An Epidemiological Investigation of Perinatal Mortality in Three Southeast Asia Countries: Indonesia, Myanmar, and Timor-Leste

Abstract

Title An Epidemiological Investigation of Perinatal Mortality in Three Southeast Asia (SEA) Countries: Indonesia, Myanmar, and Timor-Leste Introduction Child mortality rates have been reducing in most countries in recent years. However, perinatal mortality (stillbirths and deaths in the first week of life) has remained high and is a significant public health problem in many low-middle-income countries. This study aimed to identify the exposures and their association with perinatal mortality in three South East Asia (SEA) countries. Method This project involved Demographic Health Survey (DHS) data from three SEA countries, Indonesia (2017), Myanmar (2016) and Timor-Leste (2016), used to calculate perinatal mortality and its potential determinants. Geographical data were used for Myanmar and Timor-Leste to investigate the spatial pattern of perinatal mortality and socioeconomic status (SES). Logistic regression, Hot Spot (Getis-Ord Gi*) and Geographical Weighted Regression (GWR) were used to examine the association of exposures with perinatal mortality and the spatial pattern between SES and perinatal mortality across the countries. Result This study included 17,171 births in Indonesia, 4,337 in Myanmar, and 7,318 in Timor-Leste. Myanmar had the highest perinatal mortality rates per 1,000 births (30.49) compared to Indonesia (21.23) and Timor-Leste (20.48). This study included 17,171 births in Indonesia, 4,337 in Myanmar, and 7,318 in Timor-Leste. Myanmar had the highest perinatal mortality rates per 1,000 births (30.49) compared to Indonesia (21.23) and Timor-Leste (20.48). The three countries consistently identified multiple births were associated with perinatal mortality, and only size of child and child sex in Indonesia Timor Leste. The spatial GWR analysis discovered that the pattern of areas of the women who reside in rural areas, delivered in respondents' homes, in the poorest wealth index, working, and had less than 5 ANC visits are associated with increasing the incidence of perinatal mortality in Myanmar. Conclusion Perinatal mortality in the three SEA countries (Indonesia, Myanmar and Timor-Leste) was high, and multiple births were the only exposures consistently significant in the three countries. Myanmar proves spatial variation and pattern in the socioeconomic exposures associated with perinatal mortality. Further study of multilevel modelling is essential to identify clusters between countries, and advanced spatial analysis studies in SEA countries are critical to consider the wide variation between countries and within the geographical region of each country.