Knowledge and practice of early essential newborn care among health professionals in Indonesia

Authors

  • Yenita Agus Universitas Islam Negeri Syarif Hidayatullah
  • Dinda Assyifa Putri Elany Universitas Islam Negeri Syarif Hidayatullah
  • Kustati Budi Lestari Universitas Islam Negeri Syarif Hidayatullah

DOI:

https://doi.org/10.31101/jkk.4090
Abstract views 45 times

Keywords:

early essential newborn care, health professionals, Indonesia, knowledge, practice

Abstract

Indonesia's neonatal mortality rate stands at 12 deaths per 1,000 live births, driven by prematurity, asphyxia, and congenital anomalies. Inconsistent Essential Newborn Care (EENC) implementation fuels preventable first-24-hour deaths. This study aims to assess EENC knowledge and practices among Indonesian health professionals. A cross-sectional survey of 132 experienced providers (>3 years in delivery/perinatology) from hospitals, community health centers, and independent midwifery practices used a validated questionnaire via Google Forms. Descriptive statistics and chi-square tests identified associations (P<0.05). Overall, 66.4% showed poor EENC knowledge. Strengths included breastfeeding cues (99.2% correct attachment; 93.9% rooting), but deficits marked contraindications (34.8% for maternal hemorrhage >1,000 ml; 49.2% post-birth wheezing). Practices excelled in basics (93.2% recognized hypothermia/cord/skin-to-skin/breastfeeding/infection prevention; 90.2% upright positioning) yet faltered in sequencing: only 15.9% prioritized birth time announcement then thorough drying, 50.8% suctioned airways immediately, and 48.5% endorsed supine second-stage positioning. Workplace significantly affected knowledge (χ²=9.467, P=0.009): hospitals were the worst (79.1% poor), and independent midwifery practices were the best (33.3%). Age, education, experience, and training showed no association. Procedural sequencing and contraindication gaps stem from heavy workloads and patchy training. Skills-focused programs with supervision and supportive settings are essential to boost competency and decrease deaths. Observational studies should capture real behaviors and assess training/policy impacts on newborn outcomes.

Downloads

Download data is not yet available.

References

Adnani, Q. E. S., Gilkison, A., & McAra-Couper, J. (2022). Corrigendum to “Strengthening midwifery education through clinical experience: Findings from a qualitative study in Indonesia” [Women Birth 35 (2022) 87–95]. Women and Birth, 35(5), e521. https://doi.org/10.1016/j.wombi.2022.04.005

Agus, Y. (2025). The Effect of A Skin-to-Skin Contact Educational Program on Midwives’ and Nurses’ Knowledge of Early Essential Newborn Care. Indonesian Journal of Global Health Research, 7(2), 45–54. https://doi.org/10.37287/ijghr.v7i2.4386

Agus, Y., Horiuchi, S., & Iida, M. (2018). Women’s choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant. Women and Birth, 31(6), 513–519. https://doi.org/10.1016/j.wombi.2018.01.007

Ali, S. H., & Ghafel, H. H. (2022). Nurse-Midwives’ knowledge and practices about immediate newborn care. International Journal of Health Sciences, 6(S1), 8915–8940. https://doi.org/10.53730/ijhs.v6nS1.7033

Alsaqer, K., Ireifij, A., Al-Maghaireh, D. F., Kawafha, M., Nsour, A. A., Farraj, R., Hashish, S. A., Fakhoury, S., Farajat, R., Khresat, A., & Nabulsi, M. (2025). Effectiveness of a continuous training program on knowledge and professional development of healthcare providers in healthy community clinics in Jordan: A quasi-experimental study. BMC Nursing, 24, 566. https://doi.org/10.1186/s12912-025-03046-4

Arba, A., & Zana, Z. (2020). Knowledge of Essential Newborn Care and Associated Factors among Nurses and Midwives: A Cross-Sectional Study at Public Health Facilities in Wolaita Zone, Southern Ethiopia, 2019. International Journal of Pediatrics, 2020, 3647309. https://doi.org/10.1155/2020/3647309

Bakar, S. A., & Joho, A. A. (2023). Assessing Essential New-Born Care Knowledge, Skills and Associated Factors among Nurses/Midwives in Zanzibar: A Cross-Sectional Study. EA Health Research Journal, 7(1), 58–66. https://doi.org/10.24248/eahrj.v7i1.709

Bangcola, A. A., & Caorong, L. A. (2016). Barriers to the Implementation of Essential Intrapartum and Newborn Care Protocol (EINC) in Public and Private Hospitals in Iligan City.

Baso, Y. S., Syafruddin, A., Padlan, A. A., & Akbar, M. (2021). Continuing medical education for general practitioners in Indonesia: Moving toward accountability. Gaceta Sanitaria, 35 Suppl 2, S120–S122. https://doi.org/10.1016/j.gaceta.2021.07.008

Chou, V. B., Walker, N., & Kanyangarara, M. (2019). Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study. PLOS Medicine, 16(12), e1002990. https://doi.org/10.1371/journal.pmed.1002990

Dol, J., Hughes, B., Bonet, M., Dorey, R., Dorling, J., Grant, A., Langlois, E. V., Monaghan, J., Ollivier, R., Parker, R., Roos, N., Scott, H., Shin, H. D., & Curran, J. (2023). Timing of neonatal mortality and severe morbidity during the postnatal period: A systematic review. JBI Evidence Synthesis, 21(1), 98. https://doi.org/10.11124/JBIES-21-00479

Effa, E., Arikpo, D., Oringanje, C., Udo, E., Esu, E., Sam, O., Okoroafor, S., Oyo-Ita, A., & Meremikwu, M. (2021). Human resources for health governance and leadership strategies for improving health outcomes in low- and middle-income countries: A narrative review. Journal of Public Health (Oxford, England), 43(Suppl 1), i67–i85. https://doi.org/10.1093/pubmed/fdaa264

Goyet, S., Broch-Alvarez, V., & Becker, C. (2019). Quality improvement in maternal and newborn healthcare: Lessons from programmes supported by the German development organisation in Africa and Asia. BMJ Global Health, 4(5). https://doi.org/10.1136/bmjgh-2019-001562

He, H., Li, J., Li, J., Lu, H., Lu, J., Cao, L., Gong, L., Pang, R., & Zhu, X. (2025). The role of implementation climate in shaping early essential newborn care practice: Insights from a multi-center cross-sectional study in China. PloS One, 20(10), e0334855. https://doi.org/10.1371/journal.pone.0334855

He, H., Li, J., Li, Z., Lu, H., Lu, J., Quan, Y., & Zhu, X. (2024). Barriers and facilitators in implementing early essential newborn care of well‐born babies in low‐ and middle‐income countries: A mixed‐method systematic review. Journal of Clinical Nursing, 33, 1604–1625. https://doi.org/10.1111/jocn.17057

Horiuchi, S., Rattana, S., Saysanasongkham, B., Kounnavongsa, O., Kubota, S., Cayrol, J., Takahashi, K., Inoue, M., Nemoto, A., & Yamaoka, K. (2018). Study protocol of a cluster randomized controlled trial to evaluate effectiveness of a system for maintaining high-quality early essential newborn care in Lao PDR. BMC Health Services Research, 18(1), 489. https://doi.org/10.1186/s12913-018-3311-7

Jamee, A. R., Kumar Sen, K., & Bari, W. (2022). Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross‐sectional study. Health Science Reports, 5(5), e791. https://doi.org/10.1002/hsr2.791

Khosravi, S., Babaey, F., Abedi, P., Kalahroodi, Z. M., & Hajimirzaie, S. S. (2022). Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: Analyzing the attitudes of midwifery experts. BMC Pregnancy and Childbirth, 22(1), 40. https://doi.org/10.1186/s12884-022-04379-7

Kinshella, M.-L. W., Prasad, S., Hiwa, T., Vidler, M., Nyondo-Mipando, A. L., Dube, Q., Goldfarb, D., & Kawaza, K. (2021). Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: A systematic review. Global Health Research and Policy, 6(1), 21. https://doi.org/10.1186/s41256-021-00206-2

Martínez-Rodríguez, S., Rodríguez-Almagro, J., Bermejo-Cantarero, A., Muñoz-Camargo, J. C., Laderas-Díaz, E., & Hernández-Martínez, A. (2025). Efficacy of skin-to-skin contact between mother and newborn during the third stage of labour in reducing postpartum haemorrhage risk. BMC Pregnancy and Childbirth, 25(1), 393. https://doi.org/10.1186/s12884-025-07425-2

McCall, E. M., Alderdice, F., Halliday, H. L., Vohra, S., & Johnston, L. (2018). Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. The Cochrane Database of Systematic Reviews, 2(2), CD004210. https://doi.org/10.1002/14651858.CD004210.pub5

Morseth, M. S., Nguyen, T. T., Skui, M., Terragni, L., Ngo, Q. V., Vu, H. T. T., Mathisen, R., & Henjum, S. (2020). Health staff experiences with the implementation of early essential newborn care guidelines in Da Nang municipality and Quang Nam province in Viet Nam. BMC Health Services Research, 20(1), 585. https://doi.org/10.1186/s12913-020-05449-2

Mose, A., Adane, D., & Abebe, H. (2021). Skin-to-Skin Care Practice and Its Associated Factors Among Postpartum Mothers in Gurage Zone, Southern Ethiopia: A Cross-Sectional Study. Pediatric Health, Medicine and Therapeutics, 12, 289–297. https://doi.org/10.2147/PHMT.S306411

Nagamatsu, Y., Tanaka, R., Oka, M., Maruyama, N., Agus, Y., & Horiuchi, S. (2017). Identifying clinical and educational difficulties of midwives in an Indonesian government hospital maternity ward: Towards improving childbirth care. Journal of Nursing Education and Practice, 7(11), 7. https://doi.org/10.5430/jnep.v7n11p7

Pueyo-Garrigues, M., Pardavila-Belio, M., Canga-Armayor, A., Esandi, N., Alfaro-Díaz, C., & Canga-Armayor, N. (2022). NURSES’ knowledge, skills and personal attributes for providing competent health education practice, and its influencing factors: A cross-sectional study. Nurse Education in Practice, 58, 103277. https://doi.org/10.1016/j.nepr.2021.103277

Qu, W., Yue, Q., Wang, Y., Yang, J. L., Jin, X., Huang, X., Tian, X., Martin, K., Narayan, A., & Xu, T. (2020). Assessing the changes in childbirth care practices and neonatal outcomes in Western China: Pre-comparison and post-comparison study on early essential newborn care interventions. BMJ Open. https://doi.org/10.1136/bmjopen-2020-041829

Ram, U., Ramesh, B. M., Blanchard, A. K., Scott, K., Kumar, P., Agrawal, R., Washington, R., & Bhushan, H. (2024). A tale of two exemplars: The maternal and newborn mortality transitions of two state clusters in India. BMJ Global Health, 9(Suppl 2). https://doi.org/10.1136/bmjgh-2022-011413

Razavinia, F., Abedi, P., Iravani, M., Mohammadi, E., Cheraghian, B., Jahanfar, S., & Najafian, M. (2024). The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: A mixed-methods protocol. BMC Medical Education, 24(1), 338. https://doi.org/10.1186/s12909-024-05321-5

Rintani, A., & Wibowo, A. (2019). Health Sector Decentralization and its Implication to Health Services in Indonesia. Jurnal Ilmu Kesehatan Masyarakat, 10(1), 1–14. https://doi.org/10.26553/jikm.2019.10.1.1-14

Sampurna, M. T. A., Handayani, K. D., Utomo, M. T., Angelika, D., Etika, R., Harianto, A., Mapindra, M. P., Mahindra, M. P., Efendi, F., Kaban, R. K., Rohsiswatmo, R., Visuddho, V., & Permana, P. B. D. (2023). Determinants of neonatal deaths in Indonesia: A national survey data analysis of 10,838 newborns. Heliyon, 9(1). https://doi.org/10.1016/j.heliyon.2023.e12980

Shukla, V. V., & Carlo, W. A. (2020). Review of the evidence for interventions to reduce perinatal mortality in low- and middle-income countries. International Journal of Pediatrics and Adolescent Medicine, 7(Suppl 1), 4. https://doi.org/10.1016/j.ijpam.2020.02.004

Suangga, F., & Tuppal, C. P. (2017). Motivation among Indonesian Nurses in Pursuing Continuing Professional Education and Its Relationship to Their Competencies. Nurse Media Journal of Nursing, 7(1), 24–34. https://doi.org/10.14710/nmjn.v7i1.15125

Titaley, C. R., Mu’asyaroh, A., Que, B. J., Tjandrarini, D. H., & Ariawan, I. (2024). Determinants of early neonatal mortality: Secondary analysis of the 2012 and 2017 Indonesia Demographic and Health Survey. Frontiers in Pediatrics, 12. https://doi.org/10.3389/fped.2024.1288260

Tosif, S., Jatobatu, A., Maepioh, A., Gray, A., Sobel, H., Mannava, P., & Duke, T. (2020). Healthcare worker knowledge and skills following coaching in WHO early essential newborn care program in the Solomon Islands: A prospective multi-site cohort study. BMC Pregnancy and Childbirth, 20, 84. https://doi.org/10.1186/s12884-020-2739-z

Tran, H. T., Mannava, P., Murray, J. C. S., Nguyen, P. T. T., Tuyen, L. T. M., Anh, T. H., Pham, T. Q. N., Duc, V. N., & Sobel, H. L. (2018). Early Essential Newborn Care Is Associated With Reduced Adverse Neonatal Outcomes in a Tertiary Hospital in Da Nang, Viet Nam: A Pre- Post- Intervention Study. eClinicalMedicine, 6, 51–58. https://doi.org/10.1016/j.eclinm.2018.12.002

Tran, H. T., Murray, J. C. S., Sobel, H. L., Mannava, P., Huynh, L. T., Nguyen, P. T. T., Giang, H. T. N., Le, T. T. M., Hoang, T. A., Nguyen, V. D., Li, Z., & Pham, N. T. Q. (2021). Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: A pre/post-intervention study. BMJ Open Quality, 10(3), e001089. https://doi.org/10.1136/bmjoq-2020-001089

Traoré, S., Guira, O., Zoungrana, L., Sagna, Y., Bognounou, R., Paré, C. B., Dabourou, D. L., Séré, L., Zemba, D., Dembélé, L. S., Somé, P. D., Savadogo, P. P. C., Tondé, A., Hervé, T., & Drabo, J. Y. (2021). Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso). Open Journal of Internal Medicine, 11(1), Article 1. https://doi.org/10.4236/ojim.2021.111001

UNFPA. (2025, June 19). UNFPA Indonesia | Indonesia Launches New National Midwifery Curriculum, Strengthening Care for Mothers and Newborns with Support from Canada and UNFPA. https://indonesia.unfpa.org/en/news/indonesia-launches-new-national-midwifery-curriculum

UNICEF. (2018, February 1). Neonatal Care Clinical Guidelines | UNICEF Eswatini. https://www.unicef.org/eswatini/reports/neonatal-care-clinical-guidelines

Vivilaki, V. G., & Asimaki, E. (2020). Respectful midwifery care during the COVID-19 pandemic. Eur J Midwifery 2020. https://doi.org/10.18332/ejm/120070

Wang, C., Lin, Y., Zhang, H., Yang, G., Tang, K., Tian, X., Huang, X., & Xu, T. (2022). Effectiveness of early essential newborn care implementation in four counties of western China. BMC Health Services Research, 22(1), 1185. https://doi.org/10.1186/s12913-022-08570-6

WHO. (2020). Standards for improving the quality of care for small and sick newborns in health facilities. World Health Organization.

WHO. (2022). Early essential newborn care: Clinical practice pocket guide, 2nd edition (2nd edition). World Heatlh Oranization Western Pacific Region. https://iris.who.int/server/api/core/bitstreams/be675faf-b002-48f7-81bd-44f6e3751895/content

WHO. (2023). Trends in maternal mortality 2000 to 2020. World Health Organization.

WHO. (2025, June 19). Elevating nursing and midwifery: WHO and Indonesia launch new Collaborating Centre to boost capacity in Indonesia and the Western Pacific Region. https://www.who.int/indonesia/news/detail/19-06-2025-elevating-nursing-and-midwifery--who-and-indonesia-launch-new-collaborating-centre-to-boost-capacity-in-indonesia-and-the-western-pacific-region

Wiley, R. L., Ghose, I., Canfield, D. R., Sarker, M. R., Mendez‐Figueroa, H., & Chauhan, S. (2025). Immediate skin‐to‐skin contact and postpartum hemorrhagic morbidity. International Journal of Gynaecology and Obstetrics, 170(1), 423–429. https://doi.org/10.1002/ijgo.16160

Yosef, T., Getachew, D., & Weldekidan, F. (2021). Health professionals’ knowledge and practice of essential newborn care at public health facilities in Bench-Sheko Zone, southwest Ethiopia. Heliyon, 7(11), e08369. https://doi.org/10.1016/j.heliyon.2021.e08369

Zhang, H., Wu, Y., Wang, H., Zhao, W., & Cong, Y. (2024). Sixty years of ethical evolution: The 2024 revision of the Declaration of Helsinki (DoH). Health Care Science, 3(6), 371–373. https://doi.org/10.1002/hcs2.126

Downloads

Published

2025-12-23

How to Cite

Agus, Y., Elany, D. A. P., & Lestari, K. B. (2025). Knowledge and practice of early essential newborn care among health professionals in Indonesia . Jurnal Kebidanan Dan Keperawatan Aisyiyah, 21(2), 62–73. https://doi.org/10.31101/jkk.4090

Issue

Vol. 21 No. 2 (2025): Desember

Section

Original Research

License

Copyright (c) 2025 Jurnal Kebidanan dan Keperawatan Aisyiyah

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

With the receipt of the article by the Jurnal Kebidanan dan Keperawatan Aisyiyah Editorial Board and the decision to be published, then the copyright regarding the article will be diverted to Jurnal Kebidanan dan Keperawatan Aisyiyah. Universitas 'Aisyiyah Yogyakarta as the publisher of Jurnal Kebidanan dan Keperawatan Aisyiyah hold the copyright regarding all the published articles in this journal.

Jurnal Kebidanan dan Keperawatan Aisyiyah is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.