Studi validasi autopsi verbal kematian bayi di Kabupaten Purworejo

ERNANINGSIH, dr. Siswanto A. Wilopo, SU.,M.Sc.Sc.D

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang Masalah: Kematian bayi merupakan tragedi yang sulit dilupakan oleh ibu dan keluarga yang ditinggalkan. Data kematian berdasarkan data dari Rumah Sakit atau Hospital based cause of death kurang representatif. Community based cause of death dengan pendekatan autopsi verbal merupakan salah satu cara untuk menambah data statistik kematian. Pelaksana autopsi verbal adalah tenaga medis atau non medis yang sudah terlatih. Keterbatasan tenaga medis (bidan) tidak memungkinkan semua pelaksanaan autopsi verbal dikerjakan oleh tenaga medis, maka perlu dikembangkan metode autopsi verbal oleh tenaga non medis. Metode ini perlu divalidasi sebelum digunakan di masyarakat. Tujuan penelitian: Tujuan penelitian ini adalah mengetahui validitas autopsi verbal dilihat dari proses pengukuran yang dilakukan oleh petugas pengukur yang berbeda untuk menetapkan kesepakatan kesimpulan akhir penyebab kematian bayi antara petugas medis dan non medis dibandingkan dengan diagnosis dokter sebagai gold strandard. Cara Penelitian: Jenis penelitian ini menggunakan uji diagnostik dan rancangan penelitian kohort retrospektif. Jumlah sampel sebanyak 110 kasus, dan lama penelitian 3 bulan. Kasus diambil dari kematian bayi yang terjadi di rumah sakit selama 3 tahun kebelakang dan ditemukan catatan mediknya. Pelatihan petugas bidan dan mantri statistik selama 1 hari mengenai cara pelaksanaan autopsi verbal. Kuesioner yang digunakan adalah dari WHO yang sudah diterjemahkan kemudian dilakukan uji kuesioner. Petugas melakukan pengukuran atau wawancara dimulai dari petugas mantri statistik dan 1 minggu berikutnya adalah oleh bidan. Hasil penelitian:Hasil analisis uji kappa statistik diperoleh nilai kesepakatan antara diagnosis dokter dan autopsi verbal oleh mantri statistik adalah 0,57 dengan p-value 0,000. Hal ini berarti menunjukkan adanya kesepakatan yang cukup baik. Hasil uji kappa statistik antara bidan dan mantri statistik sebesar 0,63 dengan nilai p-value 0,000. Hal ini juga menunjukkan kesepakatan yang cukup baik. Petugas mantri statistik dapat melaksanakan autopsi verbal kematian bayi. Kesimpulan: Kesepakatan yang dicapai antara petugas medis dan non medis cukup baik, sehingga autopsi verbal dapat dilaksanakan oleh petugas mantri statistik.

Background: Infant mortality is a tragedy which cannot be easily forgotten by mothers and their family. Data on mortality from hospital or hospital-based cause of death was not representative. Community-based cause of death with verbal autopsy approach is a way to provide statistical data on mortality. Personnel of verbal autopsy are medical staff or skilled non-medical staff. Limited number of medical staff and midwifes has made all verbal autopsy processes impossible to be carried out by medical staff. Therefore a method of verbal autopsy needs to be developed by non medical staff. This method should be validated prior to its implementation. Objectives: The objective of the study was to identify verbal autopsy validity viewed from measurement process conducted by different measurement staff to reach final diagnosis agreement on cause of infant mortality between medical and non medical staff compared to doctor's diagnosis as gold standard. Methods: The study used a diagnostic test with retrospective cohort research design. Number of samples were 110 cases and length of study was 3 months. Cases were taken from infant mortality which occurred in hospitals during the last 3 years with their medical records. Training was given for 1 / day to midwifes and statistic officers on how to execute verbal autopsy. Questionnaires used were adapted from World Health Organization which had been translated and tested in on settings. Staff conducted measurement or interview with statistic officers and a week later with midwifes. Results: Analysis result of Kappa statistical test showed that value of agreement between doctor's diagnosis and verbal autopsy by statistic officers was 0.57 with p=0.00. This meant that there was good agreement. Result of Kappa statistical test between midwifes and statistic officers was 0.63 with p=0.000. This also showed good agreement between midwife verbal autopsy and statistic officer verbal autopsy. Statistic officers could conduct verbal autopsy. Conclusion: Agreement reached between statistic officers and doctor's diagnosis was quite good. Statistic officers could conduct verbal autopsy.

Kata Kunci : Kesehatan Anak,Kematian Bayi,Autopsi Verbal, verbal autopsy, validation, infant mortality, statistic officer, midwife.