research population was upper than 18th years old. Diabetes mellitus was diagnosed by oral glucose tolerance test based on WHO 1999 standard which has been adapted by Indonesian Society for Endocrinologist. Subjects were categorized undiagnosed if they were newly diagnosed from the survey. RESULTS From 24417 subjects who undergo oral glucose tolerance test, we choose 20249 subjects who have complete data on important variables. After eliminating subjects bellow 18 years old, we have 18956 subjects included in the study. Prevalence of undiagnosed diabetes mellitus is 4.1% from total 5.6% of diabetic population in Indonesia. Subjects are included in the analysis is undiagnosed diabetes mellitus subjects (778 subjects) and subjects with normal blood glucose or non-diabetes (16011 subjects). From bivariate analysis, variables age, sex, social economic status, education level, obesity, central obesity, hypertension, physical inactivity, and smoking habit have significant association with undiagnosed diabetes mellitus (p < 0.05). From multivariate analysis, we found prediction factors of undiagnosed diabetes mellitus are age, obesity, central obesity, hypertension, and smoking habit. CONCLUSION Prevalence of undiagnosed diabetes mellitus is 4.1%. Prediction factors of undiagnosed diabetes mellitus in Indonesia are age, obesity, central obesity, hypertension, and smoking habit.

Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia

Abstract: Trained birth attendants at delivery are important for preventing both maternal and newborn deaths West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009 Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications The limited availability of health care providers was reported by residents in remote areas In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java areas Health education strategies are required to increase community awareness about the importance of health services along with the existing financing mechanisms for the poor communities Public health strategies involving traditional birth attendants will be beneficial particularly in remote areas where their services are highly utilized