Hubungan persepsi bahaya dan manfaat dengan kepatuhan ibu hamil mengkonsumsi kemoprofilaksis malaria di Kabupaten Jayapura tahun 2004
SUEBU, Yokelyn Corlina, Prof.dr. Djaswadi Dasuki, MPH.,Sp.OG.,Ph.D
2005 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang: 10.000 kematian maternal setiap tahun di Afrika akibat malaria pada kehamilan, terutama malaria falsiparum. Malaria pada kehamilan adalah komplikasi non-obstetri tersering di Papua, 4 dari 10 ibu hamil mengalami gejala klinis setidaknya sekali selama kehamilan. Praktis semua ibu hamil menderita anemia (99,3%),30 persennya tergolong anemia berat. Tahun 2002, kematian perinatal karena malaria ibu hamil di kabupaten Jayapura tertinggi kedua setelah asfiksia, sekalipun pada tahun yang sama telah mulai dijalankan program pemberian klorokuin profilaksis malaria saat ibu hamil melakukan pemeriksaan antenatal. Tujuan: mengetahui pengaruh persepsi ibu hamil tentang bahaya malaria semasa hamil dan manfaat klorokuin profilaksis terhadap kepatuhan mengkonsumsi klorokuin profilaksis. Metode: Penelitian di kabupaten Jayapura ini dilaksanakan dengan rancangan cross-sectional. Dilakukan wawancara pada 113 ibu hamil menggunakan kuesioner terstruktur, yang dilengkapi pertanyaan-pertanyaan terbuka dan wawancara mendalam. Analisis data kuantitatif berupa analisis univariable, bivariable dan multivariable. Analisis data kualitatif dengan metode thematic analysis. Hasil: Duapuluh dua persen (25/113) ibu minum obat secara teratur, 18,6 persen tidak meminum sama sekali. Malaria falsiparum merupakan prevalensi tertinggi (55,8%), malaria vivax 34,9 persen, dan oleh keduanya 9,3 persen. Primigravida paling rentan terhadap kejadian malaria semasa hamil (47,9%) dan komplikasinya (9/12). Satu kasus (0,8%) malaria klinis mengindikasikan kemungkinan kegagalan profilaksis karena resistensi. Persepsi yang baik tentang bahaya malaria masa hamil dan manfaat klorokuin profilaksis berpotensi meningkatkan kepatuhan minum obat (OR 6,3; 95% CI 2,0-20,0). Ibu hamil dari keluarga berpendapatan tinggi jauh lebih patuh (OR 9,2; 95% CI 1,8-47,9). Rasa pahit, kekuatiran akan efek buruk klorokuin terhadap janin, dan lupa untuk minum obat merupakan hambatan utama. Berhalangan mengakses layanan antenatal saat obat habis juga menurunkan keteraturan minum obat. Kesimpulan: Persepsi ibu hamil mengenai bahaya malaria semasa hamil dan manfaat klorokuin profilaksis berpengaruh terhadap kepatuhan minum klorokuin profilaksis. Ibu dengan persepsi baik memiliki peluang patuh lebih tinggi dari ibu dengan persepsi kurang baik. Pendapatan keluarga berpengaruh pula terhadap kepatuhan minum klorokuin profilaksis. Ibu hamil dari keluarga berpendapatan tinggi memiliki kemungkinan kepatuhan lebih tinggi.
Background: Approximately 10,000 maternal deaths occur in Africa every year due to malaria in pregnancy, mainly caused by falsiparum malaria. Malaria in pregnancy is the most common non-obstetrical complication in Papua, Indonesia, 4 out of 10 experience clinical symptoms at least once during their pregnancy. Almost all pregnant women suffer anemia (99.3%), 30 percent were considered as severe anemia. In year 2002, despite the launching of the program of the chemoprophylaxis provision through ANC, perinatal death caused by malaria in pregnancy was remained the second highest right after asphixia. Objectives: To asses the relationship between pregnant womens’ perception of the threat of malaria in pregnancy and the benefit of chloroquine prophylaxis, with the adherence of taking chloroquine as antimalarial chemoprophylaxis in pregnancy. Method: A cross - sectional study was conducted in Jayapura district during March and April of year 2004. A set of structured questionnaire was performed to 113 pregnant women, which was completed by open-ended questions and indepth interview. The quantitative data was analyzed using univariable, bivariable and multivariable techniques. The qualitative data was analyzed using the thematic analysis method. Result: Twenty two percent of women (25/113) took chloroquine regularly, 18.8 percent did not take it at all. Falsiparum malaria has the highest rate of prevalence (55.9%), followed by vivax malaria (34.9%), and a combined rate of both at 9.3 percent. Women at the first pregnancies marked to be more at risk of malaria (47.9%) and it complications (9/12). One case (0.8%) was suspected as a probable prophylaxis failure case. High perception of malaria risk and prophylaxis benefit increased the adherence of taking chloroquine (OR 6,3; 95% CI 2,0-20,0). Pregnant women from high-income households were more adherent (OR 9,2; 95% CI 1,8-47,9). The bitter taste, worried about chloroquine’s harmfull to foetus, and failed to remember consuming the medicine were observed a s the main barriers of adherence. The regularity of taking the medicine has also decreased by inability to access the ANC right after running out of chloroquine. Conclusion: Perception of risk and benefit influence the pregnant womens’ adherence of taking prophylaxis chloroquine. Pregnant women with higher perception were more adherent. Higher household’s income also increased the adherence of taking chloroquine.
Kata Kunci : Kesehatan Ibu Hamil, Kepatuhan Mengkonsumsi Klorokuin Profilaksis, Malaria
