ArticlePloS one2021
Health system and quality of care factors contributing to maternal deaths in East Java, Indonesia.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Trends and causes of maternal mortality in Indonesia: a systematic review.BMC pregnancy and childbirth · 2024Pooled it
- Development and Expert Validation of a Hospital-to-Home Care Pathway for Preterm Infants in Indonesia: A Qualitative and Delphi Study.Journal of multidisciplinary healthcare · 2026Article
- Factors associated with institutional delivery in remote areas: a cross-sectional survey in Papua Region, Indonesia.BMC pregnancy and childbirth · 2025Article
- Exploring health workers' perspectives on factors affecting patient experience in emergency caesarean section response time: a qualitative study in hospitals in Makassar City, Indonesia.BMC health services research · 2025Article
- Strengthening the first antenatal visit to improve maternal health: results from a cross-sectional study in Bantul, Indonesia.BMC pregnancy and childbirth · 2025Article
- Exploring the Multilevel Determinants of Suboptimal Maternal and Child Continuum of Care in Indonesia.Maternal and child health journal · 2025Article
- Challenges of health workers in primary health facilities in implementing obstetric emergency referrals to save women from death in Indonesia: A qualitative study.Belitung nursing journal · 2024Article
- Appraisal of universal health insurance and maternal health services utilization: pre- and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia.Frontiers in public health · 2024Article
- Geospatial Access to Emergency Obstetric Surgery in Indonesia: Is Travel Time for Access Too Long?Annals of global health · 2024Article
- Men's determinant factors on antenatal care involvement and childbirth place preference in Indonesia: An analysis of the 2012 Indonesia Demographic and Health Survey (IDHS).Journal of public health research · 2023Article
- A systematic review and meta-analysis of prevalence of vitamin D deficiency among Indonesian pregnant women: a public health emergency.AJOG global reports · 2023Review
- Article
- Article
- The relationship between maternal death due to COVID-19 and the human development index in East Java, Indonesia.Journal of public health research · 2023Article
- Do mothers who meet the minimum standard of antenatal visits have better knowledge? A study from Indonesia.Journal of education and health promotion · 2022Article
- How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia.PLOS global public health · 2022Article
- Delays in maternal care and hypertensive complications at the Sabogal hospital, Callao, Peru, 2021. Case-control StudyRevista colombiana de obstetricia y ginecologia · 2021Article
- Sustainability in transformation of maternal mortality by interaction based approach in Dairi, Indonesia.Journal of public health research · 2021Article
- "Sharp downward, blunt upward": district maternal death audits' challenges to formulate evidence-based recommendations in Indonesia - a qualitative study.BMC pregnancy and childbirth · 2021Article
- Perceived Barriers in Accessing Health Care and the Risk of Pregnancy Complications in Indonesia.International journal of women's health · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite most Indonesian women now receiving antenatal care on the nationally recommended four occasions and being delivered by skilled birth attendants, the nation's maternal mortality ratio (MMR) is estimated as 177 per 100,000 live births. Recent research in a rural district of Indonesia has indicated that poor service quality due to organizational and personnel factors is now a major determinant of this high MMR. The present research is an in-depth analysis of possible health service organizational and quality of care related causes of death among 30 women admitted to a peak referral hospital in a major Indonesian city. Despite their condition being complex or deteriorating, most of these women arrived at the hospital in a state where it was feasible to prevent death with good quality care. Poor application of protocols, poor information flow from frontline hospitals to the peak referral hospital, delays in emergency care, and delays in management of deteriorating patients were the main contributing factors to these deaths. Pyramidal referrals also contributed, as many women were initially referred to hospitals where their condition could not be effectively managed. While generic quality improvement measures, particularly training and monitoring for rigorous application of clinical protocols (including forward planning for deteriorating patients) will help improve the situation, the districts and hospitals need to develop capacity to assess their local situation. Unless local organisational factors, staff knowledge and skill, blood and blood product availability, and local reasons for delays in providing care are identified, it may not be possible to effectively reduce the adverse pregnancy outcomes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.