HUBUNGAN KUALITAS PELAYANAN KUNJUNGAN NEONATAL PERTAMA (KN1) DENGAN KEMATIAN NEONATAL: ANALISIS DATA SDKI 2017

RIZKA AZIZA DARWIS, Prof. dr. Mohammad Hakimi, SpOG(K)., Ph.D., Dr. Drs. Abdul Wahab, MPH.

2020 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Lebih dari separuh kematian bayi di Indonesia terjadi pada periode neonatal. Berbagai upaya telah dilakukan untuk menurunkan angka kematian neonatal (AKN), salah satunya melalui kunjungan neonatal (KN). Meskipun cakupan kunjungan neonatal pertama (KN1) telah melebihi target Kementerian Kesehatan, namun penurunan AKN masih berjalan lambat. World Health Organization (WHO) mensinyalir peningkatan cakupan pelayanan sering tidak memberikan hasil yang diharapkan karena pelayanan yang diberikan tidak cukup berkualitas. Tujuan: Menguji hubungan kualitas pelayanan KN1 dengan kematian neonatal di Indonesia. Metode: Penelitian menggunakan data sekunder Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2017 yang dianalisis dengan desain kohort retrospektif. Sampel penelitian adalah kelahiran hidup 2 tahun sebelum survei dari wanita 15-49 tahun yang memenuhi kriteria inklusi dan eksklusi sebanyak 6.561 bayi lahir hidup. Hubungan kualitas KN1 dan variabel bebas lainnya dengan kematian neonatal dianalisis dengan uji chi square dan regresi poisson. Hasil: Bayi yang tidak mendapatkan pelayanan KN1 (aRR=63,64; 95%CI=8,57-472,7) dan bayi yang mendapatkan pelayanan KN1 tidak berkualitas (aRR=21,01; 95%CI=2,82-156,4) berisiko lebih tinggi untuk mengalami kematian neonatal dibandingkan dengan bayi yang mendapatkan pelayanan KN1 berkualitas setelah mengontrol variabel frekuensi ANC, karakteristik persalinan, berat lahir dan jenis kelamin bayi. Mayoritas (71%) bayi yang mendapatkan KN1 berkualitas adalah bayi yang berada di regional Jawa, Bali dan NTB. Bayi berat lahir rendah (BBLR) (aRR=15,93; 95%CI=8,24-30,80) dan bayi laki-laki (aRR=2,39; 95%CI=1,32-4,34) berisiko lebih tinggi untuk mengalami kematian neonatal. Kesimpulan: Kualitas KN1, berat lahir dan jenis kelamin bayi berhubungan dengan kematian neonatal di Indonesia. Upaya pencegahan kematian neonatal hendaknya difokuskan pada peningkatan kualitas pelayanan KN1, pencegahan dan perawatan BBLR serta peningkatan akses pelayanan kesehatan ibu dan anak terutama di wilayah Indonesia bagian timur.

Background: More than half of infant deaths in Indonesia occured in the neonatal period. Various efforts have been made to reduce neonatal death, one of those efforts throughed neonatal visit. The coverage of the first neonatal care has exceeded the Ministry of Health's target but the decrease in neonatal death remain slow. World Health Organization (WHO) indicated the increase in coverage often has not translated in the expected result due to the inadequacies in the quality of care. Objective: To asses the association between the quality of first neonatal visit with neonatal death in Indonesia. Methods: We conducted secodary analysis of the 2017 Indonesian Demographic and Health Survey (IDHS) which was analyzed with retrospective cohort design. We analyzed 6,561 last born children to women age 15-49 in the 2 years before the survey. The association between the quality of first neonatal visit and other independen variables with neonatal death were analyzed by chi square test and poisson regression. Results: Newborns who did not recieve first neonatal visit services (aRR= 63.64; 95% CI=8.57-472.7) and newborns who received poor-quality of first neonatal visit services (aRR=21.01; 95%CI=2.82-156.4) had higher risk of neonatal death compared with newborns who received good-quality of first neonatal visit services by controlling for frequency of antenatal care, delivery characteristics, birth weight and infant sex. The majority (71%) of newborns who received good-quality of first neonatal services were newborns in Java, Bali and NTB region. Low birth weight (LBW) infants (aRR=15.93; 95%CI=8.24-30.80) and male infants (aRR=2.39; 95%CI=1.32-4.34) had higher risk of neonatal death. Conclusion: Quality of first neonatal visit services, birth weight and infants sex were associated with neonatal death in Indonesia. Efforts to prevent neonatal deaths should be focused on quality of first neonatal visit improvement, prevention and care for LBW infants and also increasing the access to maternal and child health services, especially in eastern Indonesia.

Kata Kunci : Kematian neonatal, kunjungan neonatal pertama, kualitas pelayanan, BBLR, SDKI/Neonatal death, first neonatal visit, quality of care, LBW, IDHS.