Neonatal mortality is one of the key impediments in achieving global sustainable development goals, especially in lower middle income countries (LMICs). As an LMIC with the highest reported neonatal mortality rate in Southeast Asia, Indonesia faces inequitable distribution of health facilities across the archipelago. Therefore, in this paper, we aim to evaluate the determinants of neonatal mortality rate in Indonesia to search for better strategies to overcome this problem. We conducted an analysis of the 2017 Indonesia Demographic Health Survey dataset of 10,838 live-born infants born from singleton pregnancies in 2017. Using a hierarchical approach, multivariate analysis was conducted to identify potential factors (including socioeconomic, household, and proximate determinants) that contributed to neonatal mortality. The lack of participation in postnatal care [odds ratio (OR) = 20.394, p = 0.01)] and delivery complications other than prolonged labour (OR = 2.072, p = 0.02) were the maternal factors that significantly associated with increased risk of neonatal death. Regarding neonatal factors, low-birth-weight infants appeared to be more vulnerable to neonatal death (OR = 12.489, p = 0.01). Low participation in postnatal care, development of labour complications, and low birth weight were associated with higher neonatal mortality. It implies that in a limited resource and geographically challenging country such as Indonesia, improving the quality and optimizing services of public hospitals with equitable distribution of quality health care services in all regions should be prioritized in the efforts of reducing neonatal mortality rate.

Background: Nurses who are in charge of the Neonatal Intensive Care Units (NICUs) have a different workload and work assignments compared to other units. Evidence suggests that higher nurse workloads will increase the risk of missed nursing care. Missed nursing care in the NICU will eventually worsen the neonatal prognosis. This is a major problem in developing countries, which currently still have a high neonatal mortality rate. Methods: This was a cross sectional study using questionnaires to collect data from 48 nurses who work in Dr. Soetomo Hospital NICU from April 15th 2021 to July 25th 2021. The collected data was then processed with descriptive statistics, meanwhile the correlation between workload with missed nursing care was analyzed with Pearson and Spearman correlation. Results: The total mean of NICU nurse workload score according to the NASA-TLX (National Aeronautics and Space Administration Task Load Index) was 68.36, indicating a moderate overall workload, with effort as the highest component. Overall, 91.67% of the nurses had missed at least 1 out of 21 basic neonatal nursing care components. Labor resource factor was the most frequent missed nursing care factor, in which urgent patient situations were the most frequent problem. There was no significant correlation between the total nurse workload and the frequency of any missed nursing care (P=0.536). Conclusions: Effort was the biggest component of the NICU nurse total workload. The most frequently missed nursing care was giving emotional support for the patient’s parents and/or family. Labor resource factor was the most frequent problem which caused missed nursing care. However, there is no statistically significant correlation between the total workload with the frequency of missed nursing care.

Introduction: Health literacy on the coronavirus disease 2019 (COVID-19) affects people’s capability to ascertain their health and health care quality during the pandemic. The objective of this study was to determine the levels of health literacy about COVID-19 vaccines and vaccinations (Vaccines and Vaccinations literacy-VL) in the Indonesian adult general population, assessing the perceptions of the respondents about current adult immunization and beliefs about vaccinations in general, and analyzing correlations of these variables with the VL levels. Methods: A cross-sectional study using a rapid survey was administered via the Internet. Data were analyzed using descriptive and inferential statistics; the internal consistency of the VL scales was evaluated using Cronbach’s alpha coefficient; the inter-correlation between the functional and interactive-critical VL questions, the underlying components (factors) and each question’s load on the components were identified using a Principal Component Analysis (PCA). An alpha level lesser than 0.05 was considered significant. Results: Responses to functional- and interactive/ critical- VL questions were acceptable and showed internal consistency (Cronbach’s alpha = 0.817 and 0.699, respectively), lowest values observed were 0.806 for functional scale and 0.640 for the interactive-critical scale. The PCA demonstrated that there were two components accounting for 52.45% of the total variability. Approximately 60% of respondents were females (n=686). Almost all respondents used the internet to seek information regarding COVID-19 and COVID-19 vaccinations. Many used at least one social media actively with 74.4% of respondents sometimes believing the validity of this information. Conclusions: High scores were observed in both functional- and interactive/ critical-VL, and were quite in a balance between sexes in the prior VL and higher in females for the latter; these were also closely related to the educational level and age group. It is crucial to increase public health literacy in managing the pandemic.

Background: Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality in low- and middle-income countries. Blood culture positivity rates and antibiotic resistance pattern of neonatal sepsis differs across various regions. This study aims to identify clinical cofactors associated with blood culture-proven neonatal sepsis and in vitro resistance to first-line antibiotics (ampicillin and gentamicin) from cases originating in a tertiary healthcare center in Surabaya, Indonesia. Methods: A retrospective cohort study was conducted from January 2020 to August 2022 by utilizing secondary data collected from standardized electronic medical records. Microbiologic characteristics and associated factors were statistically analyzed using multivariable logistic regression. Results: Across 266 neonatal sepsis cases, 46.9% were culture-proven and 79.2% of confirmed sepsis were resistant to first-line antibiotics. The most common isolated pathogen is Klebsiella pneumoniae, followed by coagulase-negative Staphylococci, Acinetobacter baumannii and Enterobacter cloacae. Extremely preterm delivery [adjusted odds ratio (aOR): 5.813; 95% confidence interval (CI): 1.70–19.91] and late-onset sepsis (aOR: 9.165; 95% CI: 5.12–16.40) were associated with culture-proven neonatal sepsis. Increased odds of resistance to first-line antibiotics were identified in extremely preterm (<28 weeks) or very-preterm delivery (28 to <32 weeks) (aOR: 50.80; 95% CI: 1.66–1554.21 and aOR: 45.679; 95% CI: 3.22–647.46, respectively), cesarean section (aOR: 4.149; 95% CI: 1.04–16.53) and an absence of antenatal corticosteroid use (aOR: 0.233; 95% CI: 0.07–0.76). Conclusions: The association between clinical cofactors with culture-proven sepsis and antibiotic resistance emphasizes the importance for clinicians to adjust empirical antibiotic regimens based on the local antibiogram and resource availability.

Introduction: Severe morbidity and mortality in COVID-19 are linked to an inflammatory ‘cytokine storm’ driven by hyperactive macrophages and altered monocyte function. Identifying early immune predictors of severe COVID-19 outcomes is critical for optimizing patient care and resource allocation, especially under a resource-limited setting. Objectives: This study aimed to investigate the relationship between monocyte and platelet levels and COVID-19 severity at a secondary hospital in East Java, Indonesia. Patients and Methods: A single-center, cross-sectional study was conducted by utilizing electronic medical health records from 100 patients admitted to the Siti Khodijah Muhaammadiyah Sepanjang hospital May to September 2021. Initial complete blood counts were retrieved from adult patients who tested positive for COVID-19 by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR ). A backward-stepwise multivariate regression model was incorporated to evaluate the association between platelet and monocyte levels with COVID-19 severity. Results: Despite the non-association in the bivariate analysis, thrombocytopenia significantly reduced the risk of severe COVID-19 manifestation in the multivariate model (aPR 0.184; 95% CI: 0.047-0.722). Interestingly, patients with monocytosis had a lower risk of the severe disease compared to those with normal monocytes both in the bivariate and multivariate analyses (PR 0.364; 95% CI [0.157-0.841] and aPR 0.334; 95% CI [0.126-0.882], respectively). However, there was no significant increase in severity among those presenting with low monocyte or high platelet counts. Conclusion: There is a unidirectional association between low platelets and high monocyte levels with severe manifestations of COVID-19 disease. Further research is warranted to validate these findings and explore their utility in risk stratification and clinical management of COVID-19 patients.