Assessing the effect of the Expanding Maternal and Neonatal Survival program on improving stabilization and referral for maternal and newborn complications in Indonesia

Alisa Pedrana, Siti Nurul Qomariyah, Maya Tholandi, Bambang Wijayanto, Trisnawaty Gandawidjaja, Dwirani Amelia, Mandri Apriatni, Sudirman Sudirman, Ali Zazri, Reena Sethi, Mark Emerson, Saifuddin Ahmed

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10 Citations (Scopus)


Objective: To determine if the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved effectiveness of the referral system in Indonesia to facilitate timely and effective management of complications experienced by women and newborns. Methods: Poisson regression using longitudinal monitoring data was used to assess the impact of the EMAS program on stabilization practices prior to referral. Data from a nonrandomized quasi-experimental pre-post evaluation study were used to assess the impact of the EMAS program along the referral pathway using χ 2 analysis. Results: Monitoring data demonstrated improvements in intervention areas for stabilization of pre-eclampsia/eclampsia (24% vs 61%, incidence rate ratio [IRR] 2.4; 95% confidence interval [CI], 2.3–2.6) and treatment of newborns with suspected severe infection (30% vs 54%, IRR 2.0; 95% CI, 1.6–2.4) prior to referral. The EMAS program was associated with significantly higher levels of communication, advanced notification, back referral, and hospital emergency readiness and staff preparedness compared with the comparison arm. Conclusion: The EMAS program contributed to improvements in the management of obstetric and newborn complications, including communication, transportation, and preparation of pregnant mothers in need of referral and hospital emergency readiness and staff preparedness.

Original languageEnglish
Pages (from-to)30-41
Number of pages12
JournalInternational Journal of Gynecology and Obstetrics
Publication statusPublished - Feb 2019
Externally publishedYes


  • Health facility delivery
  • Indonesia
  • Maternal health
  • Monitoring and surveillance
  • Referral

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