A population-based study of neonatal deaths in Indonesia based on the Indonesian demographic health survey: what determinants play an essential role?

Background: Neonatal mortality appears to be one of the most concerning problems to fulfill Sustainable Developmental Goals globally. Indonesia, as a developing country with uneven distribution of standardized health facilities over the archipelago, has been reported to be the country with the highest fatality cases of the newborn in Southeast Asia. To address this problem, we evaluate how substantive the socioeconomic spectrum and proximate determinants as a substantial predictor of the neonatal mortality rate in advance to maximize the health policies’ quality in reducing the rate of newborn death. Method The analysis was conducted using the data source of the 2017 Indonesia Demographic Health Survey from 11.965 live-born infants born from singleton pregnancy in the year of 2017. By using a hierarchical approach and logistic regression, the multilevel analysis was carried out to assess the possible contributing factors including socioeconomic, household, and proximate factors to neonatal mortality. Results At socioeconomic determinants, the odds of newborn death was significantly higher for those who born from mothers with poor education level (OR = 1.72, p = 0.03), insufficient antenatal visits (OR = 3.98, p = 0.01), and not being involved to postnatal care (OR = 6.60, p = 0.01). Regarding community factors, the variable of traditional birth attendants was significantly higher for the odds of newborn death (OR = 2.06, p = 0.01) as well as the delivery in government public hospitals (OR = 1.89, p = 0.01). In terms of proximate determinants, the odds of newborn death found to be higher for male infants (OR = 1.43, p = 0.03) and low birth (< 2.5 kg) weight infants (OR = 4.15, p = 0.01). After the adjustment of these covariates, the newborn death were associated to mothers with insufficient antenatal care (OR = 2.58, p = 0.01), not participating in postnatal care (OR = 5.66, p = 0.01), assisted by traditional birth attendants (OR = 1.46, p = 0.03), and neonatal factors such as male gender (OR = 5.66, p = 0.01 and low birth weight (OR = 4.37, p = 0.01). Conclusion In reducing neonatal death, public health interventions should be targeted to individual and community-level factors of socioeconomic determinants. Improving the quality and coverage of perinatal health services such as the utilization of either antenatal care or postnatal care, the availability of trained birth attendants, and the optimization in public hospitals’ services have a significant meaning for better infants’ lives.