Evaluasi Implementasi Program Deteksi Dini Hepatitis B Pada Ibu Hamil Di Kabupaten Sleman Tahun 2019-2021

Yusup Maulana, dr. Vicka Oktaria, MPH, Ph.D. ; Dr. dr. Tunjung Wibowo, MPH, Sp. A(K)

2023 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Penyakit Hepatitis B merupakan masalah kesehatan masyarakat di negara berkembang di dunia, termasuk di Indonesia. Ibu hamil adalah salah satu kelompok populasi yang beresiko tertular Hepatitis B dari pasangannya. Langkah awal pencegahan penularan secara vertikal adalah dengan mengetahui status HBsAg ibu hamil. Tujuan penelitian ini adalah untuk mengevaluasi implementasi program Deteksi Dini Hepatitis B (DDHB) pada Ibu Hamil di Kabupaten Sleman tahun 2019-2021.

 

Metode: Penelitian ini terdiri 3 sub studi penelitian. Penelitian pertama mengevaluasi sistem surveilans dengan metode diskriptif. Responden terdiri dari 26 pengelola program Hepatitis B baik di Puskesmas dan Dinas Kesehatan.  Peneletian kedua mengevaluasi program DDHB dan pemeriksaan HBsAg bayi usia 9-12 bulan pasca HBIg dengan metode diskriptif. Total 24 responden untuk sub studi kedua terdiri dari pemegang program Hepatitis B, staf laboratorium, staf logistik dan penanggung jawab Hepatitis B di rumah sakit. Kuesioner terstandar dan observasi langsung digunakan dalam penelitian pertama dan kedua.  Penelitian ketiga terkait efek infeksi hepatitis B terhadap komplikasi kehamilan dan bayi yang dilahirkan di Kabupaten Sleman Tahun 2019-2021 dengan cohort retrospective. Sub studi ke tiga menggunakan data rekam medis di 6 rumah sakit yang dipilih dengan purposive sampling. Sampel berjumlah 270 ibu hamil yang terekam di rekam medis rumah sakit. Fisher exact dan regresi logistik digunakan dalam penelitian ini

 

Hasil: Sub sudi evaluasi surveilans terkait pencatatan dan pelaporan sederhana dan mudah dipahami. Sistem surveilans sudah berjalan sesuai dengan pedoman. Kelamahan dalam sistem surveilans diantaranya data dari petugas kurang lengkap, kurangnya koordinasi antar petugas, beban tugas dilayanan dan supervisi belum dilakukan oleh dinas kesehatan. Sub studi evaluasi program, didapatkan kegiatan DDHB dilakukan terintegrasi dengan ANC (Antenatal Care) terpadu. Pemeriksaan dengan HBsAg dan pemberian HBIg difasilitasi gratis oleh pemerintah daerah. Follow up pada bayi pasca HBIg belum dilakukan dari tahun 2019-2021. Sub studi analatik terkait efek infeksi hepatitis terhadap bayi yang dilahirkan, antara lain BBLR mempunyai hubungan bermakna secara statistik (aOR:4,97; 95% CI 1.37-17,98) dan lahir mati tidak berhubungan.

 

Kesimpulan: Implementasi deteksi dini Hepatitis B pada ibu hamil di Kabupaten Sleman berjalan dengan baik. Inovasi program, penguatan koordinasi dan kerjasama antar bidang diperlukan untuk luaran program yang lebih optimal.

 

 

Kata Kunci: Hepatitis B, Evaaluasi surveilans, Evaluasi Program, Sleman

Background: Hepatitis B is a public health problem in developing countries, including Indonesia. Pregnant women are one of the population groups at risk of contracting Hepatitis B from their partners. The first step to prevent vertical transmission is to know the HBsAg status of pregnant women. This study aimed to evaluate the implementation of the Early Detection of Hepatitis B (EDHB) program for Pregnant Women in Sleman Regency in 2019-2021.

 

Methods: This study consisted of 3 sub-research studies. The first study evaluated the surveillance system with descriptive methods. Respondents consisted of 26 Hepatitis B program managers at both the Public Health Centers and the District Health Office. The second study used descriptive methods to evaluate the EDHB program and HBsAg testing of infants aged 9-12 months post-HBIg. A total of 24 respondents for the second sub-study consisted of Hepatitis B program holders, laboratory staff, logistics staff and hospital Hepatitis B program holder. Standardized questionnaires and direct observation were used in the first and second studies. The third study was related to the effect of Hepatitis B infection on pregnancy complications and babies born in Sleman Regency in 2019-2021 with a retrospective cohort. The third sub-study used medical records data in 6 hospitals selected by purposive sampling. The sample totaled 270 pregnant women recorded in hospital medical records. Fisher exact and logistic regression were used in this study.

 

Results: The surveillance evaluation sub-study on recording and reporting is simple and easy to understand. The surveillance system has been running under the guidelines. Weaknesses in the surveillance system include incomplete data from officers, lack of coordination between officers, workload in the service, and supervision that has yet to be carried out by the health office. The program evaluation sub-study found that EDHB activities were integrated with integrated ANC (Antenatal Care). Testing with HBsAg and providing HBIg is facilitated free of charge by the local government. Follow-up on post-HBIg infants has not been carried out from 2019-2021. Analytical sub-studies related to the effects of hepatitis infection on babies born, including LBW, had a statistically significant association (aOR: 4.97; 95% CI 1,37-17.98), and stillbirth was not associated.

 

Conclusion: The implementation of early detection of Hepatitis B in pregnant women in Sleman District is running well. Program innovation, strengthening coordination and cooperation between sectors are needed for optimal program outcomes.

 

 

Keywords: Hepatitis B, surveillance evaluation, program evaluation, Sleman.

Kata Kunci : Hepatitis B, Evaaluasi surveilans, Evaluasi Program, Sleman