Jurnal Kesehatan Reproduksi
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THE USE OF NEW INSERTER (R_INSERTER) FOR DELIVERING CuT-380A IUD DURING POSTPARTUM PERIOD PHASE II CLINICAL TRIAL
Get PDFTHE USE OF NEW INSERTER (R_INSERTER) FOR DELIVERING CuT-380A IUD DURING POSTPARTUM PERIOD PHASE II CLINICAL TRIALRisanto Siswosudarmo1, Kadek Kurniawan2, Herdhana Suwartono3, Taufik Rahman Alkaff4, and Maria Anggraeni5ABSTRAKLatar Belakang: IUD adalah salah satu alat kontrasepsi jangka panjang yang efektif, tetapi penggunaan di Indonesia masih rendah. Karena inserter IUD yang biasa di pakai terlalu pendek untuk pemasangan segera pascasalin maka bentuk inserter baru (R_inseter) telah dikembangkan.Tujuan: Untuk mengetahui apakah R_inserter dapat digunakan dengan mudah sesuai standard pemasangan IUD dan untuk mengetahui keamanannya.Metode: Uji klinis fase II, post test observation.Bahan dan cara: IUD yang dipasang adalah TCu380A dengan modifikasi pada inserternya (R_inserter) buatan PT Kimia Farma. Penelitian ini dilakukan di 3 Rumah Sakit dan 3 Puskesmas yang merupakan afiliasi rumah sakit pendidikan Dr Sardjito dari bulan Januari 2012 sampai April 2013. Semua klien yang memenuhi kriteria inklusi dan eksklusi dimasukkan dalam penelitian ini. Pemasangan dilakukan oleh Residen atau Bidan yang telah mendapatkan pelatihan. Follow up dilakukan setelah 1 minggu, 1, 3, 6, 9 dan 12 bulan pascapasang. Kemudahan, angka ekspulsi, infeksi, nyeri, perdarahan, dan angka kelangsungan merupakan hasil utama yang diobservasi. Hasil dan Pembahasan: Selama kurun waktu tersebut telah direkrut sebanyak 142 klien yang memenuhi kriteria kelayakan. Lama pemasangan rata-rata adalah 3,89 ± 2,08 menit dengan minimum 2 menit dan maksimum 10 menit. Tidak ada kesulitan yang dirasakan. Secara kumulatif kejadian dalam 1, 3, 6, 9 dan 12 bulan untuk ekspulsi masing-masing adalah 9,9%, 9,9%, 10,6%, 10,6% dan 10%. Angka ekspulsi jika IUD dipasang dalam 10 menit pertama setelah plasenta lahir adalah 6,2% dibanding 24,1% bila pemasangan dilakukan setelah 10 menit (RR 3,90; 95%CI 1,37-11,2). Kejadian seperti infeksi, nyeri dan perdarahan relatif kecil dan dapat diatasi. Angka kelangsungan selama 1, 3, 6, 9 dan 12 bulan berturut turut adalah 89,4%, 89,4%, 86,6% 86,6% dan 85,9%. Tidak dijumpai kehamilan pada penelitian ini.Kesimpulan: R_inserter dapat dipakai untuk memasang IUD CuT-380A dengan mudah dan aman. Angka kejadian ekspulsi tertinggi terjadi dalam satu bulan pertama pascapasang dan berhubungan dengan saat pemasangan.Kata kunci: R_inserter, IUD pascasalin, ekspulsi, infeksi, angka kelangsungan. ABSTRACT Background: IUD is one of the most effective and long acting contraception, but the rate of its use in Indonesia is still low. As conventional IUD inserter is too short to deliver it during immediate postpartum (postplacental) period, then the new inserter, R_inserter, is developped.Objective:To find out whether the R_inserter can be used easily to deliver CuT-380A IUD during postpartum period in a standard procedure and to find out its safety.Method: Phase II clinical trial, post-test observation.Materials and Method: The IUD’s used were the conventional CuT-380A with a modification on its inserter namely 9 cm longer, produced by PT Kimia Farma Indonesia. The study was carried out in three hospitals and three community health centers (Puskemas) which were the network of Sardjito teaching hospital, from January 2012 to April 2013. All eligible women needing IUD as their contraception were recruited. IUD insertion was carried out by trained obstetric and gynecology resident or midwives. Follow up was done after 1 week, then 1, 3, 6, 9 and 12months after insertion.The ease of insertion, rate of the following events namely expulsion, infection, pain, bleeding, and continuation were main outcomes of interest.Results and Discussion: During the study period, a total 142 participants were recruited. The mean duration of insertion was 3.89 ± 2.08 minutes (ranged 2 to 10 minutes). No subjective difficulties were perceived by the providers. The cumulative expulsion rate for 1, 3, 6, 9 and 12 months were 9.9%, 9.9%, 10.6%, 10.6% and 10.% consecutively. The rate of expulsion if the IUD was inserted during 10 minutes after placental delivery was 6.2% compared to 24.1% if it was inserted after 10 minutes (RR 3.90; 95% CI 1.37-11.2). Infection, pain, and bleeding were relatively small and could be appropriately managed. The continuation rate for 1, 3, 6, 9 and 12 months were 89.4%, 89.4%, 86.6%, 86.6% and 85.9% consecutively. No pregnancy was found during the study period.Conclussion: The R_inserter could be easily used to deliver a CuT-380A IUD. The rate of expulsion was highest during the first month of insertion and was related to the time of insertion.Keywords: R_ inserter, postpartum IUD, expulsion, infection, continuation rate.1,2,3,4 Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Gadjah Mada/ Sardjito Hospital Yogyakarta5 National Family Planning Board, Jakart
PENGETAHUAN DAN KETERAMPILAN BIDAN UNTUK SKRINING KANKER SERVIKS DENGAN METODE INSPEKSI VISUAL ASAM ASETAT (IVA) DI KALIMANTAN BARAT
Get PDFMardiana1, Djaswadi Dasuki2, Heru Pradjatmo2 ABSTRACT Background: Globally it is estimated that every two minutes a woman dies of cervical cancer and 500,000 women are diagnosed to have cervical cancer each year. In Indonesia, the incidence of cervical cancer is by 12.6 per 100,000 women with a mortality rate of 7 per 100,000. Screening method can reduce the incidence of cervical cancer if done cumulatively in 2012, the coverage of screening with a VIA method in Indonesia was 1.57%, whereas screening coverage with IVA in West Kalimantan Province was 1.06 %Objective: To assess midwives’ knowledge and skills of screening practices with a VIA method in health centers Method: This was an observational study with a cross-sectional study, using quantitative and qualitative approaches. The study was conducted in health centers in the province of West Kalimantan. This study was conducted in September to October 2014. The subjects of research were midwives who served in health centers doing a VIA examination in West Kalimantan who met inclusion and exclusion criteria. The total sample of this study was 42 taken with purposive sampling. The variables of this study were the dependent variable, ie, the practice of screening skills with a VIA method, the independent variable, ie, knowledge, and the extraneous variables, ie, age, education, and years of service. Analysis of the data included univariable, bivariable, multivariable, and qualitative. The quantitative data analysis used the chi-square and logistic regression with a significance level of p <0.05 and an OR value with confidence interval (CI) of 95%.Result & Discussion: The mean value of midwives’ knowledge was 26.0 from assessment scores of 0-30. A mean score of screening practice skills was 94.4 from 38-114. Of clinical assessment scores skill practice of competent midwives with good knowledge was higher than bad knowledge (OR= 6,98 CI 95% 1,21-40,33). After controlling education and years of service variables, good knowledge influenced screening clinical practice by 33%. Conclusion: Most of the midwives in West Kalimantan had good knowledge and skills to perform cervical cancer screening with a VIA method.Keywords: Knowledge, screening practice skills, VIA methods ABSTRAKLatar Belakang: Di seluruh dunia diperkirakan setiap dua menit seorang wanita meninggal karena kanker servik dan sekitar 500.000 wanita di diagnosis kanker seviks setiap tahun. Di Indonesia insiden kanker serviks sebesar 12,6 per 100.000 perempuan dengan angka kematian sebesar 7 per 100.000. Metode skrining dapat menurunkan kejadian kanker serviks jika dilakukan secara kumulatif. Pada tahun 2012 cakupan skrining dengan metode IVA di Indonesia sebesar 1,57%, sedangkan cakupan skrining dengan metode IVA Propinsi Kalimantan Barat sebesar 1,06%.Tujuan: Menilai pengetahuan dan keterampilan praktek skrining bidan dengan metode IVA di puskesmas Metode: Jenis penelitian observasional dengan rancangan cross-sectional study, menggunakan pendekatan kuantitatif dan kualitatif. Penelitian dilakukan di puskesmas di Provinsi Kalimantan Barat. Penelitian ini dilaksanakan bulan September sampai dengan Oktober 2014. Subjek penelitian bidan yang melayani pemeriksaan IVA di puskesmas di Provinsi Kalimantan Barat yang memenuhi kriteria inklusi dan eksklusi. Total sampel penelitian ini 42 sampel dengan pengambilan sampel purposive sampling. Variabel penelitian ini yaitu: variabel terikat adalah keterampilan praktek skrining metode IVA, variabel bebas: pengetahuan, dan variabel luar: usia, pendidikan, dan lama bekerja. Analisis data meliputi: univariabel, bivariabel, multivariabel, dan kualitatif. Untuk analisis data kuantitatif meng-gunakan metode chi square dan logistic regresi dengan tingkat kemaknaan p < 0,05 dan nilai OR dengan Confidence Interval (CI) 95%.Hasil & Pembahasan: Nilai mean pengetahuan bidan sebesar 26,0 dari skor penilaian 0-30. Keterampilan praktik dengan nilai mean 94,4 dari skor 38-114. Keterampilan praktik klinik yang kompeten lebih tinggi pada bidan berpengetahuan baik daripada bidan berpengetahuan kurang (OR= 6,98 CI 95% 1,21-40,33). Pengetahuan baik setelah dikontrol variabel pendidikan dan lama bekerja berpengaruh terhadap keterampilan praktik skrining sebesar 33%.Kesimpulan: Sebagian besar bidan di Kalimantan Barat memiliki pengetahuan baik dan keterampilan yang kompeten untuk skrining kanker serviks dengan metode IVA. Kata Kunci: Pengetahuan, keterampilan praktek skrining, metode IVA 1 Dinas Kesehatan Provinsi Kalimantan Barat2 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakart
HUBUNGAN PEMBELAJARAN KESEHATAN REPRODUKSI REMAJA DENGAN PENGETAHUAN TENTANG NAPZA SISWA SMU DI SURAKARTA
Get PDFHUBUNGAN PEMBELAJARAN KESEHATAN REPRODUKSI REMAJA DENGAN PENGETAHUAN TENTANG NAPZA SISWA SMU DI SURAKARTASoetrisno1, Didon Muhammad Trimulya2 , Slamet Riyanto3ABSTRACTBackground: Narcotics, psychotropic and other addictive substances misuse (drugs abuse) could effect various society segments, mostly young people age 15-24 years. The young generation is a strategic target for drug distribution including illegal trade in Surakarta. Necessary precautions should be taken as it could lead to addiction, could affect on survival, especially the young generation, including senior high school students. Policy to introduce adolescent reproductive health (ARH) education in particular with drugs abuse topic has been enacted in Surakarta since 2012, but had not covered the entire high school.Objective: Observing the correlation between adolescent reproductive health education with knowledge of NAPZA on high school students in Surakarta.Method: This study used an observational analytic with cross sectional design. A total of 120 students were taken by purposive random sampling. Total of 120 students were involved from second grade they consisted 60 students who had been given adolescent reproductive health education for one year (since first grade) and 60 students who had not. Students were given a questionnaire about NAPZA that has been tested for validity and reliability. Data analysis was then performed using chi-square.Results and Discussion: There is a significant correlation between adolescent reproductive health education with knowledge about types, characteristic of high risk youth, sign of addiction, category of drug users, as well as the dangers of drug prevention among high school students in Surakarta (p<0.05).Conclusion: There is a significant correlation between adolescent reproductive health education with knowledge of NAPZA on high school students in Surakarta.Keywords: Knowledge of NAPZA, Adolescent Reproductive Health Education, Youth of Surakarta. ABSTRAKLatar Belakang: Penyalahgunaan Narkotika, Psikotropika, dan Zat adiktif lain (NAPZA) dapat dilakukan oleh berbagai lapisan masyarakat, terbanyak generasi muda 15–24 tahun. Generasi muda adalah sasaran strategis perdagangan gelap NAPZA termasuk di Surakarta. Diperlukan kewaspadaan terhadap bahaya serta pengaruh NAPZA yang dapat menimbulkan ketagihan, dengan dampak terhadap kelangsungan hidup dengan pembinaan, khususnya generasi muda termasuk siswa Sekolah Menengah Umum (SMU). Kebijakan pembelajaran kesehatan reproduksi remaja (KRR) khususnya topik NAPZA telah diberlakukan di Surakarta sejak ajaran baru 2012 sampai sekarang, namun belum mencakup keseluruhan SMU.Tujuan: Mengamati hubungan pembelajaran KRR dengan pengetahuan NAPZA siswa SMU di Surakarta.Metode: Penelitian observasional analitik rancangan cross sectional. 120 subyek penelitian (siswa) diambil secara purposive random sampling. Sebanyak 60 subyek penelitian diambil dari siswa SMU kelas 2 yang sudah mendapatkan pembelajaran KRR selama satu tahun (sejak kelas 1) dan sebanyak 60 subyek penelitian siswa SMU yang belum mendapatkan pembelajaran. Subyek penelitian, baik yang sudah dan belum mendapatkan pembelajaran KRR diberikan kuesioner tentang NAPZA yang sudah diuji validitas dan reliabilitas. Kemudian dilakukan uji chi square.Hasil dan Pembahasan: Terdapat hubungan bermakna pembelajaran KRR dengan pengetahuan tentang jenis, ciri remaja beresiko pengguna, tanda kecanduan, golongan gangguan pengguna, bahaya serta penanggulangan NAPZA siswa SMU di Surakarta (p<0.05).Kesimpulan: Terdapat hubungan bermakna pembelajaran Kesehatan Reproduksi Remaja (KRR) dengan pengetahuan tentang NAPZA siswa SMU di Surakarta.Kata Kunci: Pengetahuan NAPZA, KRR, siswa SMU 1,2 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Negeri Sebelas Maret Surakarta telp:0271-665145/08166725643 Dinas Kesehatan Kota Surakart
PELAYANAN KESEHATAN PEDULI REMAJA MENURUT PERSPEKTIF REMAJA DI KOTA MAGELANG
Get PDF Rohmayanti1, Irwan Taufiqur Rachman2, Wenny Artanty Nisman3 ABSTRACTBackground:Teenagers have greater risk for health problems, especially sexuality and reproduction problems. Government has already developed Adolescent Friendly Health Services (AFHS). This program has already run in primary health care to overcome teenager’s health problems. On the other hand, this program does not seem to accommodate some of teenager’s expectation. Therefore, we need to conduct a research for knowing what kind of health services are suitable with teenager’s perspective. Objective: This study was design to explore type of AFHS which were suitable in adolescent’s perspective. Method: In this qualitative study, phenomenology was used for the approach. This study was conducted from September-October 2014 in primary health care region of Magelang. The participants for this study were 10-19 years old teenagers and they had already received adolescent friendly health services. The participants had been chosen using purposive sampling. The data was collected using focus group discussion, observation and indepth interview. Colaizzi’s analysis had been used for data analysis manually.Result and Discussion: Adolescent’s perspective about AFHS consist of three theme. The first theme was adolescent perspective on existence of AFHS which was still various. The second theme was the perception of adolescents on the AFHS given in adolescents.The result was that not all six AFHS programs were given. The Third theme was adolescents hope for the result was AFHS health workers should be able to provide an explanation of the problems experienced by adolescents, be friendly, and the need to involve youth, teachers, parents and the community in AFHS services. Health Services that are conducted in teenagers, should be confidential,the service time was able to adjust school hours, use short massage, email for communication and information.Conclusion: adolescent’s have various expectations of the AFHS services in the future. Health services in accordance with the expectations of adolescents can be developed as a modified form of health care that can be implemented in AFHS primary health care.Keywords: Adolescent Friendly Health Services (AFHS), Adolescent.ABSTRAKLatar Belakang: Remaja sangat rentan terhadap berbagai ancaman risiko kesehatan terutama seksual dan reproduksi. Pemerintah telah mengadakan program Pelayanan Kesehatan Peduli Remaja (PKPR) yang dilaksanakan di puskesmas untuk mengatasi masalah kesehatan remaja. Program PKPR yang sudah berjalan, belum mengakomodir kepentingan remaja, sehingga perlu diketahui bagaimana pelayanan kesehatan peduli remaja yang sesuai dengan perspektif remaja.Tujuan: Mengetahui pelayanan kesehatan peduli remaja (PKPR) menurut perspektif remaja.Metode:Penelitian kualitatif dengan pendekatan fenomenologi. Subjek penelitian adalah remaja usia 10-19 tahun yang telah mendapatkan pelayanan kesehatan peduli remaja, dipilih secara purposive sampling. Pengumpulan data dengan cara FGD, observasi dan wawancara. Analisa data dilakukan secara manual, menggunakan tahapan analisa data menurut Colaizzi (1978). Penelitian dilakukan pada bulan September-Oktober 2014, di puskesmas wilayah Kota Magelang. Hasil dan Pembahasan: Perspektif remaja tentang PKPR terdiri atas tiga tema. Pertama, persepsi remaja tentang keberadaan PKPR masih sangat variatif. Kedua, persepsi remaja tentang program PKPR yang diberikan pada remaja, bahwa dari 6 program PKPR belum semua diberikan. Ketiga, harapan remaja terhadap PKPR ke depan bahwa petugas kesehatan harus mampu memberikan penjelasan tentang masalah yang dialami remaja, berlaku seperti sahabat, dan perlu melibatkan remaja, guru BP/UKS, orangtua serta masyarakat dalam pelayanan. Pelayanan dilakukan di tempat remaja berada, yang terjaga kerahasiaannya, waktu pelayanan menyesuaikan jam sekolah, perlu pemanfaatan sms, email untuk komunikasi dan informasi pada remaja. Kesimpulan: Remaja memiliki berbagai harapan terhadap PKPR di masa depan. Pelayanan kesehatan yang sesuai dengan harapan remaja dapat dikembangkan sebagai bentuk modifikasi pelayanan kesehatan peduli remaja yang dapat diterapkan di puskesmas. Kata Kunci: Pelayanan Kesehatan Peduli Remaja (PKPR), remaja. 1 Fakultas Ilmu Kesehatan, Universitas Muhammadiyah Magelang2 Bagian Obstetri Ginekologi, Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta3 Program Studi Magister Keperawatan, Universitas Gadjah Mada Yogyakarta
PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI
Get PDFPERBANDINGAN LUARAN SEKSIO SESAREA DENGANANESTESI UMUM DAN SPINAL: PERUBAHAN KADARHEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYIIfrinda Giantari, Ibnu Pranoto, Risanto SiswosudarmoABSTRACTBackground: Cesarean section is the most common surgical procedure in obstetrics. In 2008, nearly a third ofdeliveries was done by cesarean section. Two types of anestesi are used in cesarean section i.e., general andregional anestesi with their advantages and disadvantages. General anestesi is often used in emergency casesbut is often associated with greater risk of blood loss during surgery and depression of central nervous system ofthe newborn. Based on these facts, the decision of the type of anesthesia for cesarean section is still debated.Objective: To compare the effects between general and spinal anestesi in the alteration of maternal hemoglobinand hematocrit levels and the neonatal Apgar score.Method: This study was conducted at Setjonegoro Hospital Wonosobo, Banjarnegara, and Sardjito HospitalYogyakarta between September to December 2010. Patients undergoing cesarean section, who met inclusionand exclusion criteria were included in this study. Hemoglobin and hematocrit levels before and 6-12 hours aftersurgery were recorded, as well as the first minute Apgar score. Chi-square and t-test were used for statisticalanalysis.Results and Discussion: A total of 114 patients consisting of 59 cases for general anestesi and 55 for spinalgroups were recruited. They were comparable in terms ofmaternal age, age of gestation, parity, BMI and indicationof operation. Hemoglobin and hematocrit levels before surgery were also comparable.The decrease of hemoglobin level after operation in the group of general anesthesia was greater than in thespinal group (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d; p=0,00). The same was seen in the decrease of hematocritlevel (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). There were 28 cases of asphyxia in the group of general comparedto 22 cases in the group of spinal anestesi, but it was not statistically different (RR 1,16; 95% CI 0,81-1,65).Conclusion: The decreased level of hemoglobin and hematocrit after cesarean section in general anesthesia werehigher than spinal anesthesia group, although the difference was not clinically significant. There was no significantdifference in the incidence of asphyxia at first minute in both groups.Keywords: general anestesi, spinal anesthesia, cesarean section, hemoglobin, hematocrit, Apgar score ABSTRAKLatar belakang: Seksio sesarea merupakan prosedur operatif obstetri yang paling sering dilakukan. Pada tahun2008, hampir sepertiga dari persalinan dilakukan dengan cara seksio sesarea. Dua jenis anestesi sering digunakanyakni anestesi umum dan spinal yang masing-masing mempunyai kelebihan dan kekurangannya. Anestesi umumsering digunakan pada kasus kedaruratan meskipun sering dikaitkan dengan risiko kehilangan darah yang lebihbesar dan penekanan pada susunan syaraf pusat bayi. Anestesi spinal sering dikaitkan dengan keadaan hipotensimaternal.Tujuan: Membandingkan penurunan kadar hemoglobin dan hematokrit ibu dan skor Apgar bayi pada seksiosesarea dengan anestesi umum dan spinal.Metode: Kohort prospektif.Penelitian dilakukan di RS Setjonegoro Wonosobo, RS Banjarnegara, dan RS Sardjitopada bulan September sampai Desember 2010. Pasien yang menjalani seksio sesarea dan memenuhi kriteriainklusi dan eksklusi dimasukkan dalam penelitian ini. Sampel penelitian diikuti sesuai dengan kelompok jenisanestesi. Kadar hemoglobin dan hematokrit sebelum operasi dan 6-12 jam sesudah operasi serta skor Apgar 1menit dicatat. X-square dan t-test dipakai untuk analisis data.Hasil dan Pembahasan: Sebanyak 114 kasus seksio sesarea memenuhi kriteria kelayakan, yang terdiri dari 59kasus kelompok anestesi umum dan 55 kasus anestesi spinal. Kedua kelompok komparabel dalam hal umur,umur kehamilan, paritas BMI dan indikasi operasi. Demikian juga kadar hemoglobin dan hematokrit sebelumoperasi, tidak menunjukkan perbedaan yang bermakna. Penurunan kadar hemoglobin setelah operasi padakelompok anestesi umum lebih besar dibanding kelompok spinal (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d;p=0,00), demikian juga penurunan kadar hematocrit (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). Pada penilaianmenit pertama terdapat 28 kasus asfiksia (skor Apgar < 6) pada kelompok anestesi umum dan 22 kasus padakelompok anestesi spinal (RR 1,16, 95%CI 0,81-1,65), tetapi tidak bermakna secara statistik (p=0,42).Kesimpulan: Terdapat penurunan kadar hemoglobin dan hematokrit ibu yang bermakna pada kelompok yangmenjalani seksio sesarea dengan anestesi umummeskipun secara klinis tidak bermakna. Tidak terdapat perbedaanbermakna secara statistik pada kejadian asfiksia pada menit pertama.Kata kunci: anestesi umum, anestesi spinal, seksio sesarea, hemoglobin, hematokrit, skor Apga
PERSEPSI REMAJA TERHADAP FAKTOR PENGHAMBAT PEMANFAATAN PELAYANAN KESEHATAN REPRODUKSI DI PUSKESMAS GAMBOK KABUPATEN SIJUNJUNG
Get PDFPERSEPSI REMAJA TERHADAP FAKTOR PENGHAMBATPEMANFAATAN PELAYANAN KESEHATAN REPRODUKSIDI PUSKESMAS GAMBOK KABUPATEN SIJUNJUNGVella Dwi Yani, Ova Emilia, Hari KusnantoABSTRACTBackground: Reproductive health service is an important component that has to be improved globally becauseteenagers often lack basic information about reproductive health. Despite the need for reproductive health serviceonly a few teenagers utilize the service due to several constraints in having reproductive and sexual health serviceas a result of limited access to the service and negative perception about center of reproductive health service.Data of Sijunjung District Health Office Sumatera Barat show that only 20% of teenagers utilize reproductivehealth service available. Whereas cases in teenagers indicate that 9.2% of teenagers have had premarital sexualintercourse and 40% are married at teenage period (<20 years) and 10% is caused by unwanted pregnancy.Objective: To study the perception of teenagers about physical, process, economic and psychosocial factors asobstacles in the utilization of reproductive health service.Method: The study was observational with cross sectional design and descriptive quantitative approach thatused qualitative data obtained from indepth interview. Subject of the study were students of SMU 1 and 2 of 14-16 years old around the working area of Health Centers that have health service for teenagers with as many as131 respondents.Result and Discussion: Perception of teenagers about physical, process and economic factors showed that themajority had good perception so these factors were not obstacles for teenagers in utilizing reproductive healthservice. The majority of teenagers (68%) had bad perception about psychosocial factor so this was an obstacle inthe utilization of reproductive health service.Conclusion: Obstacles in the utilization of reproductive health service at the health center were caused bypsychosocial factor because of shame and unwillingness to tell the problem to staff that was considered asstrangers. Teenagers also doubted the confidentiality of the problem they told to the staff.Keywords: perception, teenagers, reproductive health, utilizationABSTRAKLatar belakang: Pelayanan kesehatan reproduksi merupakan komponen penting yang harus diperbaiki secaraglobal. Remaja sering kali kekurangan informasi dasar tentang kesehatan reproduksi. Meskipun kebutuhanpelayanan kesehatan reproduksi tinggi namun pemanfaatannya masih rendah karena berbagai hambatanmemperoleh pelayanan dan juga adanya persepsi negatif terhadap pusat pelayanan kesehatan reproduksi. Datadari dinas Kesehatan kabupaten Sijunjung Sumatera Barat menunjukkan hanya 20% remaja yang memanfaatkanpelayanan kesehatan reproduksi. Sedangkan kasus dan masalah kesehatan reproduksi menunjukkan 9,2% sudahberhubungan seks sebelum menikah, dan 40% menikah pada usia remaja (<20 tahun) serta 10% mengakibatkankehamilan tak dikehendaki.Tujuan: Untuk mempelajari persepsi remaja terhadap faktor fisik, proses, ekonomi dan psikososial untukmemanfaatkan pelayanan kesehatan reproduksi remaja.melalui wawancara mendalam.Subyek penelitian adalah siswa SMA kelas 1 dan 2 usia 14-16 tahun di wilayahkerja puskesmas sebanyak 131 responden.Hasil dan Pembahasan: Mayoritas remaja memiliki persepsi baik terhadap faktor fisik, proses, dan ekonomi. Tigafaktor bukanmerupakan penghambatmemperoleh layanan kesehatan reproduksi. Sementara itu faktor psikososialdianggap sebagai penghambat (68%) untuk memanfaatkan pelayanan kesehatan reproduksi.Kesimpulan: Hambatan pemanfaatan layanan kesehatan reproduksi adalah faktor psikososial karena malu dantidak percaya untuk menceritakan masalah pada petugas kesehatan yang tidak dikenal. Remaja juga meragukankerahasiaan masalah yang diungkapkan.Kata kunci: persepsi, remaja, kesehatan reproduksi, pemanfaata
PAJANAN ASAP DALAM RUMAH TERHADAP KEJADIAN ISPA NONPNEUMONIA PADA ANAK BALITA DI KABUPATEN KAPUAS
Get PDFPAJANAN ASAP DALAM RUMAH TERHADAP KEJADIANISPA NONPNEUMONIA PADA ANAK BALITA DI KABUPATENKAPUASMayae Hugo, Ova Emilia,Mei Neni SitaresmiABSTRACTBackground: Acute respiratory infections (ARI) is one of themain causes of disease burden in developing countries,and 40-60% patients visits at the health center. Riskesdes analysis report the under–five children who suffer fromupper respiratory tract infection prevalence 42.8%. ARI occurrence is affected by many factors, includingenvironmental factors. Little attention has been given to indoor air pollution particularly for people in ruralareas, although the known particles of smoke in the room known as the most influential factors on the health ofchildren where children spend most of their time indoorsObjective: To know whether smoke exposure inside the house is a risk factor toward non pneumonia ARI amongunder-five children.Method: This was a study using a case control study design. Subjects were under-five children aged 12-59 monthsold in Kapuas District taken by non probability sampling method. Sample size was 106, divided into two groupsnamely case (n=53) and control (n=53). Data analysis used univariate analysis, bivariate analysis, and multivariateanalysis with logistic regression.Result: Non pneumonia ARI had a 2.7 time greater risk of contracting under-five children exposed by smokeinside their house (95%CI=1.16-6.60). Multivariate analysis proportion of house condition which was not reallyhygienic, member of family who contracted ARI, bad nutritional status had a significant relationship to nonpneumonia ARI among under-five children.Conclusion: Non pneumonia ARI among under-five children had a significant relationship to smoke exposureinside the house.Keywords: non pneumonia ARI, smoke exposure inside the house, under-five children ABSTRAKLatar Belakang: Infeksi saluran pernapasan akut (ISPA) merupakan salah satu penyebab utama beban penyakit dinegara berkembang. Terdapat 40-60% kunjungan pasien di pusat layanan kesehatan. Analisis Riskesdesmelaporkanprevalensi anak-anak balita yang menderita infeksi saluran pernapasan atas 42,8%. Kejadian ISPA dipengaruhioleh banyak faktor, termasuk faktor lingkungan. Sedikitnya perhatian yang diberikan terhadap polusi udara dalamruangan terutama bagimasyarakat di daerah pedesaan,meskipun partikel yang berasal dari asap di dalam ruangandikenal sebagai faktor yang paling berpengaruh pada kesehatan anak di mana anak-anak menghabiskan sebagianbesar waktu mereka di dalam ruangan.Tujuan: Untuk mengetahui apakah paparan asap di dalam rumah merupakan faktor risiko terhadap non pneumoniaISPA pada balita.Metode: Penelitian ini merupakan penelitian dengan menggunakan disain penelitian kasus kontrol. Subyekpenelitian adalah balita berusia 12-59 bulan di Kabupaten Kapuas diambil dengan metode non probabilitysampling. Jumlah sampel adalah 106, dibagi menjadi dua kelompok yaitu kelompok kasus (n=53) dan kelompokkontrol (n=53). Analisis data yang digunakan analisis univariat, analisis bivariat, dan analisis multivariat denganregresi logistik. Hasil dan Pembahasan: ISPA non pneumonia memiliki risiko 2,7 kali lebih besar menjangkiti anak yang terpaparasap di dalam rumah mereka (95% CI=1,16-6,60). Proporsi analisis multivariabel kondisi rumah yang tidak benarbenarhigienis, anggota keluarga yang terjangkit ISPA, status gizi buruk memiliki hubungan yang signifikan terhadapISPA non pneumonia pada balita.Kesimpulan: ISPA non pneumonia pada balita memiliki hubungan yang signifikan terhadap paparan asap di dalamrumah.Kata kunci: ISPA non pneumonia, paparan asap di dalam rumah, balit
Hubungan Pemakaian Antibiotik dengan Kejadian Infeksi Sectio Caesarea pada Pasien di RSUD Abepura Jayapura Papua
Get PDFBackground: The number of caesarean section (CS) operations in the world has increased sharply within the last 20 years. Increase of the need for CS operations also increases the problem related to surgical process. Infection happens about 2% to 16% after CS operation. The incidence of post CS is associated with some factors such as supplementation of prophylaxis antibiotics, duration of childbirth, width of membrane wound, duration of surgical nursing monitoring and number of CS. CS infection associated with antibiotic use occurs before or after CS operation. The incidence increases 3 times in patients that do not use antibiotics before CS operation. Use of prophylaxis antibiotics in CS operation significantly minimizes the incidence of infection.Objective: To identify antibiotic use according to standard operational procedure to the incidence of infection in CS mothers.Method: The study was analytical with cross sectional design, undertaken at Abepura Local Hospital. Population were all mothers who gave birth through CS at the hospital. Samples were taken using systematic random sampling technique as many as 44 samples. Data were obtained through questionnaire, interview and document studies and analyzed using chi square and logistic regression test, risk prevalence at confidence interval (CI) 95% and significance p<0.05.Result: The majority of subject (56.82%) had no infection; 59.09% used antibiotics according to the procedure; 52.27% had good nutrition status; 54.55% had emergency operation; 50% had anemia. Average length of CS operation was 2.26 +1.38 hours. There was significant association between antibiotic use, nutrition status, Hb level, and types of operation and the incidence of CS infection (p<0.05). The result of multivariate analysis showed there was significant association between antibiotic use, nutrition status, types of operation and the incidence of infection. Use of antibiotic brought dominant risk for the incidence of CS infection (PR=2.36; 95% CI=1.45-3.38) whereby antibiotic use, nutrition status and types of operation could predict the incidence of CS infection as much as 10.7%.Conclusion: The majority of subject had no infection and used antibiotic according to the procedure. The probability for the incidence of CS infection was greater in antibiotic use irrelevant with the procedure. Factor most dominantly affecting the incidence of CS infection was antibiotic use irrelevant with the procedure. Keywords: antibiotic use, caesarean section, incidence of infectio
DENSITAS MASSA TULANG PADA PENGGUNA KONTRASEPSI IMPLAN LEVONORGESTREL
Get PDFDENSITAS MASSA TULANG PADA PENGGUNA KONTRASEPSI IMPLAN LEVONORGESTREL Andriana Kumala Dewi1 , Djaswadi Dasuki2, Diah Rumekti Hadiati3 ABSTRACT Background: BKKBN reported that implant as a long term method of contraception was the most widely used among new users in 2012. The contraceptive action is mainly by inhibition of ovulation and production of estrogen is supressed. Estrogen is one of the most important factors related to bone remodelling. Thus, it has raised concerns regarding the adverse effect of long term use of this contraceptive method on the bone status of women who use them. So, it is necessary to study the effects of long term use of progestogens on bone mineral density.Objective: Comparing bone mass density in contraceptive implant users and non-hormonal users.Methods: Cross sectional study. This study was conducted in Kontap, outpatient department, Sardjito Hospital in August-December 2013. The participants’ age were 20-50 years who met the inclusion criteria and regardless of the exclusion criteria. Total of 110 women were divided into 2 groups, contraceptive implant users and non-hormonal contraceptive users. Bone mass density was measured using ultrasound densitometry on the calcaneus bone.Results: Bivariate Chi-square analysis showed that there was no significant association between the use of the contraceptive implant with incidence of abnormal bone density (RP 1.75; 95% CI (0.80-3.83), p = 0.23). BMI as confounding variable provide a significant relationship with bone density with OR 23.24; 95% CI (4.26 to 126.86), p <0.001Conclusion: In this study, there was no significant difference of bone mass density between contraceptive implant group and non hormonal group. BMI were significantly related to bone mass density. Keyword: Bone mineral density, contraceptive implant, contraceptive progestin-only, levonorgestrel ABSTRAK Latar belakang: Data BKKBN menunjukkan bahwa implan merupakan metode kontrasepsi jangka panjang terbanyak dipakai oleh peserta baru KB tahun 2012. Cara kerja utama implan levonorgestrel dengan inhibisi ovulasi sehingga terjadi supresi produksi estrogen. Estrogen adalah salah satu faktor penting dalam remodelling tulang. Hal inilah yang memunculkan kekhawatiran tentang pengaruh penggunaan implan terhadap status kesehatan tulang pemakainya.Tujuan: Membandingkan densitas massa tulang pada pengguna kontrasepsi implan levonorgetrel dan non hormonal.Metode penelitian: Studi potong lintang. Penelitian dilakukan di Poliklinik Kontap, RSUP Dr. Sardjito. Jumlah peserta penelitian 110 wanita berusia 20-50 tahun yang memenuhi kriteria inklusi dan terlepas dari kriteria eksklusi, terbagi menjadi 2 kelompok, yaitu kelompok pengguna kontrasepsi implan dan pengguna kontrasepsi non hormonal. Densitas massa tulang diukur dengan menggunakan alat densitometri ultrasonografi pada tulang kalkaneus.Hasil: Analisis bivariat Chi-square menunjukkan bahwa tidak ada hubungan bermakna antara penggunaan kontrasepsi implan dengan kejadian densitas tulang yang tidak normal (RP 1,75; IK 95% (0,80-3,83), p=0,23). BMI sebagai variabel luar memberikan hasil analisis yang bermakna terhadap kejadian densitas tulang tidak normal dengan nilai OR 23,24; IK 95% (4,26-126,86), p<0,001.Kesimpulan: Tidak ada perbedaan densitas massa tulang yang bermakna antara kelompok pengguna kontrasepsi implan dan non hormonal. BMI kategori underweight secara signifikan memiliki hubungan dengan kejadian densitas tulang tidak normal. Kata kunci: densitas massa tulang, kontrasepsi implan, kontrasepsi progestin-only, levonorgestrel 1,2,3 Bagian Obstetri dan Ginekologi FK UGM/RSUP Dr.Sardjito Yogyakart
PEMANFAATAN POJOK LAKTASI DI PUSKESMAS I CILONGOK KABUPATEN BANYUMAS
Get PDFPEMANFAATAN POJOK LAKTASI DI PUSKESMAS I CILONGOKKABUPATEN BANYUMASKhusnul Khotimah, Ova Emilia,Mohammad HakimiABSTRACTBackground : Based on survey Indonesian demographic and health in 2007 that exclusive breastfeeding 38 %decrease from 39,5% in 2002-2003, child under 6 months who gets milk incease from 16,7% until 27,9% in2007. American Academy of Pediatrics (1)get recomendation baby must get exclusive breastfeeding in 6 monthuntil 2 years old. Banyumas regency are have a program to increase scope of exclusive breastfeeding by regulationof regent number 52 in 2012 about increase exclusive breastfeeding in Banyumas Regency. One of the material insocialization is about lactation room and standardization, right of women worker to breastfed in office, publicfacility.Objective : to determine factors can effected utilization of lactation room in Puskesmas I Cilongok.Methods : this study was an observational study with a cross sectional design and qualitative study or called mixmethod. Location of study in Puskesmas I Cilongok. Sample of this study is employed mother who breastfeedand visitors of Puskesmas I Cilongok in Banyumas Regency. Sampling method used sampling convinience get 41women until this study done. independent variable are attitude of breastfeed mother about lactation room andbehavior of breastfeed mother. Dependent variable is utilization of lactation room. Data analysis consisted ofunivariable analysis, bivariable analysis using chi-square test and multivariable analysis using logistic regressiontest and also qualitative analysis.Results and Discussion : there is no effect attitude of breastfeed mother about lactation room with utilization oflactation room, can we see from p = 0,247 (RP1,58; 95% CI 0,70-3,55), the similar result from dialogue thatmother have good attittude but not utilized, they say not get socialization from health worker. The good Behaviorbreastfeed mother have relation with utilization, can we see p = 0,028, RP2,35 (95% CI 1,05-5,23). Results fromdialogue mother who get bad behavior not utilized. Utilization in lactation room only just breastfeeding, neverused to pamp and saving breastmilk. People not respond that room lactation is a necessary, because withoutpolicy about room lactation, they are can breastfed in any where.Conclusion : Good attitude of breastfeed mother about lactation room can not get effect utilization of lactationroomand good behavior breastfeedmother can get effect with utilization lactation room in Puskesmas I Cilongok.Keyword: attitude breastfeed mother, behavior breastfeed mother and utilization lactation room ABSTRAKLatar Belakang:Berdasarkan data Survey Demografi dan Kesehatan Indonesia (SDKI) tahun 2007 tercatat bahwacakupan ASI eksklusif sebesar 38% menurun dari 39,5%di tahun 2002-2003, sementara jumlah bayi dibawah 6bulan yang diberi susu formula meningkat dari 16,7% menjadi 27,9% ditahun 2007. American Academy ofPediatrics (1)merekomendasikan bahwa durasi minimal ASI eksklusif menjadi 6 bulan tetapi optimal harus terusselamaminimal 2 tahun.Kabupaten Banyumas sedangmemiliki program gunameningkatkan cakupan ASI eksklusifyang dituangkan lewat Peraturan Bupati Banyumas nomor 52 tahun 2012 tentang peningkatan pemberian ASI diKabupaten Banyumas. Salah satu materi sosialisasi tersebut berisi tentang anjuran pengadaan pojok laktasibeserta standarisasinya, hak ibu bekerja yang menyusui di kantor pemerintahan, sarana pra sarana umum juga.Tujuan:Untuk mengetahui faktor-faktor yang mempengaruhi pemanfaatan pojok laktasi di Puskesmas I Cilongok.Metode:Penelitian ini menggunakan jenis observasional dengan desaincross sectionaldan kualitatif. Tempatpenelitian Puskesmas I Cilongok. Sampel penelitian ibu bekerja menyusui dan pengunjung puskesmas memilikibayi umur 0 bulan sampai dengan 2 tahun berada di Puskesmas I Cilongok. Pengambilan sampel menggunakansampling conviniencediperoleh 41 orang selama penelitian dilakukan.Variabelindependen adalah sikap ibumenyusui terhadap pojok laktasi, perilaku ibu menyusui. Variabel dependen ialah pemanfaatan pojok laktasi.Analisa data meliputi analisis univariabel, bivariabeldengan menggunakan chi square sedangkan multivariabelmenggunakan uji regresi logistik serta analisis kualitatif.Hasil dan Pembahasan:Sikap ibu menyusui terhadap ketersediaan pojok laktasi tidakmempengaruhi pemanfaatanpojok laktasi dilihat dari nilai p = 0,247 (RP1,58; 95% CI 0,70-3,55), hasil ini didukung hasil wawancara bahwasikap baik tetapi tidak memanfaatkan pojok laktasi dengan alasan sosialisasi yang kurang dari petugas kesehatan.Perilaku ibu menyusui yang baik berhubungan dengan pemanfaatan pojok laktasi dilihat dari nilai p = 0,028,RP2,35 (95% CI 1,05-5,23). Hasil wawancara ibu yang berperilaku tidak baik cenderung tidak memanfaatkanpojok laktasi. Pemanfaatan pojok laktasi hanya untuk menyusui saja, tidak digunakan untuk memeras danpenyimpanan ASI. Rendahnya pemanfaatan pojok laktasi dikarenakan faktor kebutuhan. Masyarakat desa tidakmenganggap bahwa pojok laktasi merupakan kebutuhan, karena tanpa adanya kebijakan pengadaan pojok laktasimereka dapat menyusui dimanapun.Kesimpulan:sikap ibu menyusui terhadap ketersediaan pojok laktasi yang baik tidak mempengaruhi pemanfaatanpojok laktasi dan perilaku ibu menyusui yang baik dapat mempengaruhi pemanfaatan pojok laktasi di PuskesmasI Cilongok Kabupaten Banyumas.Kata kunci: sikap ibu, perilaku ibu, pemanfaatan pojok laktas