{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:04:56Z","timestamp":1789178696084,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T00:00:00Z","timestamp":1647216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"USAID","doi-asserted-by":"crossref","award":["AID-497-C-17-00001"],"award-info":[{"award-number":["AID-497-C-17-00001"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Government of Indonesia is determined to follow global commitments to reduce the neonatal mortality rate. Yet, there is a paucity of information on contributing factors and causes of neonatal deaths, particularly at the sub-national level. This study describes care-seeking during neonates\u2019 fatal illnesses and their causes of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional community-based study to identify all neonatal deaths in Serang and Jember Districts, Indonesia. Follow-up interviews were conducted with the families of deceased neonates using an adapted verbal and social autopsy instrument. Cause of death was determined using the InSilicoVA algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The main causes of death of 259 neonates were prematurity (44%) and intrapartum-related events (IPRE)-mainly birth asphyxia (39%). About 83% and 74% of the 259 neonates were born and died at a health facility, respectively; 79% died within the first week after birth. Of 70 neonates whose fatal illness began at home, 59 (84%) sought care during the fatal illness. Forty-eight of those 59 neonates went to a formal care provider; 36 of those 48 neonates (75%) were moderately or severely ill when the family decided to seek care. One hundred fifteen of 189 neonates (61%) whose fatal illnesses began at health facilities were born at a hospital. Among those 115, only 24 (21%) left the hospital alive\u2013of whom 16 (67%) were referred by the hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high proportion of deaths due to prematurity and IPRE suggests the need for improved management of small and asphyxiated newborns. The moderate to severe condition of neonates at the time when care was sought from home highlights the importance of early illness recognition and appropriate management for sick neonates. Among deceased neonates whose fatal illness began at their delivery hospital, the high proportion of referrals may indicate issues with hospital capability, capacity, and\/or cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0265032","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T13:44:44Z","timestamp":1647265484000},"page":"e0265032","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Neonatal mortality in two districts in Indonesia: Findings from Neonatal Verbal and Social Autopsy (VASA)"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9911-1699","authenticated-orcid":true,"given":"Poppy E.","family":"Deviany","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9042-5699","authenticated-orcid":true,"given":"Philip W.","family":"Setel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry D.","family":"Kalter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trisari","family":"Anggondowati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martini","family":"Martini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0139-9784","authenticated-orcid":true,"given":"Fitri","family":"Nandiaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9097-1350","authenticated-orcid":true,"given":"Kamaluddin","family":"Latief","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily H.","family":"Weaver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7496-0782","authenticated-orcid":true,"given":"Tika","family":"Rianty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anhari","family":"Achadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Wahyuni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania W.","family":"Setyaningtyas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nila R.","family":"Haryana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luna M.","family":"Mehrain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endang L.","family":"Achadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,14]]},"reference":[{"key":"pone.0265032.ref001","volume-title":"Levels & Trends in Child Mortality: Report 2019, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation.","author":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)","year":"2019"},{"key":"pone.0265032.ref002","volume-title":"Every newborn: an action plan to end preventable deaths.","author":"World Health Organization","year":"2014"},{"issue":"9462","key":"pone.0265032.ref003","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"4 million neonatal deaths: When? Where? Why?","volume":"365","author":"JE Lawn","year":"2005","journal-title":"The Lancet"},{"key":"pone.0265032.ref004","volume-title":"Indonesia demographic and health survey","author":"Ministry of Health, ICF","year":"2017"},{"key":"pone.0265032.ref005","unstructured":"Atlas World Data. Atlas World Data: Neonatal mortality rate. 2019 [cited 2019 November 4]. Available from: https:\/\/knoema.com\/atlas\/ranks\/Neonatal-mortality-rate."},{"issue":"S1","key":"pone.0265032.ref006","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1038\/jp.2016.27","article-title":"When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries","volume":"36","author":"MJ Sankar","year":"2016","journal-title":"Journal of Perinatology"},{"issue":"1","key":"pone.0265032.ref007","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1186\/1471-2458-8-232","article-title":"Determinants of neonatal mortality in Indonesia.","volume":"8","author":"CR Titaley","year":"2008","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0265032.ref008","doi-asserted-by":"crossref","first-page":"30445","DOI":"10.3402\/gha.v9.30445","article-title":"Risk factors associated with neonatal deaths: a matched case\u2013control study in Indonesia.","volume":"9","author":"A Abdullah","year":"2016","journal-title":"Global Health Action"},{"issue":"1","key":"pone.0265032.ref009","doi-asserted-by":"crossref","first-page":"010605","DOI":"10.7189\/jogh.06.010605","article-title":"Factors associated with delay in care\u2013seeking for fatal neonatal illness in the Sylhet district of Bangladesh: results from a verbal and social autopsy study","volume":"6","author":"BA Nonyane","year":"2016","journal-title":"Journal of Global Health"},{"issue":"1","key":"pone.0265032.ref010","first-page":"010416","article-title":"Social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi","volume":"5","author":"AK Koffi","year":"2015","journal-title":"Journal of global health"},{"issue":"10166","key":"pone.0265032.ref011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(18)31647-7","article-title":"Universal health coverage in Indonesia: concept, progress, and challenges","volume":"393","author":"R Agustina","year":"2019","journal-title":"The Lancet"},{"key":"pone.0265032.ref012","article-title":"Has Indonesia\u2019s national health insurance scheme improved access to maternal and newborn health services?.","author":"L Teplitskaya","year":"2018"},{"issue":"2","key":"pone.0265032.ref013","doi-asserted-by":"crossref","first-page":"131","DOI":"10.30994\/jgrph.v3i2.57","article-title":"The effect Referral Barriers to Barriers Delay in Perinatal Mortality in Karawang","volume":"3","author":"LN Arminia","year":"2018","journal-title":"Journal of Global Research in Public Health"},{"issue":"1","key":"pone.0265032.ref014","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1472-698X-8-4","article-title":"Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study.","volume":"8","author":"M M\u00e5lqvist","year":"2008","journal-title":"BMC International Health and Human Rights"},{"key":"pone.0265032.ref015","volume-title":"WHO News","author":"World Health Organization","year":"2016"},{"issue":"12","key":"pone.0265032.ref016","doi-asserted-by":"crossref","first-page":"e0168743","DOI":"10.1371\/journal.pone.0168743","article-title":"Understanding Misclassification between Neonatal Deaths and Stillbirths: Empirical Evidence from Malawi.","volume":"11","author":"L Liu","year":"2016","journal-title":"PLOS ONE"},{"key":"pone.0265032.ref017","unstructured":"DAI. Indonesia\u2014Jalin. Our work. [cited 2020 August 30]. Available from: https:\/\/www.dai.com\/our-work\/projects\/indonesia-jalin."},{"key":"pone.0265032.ref018","volume-title":"Every mother and newborn counts study report","author":"Center for Family Welfare FPH UI, Vital Strategies","year":"2020"},{"key":"pone.0265032.ref019","volume-title":"Serang Regency in Figures 2017","author":"Statistics of Serang Regency","year":"2017"},{"key":"pone.0265032.ref020","volume-title":"Jember regency in figures 2017","author":"Statistics of Jember Regency","year":"2018"},{"key":"pone.0265032.ref021","volume-title":"Summary tables Banten 2 Study report","author":"Center for Family Welfare","year":"2017"},{"issue":"1","key":"pone.0265032.ref022","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/1471-2393-10-74","article-title":"An option for measuring maternal mortality in developing countries: a survey using community informants.","volume":"10","author":"SN Qomariyah","year":"2010","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"1","key":"pone.0265032.ref023","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1478-7954-9-45","article-title":"Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method","volume":"9","author":"HD Kalter","year":"2011","journal-title":"Population Health Metrics"},{"key":"pone.0265032.ref024","volume-title":"Stata Statistical Software: Release 15.","author":"StataCorp","year":"2017"},{"issue":"1","key":"pone.0265032.ref025","doi-asserted-by":"crossref","first-page":"010604","DOI":"10.7189\/jogh.06.010604","article-title":"Verbal\/social autopsy study helps explain the lack of decrease in neonatal mortality in Niger, 2007\u20132010","volume":"6","author":"HD Kalter","year":"2016","journal-title":"Journal of Global Health"},{"key":"pone.0265032.ref026","volume-title":"Overcoming remaining barriers: The pathway to survival.","author":"R. Waldman","year":"1996"},{"issue":"1","key":"pone.0265032.ref027","doi-asserted-by":"crossref","first-page":"e1002486","DOI":"10.1371\/journal.pmed.1002486","article-title":"The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.","volume":"15","author":"EK Nichols","year":"2018","journal-title":"PLOS Medicine"},{"issue":"515","key":"pone.0265032.ref028","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1080\/01621459.2016.1152191","article-title":"Probabilistic cause-of-death assignment using verbal autopsies","volume":"111","author":"TH McCormick","year":"2016","journal-title":"Journal of the American Statistical Association"},{"issue":"1","key":"pone.0265032.ref029","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.05.010413","article-title":"Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong\u2013Mbang health districts, Eastern Region of Cameroon","volume":"5","author":"AK Koffi","year":"2015","journal-title":"Journal of Global Health"},{"issue":"Suppl 1","key":"pone.0265032.ref030","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s41043-017-0122-0","article-title":"Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study.","volume":"36","author":"A Rosales","year":"2017","journal-title":"Journal of health, population, and nutrition"},{"issue":"3","key":"pone.0265032.ref031","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jped.2012.11.005","article-title":"Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history.","volume":"89","author":"SB Kassar","year":"2013","journal-title":"Jornal de Pediatria"},{"issue":"3","key":"pone.0265032.ref032","first-page":"366","article-title":"The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda.","volume":"32","author":"W Wang","year":"2016","journal-title":"Health Policy and Planning"},{"issue":"4","key":"pone.0265032.ref033","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1093\/heapol\/17.4.384","article-title":"The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan.","volume":"17","author":"T-C Liu","year":"2002","journal-title":"Health Policy and Planning"},{"key":"pone.0265032.ref034","unstructured":"Presidential of RI Decree on Health Insurance, No. 82 of 2018, Cabinet Secretary of RI. (September 18, 2018)."},{"issue":"9940","key":"pone.0265032.ref035","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?","volume":"384","author":"ZA Bhutta","year":"2014","journal-title":"The Lancet"},{"issue":"5","key":"pone.0265032.ref036","doi-asserted-by":"crossref","first-page":"e1381","DOI":"10.1542\/peds.2007-1966","article-title":"Risk Factors for Neonatal Mortality Due to Birth Asphyxia in Southern Nepal: A Prospective, Community-Based Cohort Study.","volume":"121","author":"AC Lee","year":"2008","journal-title":"PEDIATRICS"},{"issue":"3","key":"pone.0265032.ref037","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.siny.2017.02.006","article-title":"Early neonatal death: A challenge worldwide.","volume":"22","author":"L Lehtonen","year":"2017","journal-title":"Seminars in Fetal and Neonatal Medicine"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T13:45:20Z","timestamp":1647265520000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265032"}},"subtitle":[],"editor":[{"given":"Mohammad Bellal","family":"Hossain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,14]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0265032","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,14]]}}}