EFEK INTERVENSI NUTRITION EDUCATION PADA IBU HAMIL TERHADAP PRAKTIK EXCLUSIVE BREASTFEEDING DAN PERTUMBUHAN BAYI

Sri Wahyuni, Prof. dr. Moh. Hakimi, PhD., Sp.OG (K).; Prof. dr. Madarina Julia, MPH., SpA (K)., Ph.D.; Prof. Dra. Yayi Suryo Prabandari, M.Si., Ph.D.

2018 | Disertasi | S3 Kedokteran Umum

Latar belakang: Jumlah kematian anak-anak kurang dari lima tahun hampir 11 juta setiap tahun, sekitar empat juta kematian terjadi dalam 28 hari setelah kelahiran dan 35% sampai 53% dari semua kematian dikaitkan dengan malnutrisi. Sekitar 1,5 juta dan 10% kematian per tahun disebabkan kurangnya pemberian ASI awal (inisiasi menyusu dini/IMD) dan eksklusif pada bayi. Intervensi nutrition education berupa professional education dapat mengaktifkan profesional kesehatan dalam mempromosikan informasi pengambilan keputusan menyusui oleh ibu hamil yang pada akhirnya akan meningkatkan angka menyusui (inisiasi, eksklusivitas, dan durasi). Tujuan: Menilai perbedaan pengetahuan dan keterampilan breastfeeding counseling tenaga kesehatan setelah mendapatkan intervensi, dan menilai perbedaan pengetahuan breastfeeding, niat EBF, dukungan profesional, prenatal self efficacy, pelaksanaan IMD, self efficacy, attitude, praktik breastfeeding, hambatan yang dihadapi saat breastfeeding, praktik EBF, durasi breastfeeding dan pertumbuhan status gizi bayi antara kelompok subjek ibu intervensi dengan kelompok kontrol. Metode: Pada tahap pertama dilakukan penelitian observasional terhadap tenaga kesehatan dan ibu hamil trimester III sebagai kelompok kontrol. Pada tahap kedua dilakukan penelitian quasi experiment dengan non-equivalent control group design dengan rancangan pre-test and post-test pada kelompok tenaga kesehatan dan the posttest only control group design pada kelompok ibu hamil. Untuk melihat efektivitas penerapan intervensi dilakukan uji komparatif, dengan membandingkan indikator intervensi antar kelompok perlakuan dengan kelompok kontrol dengan menggunakan T test, uji one way ANOVA dan post hoc, dan uji chi-square pada taraf signifikansi 95% (p < 0,05). Hasil: Setelah mendapatkan intervensi professional education, tenaga kesehatan memiliki perbedaan rerata skor pengetahuan breastfeeding 26,85 (19,94-33,76) dan keterampilan breastfeeding counseling, 13,17 (25,85-36,48) lebih tinggi, dibandingkan dengan sebelum mendapat intervensi. Kelompok subjek ibu yang mendapatkan intervensi mother education skor pengetahuan breastfeeding, niat EBF, dukungan profesional, prenatal self efficacy, pelaksanaan IMD, self efficacy, attitude, praktik breastfeeding, praktik EBF, durasi breastfeeding dan pertumbuhan status gizi bayi pada kelompok intervensi lebih tinggi daripada kelompok kontrol, sedangkan skor hambatan yang dihadapi saat breastfeeding pada kelompok intervensi lebih rendah daripada kelompok kontrol. Kesimpulan: Terdapat perbedaan pengetahuan breastfeeding, niat EBF, dukungan profesional, prenatal self efficacy, pelaksanaan IMD, self efficacy, attitude, praktik breastfeeding, hambatan pada saat breastfeeding, praktik EBF, durasi breastfeeding dan pertumbuhan status gizi bayi antar kelompok.

Background: The number of child deaths less than five years is almost 11 million annually, about four million deaths occur within 28 days after birth and 35% to 53% of all deaths are associated with malnutrition. Approximately 1.5 million and 10% deaths per year are due to the lack of early breastfeeding initiation and exclusive breastfeeding to infants. Nutrition education interventions in the form of professional education can enable health professionals to promote breastfeeding decision making information by pregnant women which will ultimately increase breastfeeding rates (initiation, exclusivity, and duration). Objective: Assessing differences in knowledge and skills of breastfeeding counseling of health personnel after obtaining interventions, and assessing differences in breastfeeding knowledge, EBF intentions, professional support, prenatal self-efficacy, early breastfeeding initiation implementation, self efficacy, attitude, breastfeeding practices, obstacles faced during breastfeeding, EBF practice , duration of breastfeeding and growth of infant nutritional status between maternal intervention group and control group. Method: In the first stage, an observational study of health workers and trimester Pregnant women of third trimester as a control group was conducted. In the second phase, a quasi experiment was conducted with non-equivalent control group design with pre-test and post-test design in the health worker group and the posttest only control group design in the group of pregnant women. In order to see the effectiveness of intervention implementation, comparative test was done by comparing the intervention indicator between treatment group and control group using T test, one way ANOVA and post hoc test, and chi-square test at 95% significance level (p <0,05). Results: After the intervention of professional education, health workers had a Mean difference breastfeeding knowledge score of 26.85 (19.94-33.76) and breastfeeding counseling skills, 13.17 (25.85-36.48) before getting an intervention. Maternal subjects who received mother education interventions breastfeeding knowledge scores, EBF intentions, professional support, prenatal self-efficacy, early breastfeeding initiation implementation, self efficacy, attitude, breastfeeding practice, EBF practice, breastfeeding duration and growth of infant nutritional status in the intervention arm were higher than the group control, while the barrier scores encountered during breastfeeding in the intervention group were lower than in the control group. Conclusions: There is a difference in breastfeeding knowledge, EBF intentions, professional support, prenatal self efficacy, early breastfeeding initiation implementation, self efficacy, attitude, breastfeeding practices, breastfeeding barriers, EBF practice, breastfeeding duration and growth of infant nutritional status between groups.

Kata Kunci : Intervensi professional education, mother education, prenatal breasfeeding education,, Intervention of professional education, mother education, prenatal breasfeeding education, breastfeeding counseling