Faktor-faktor yang berhubungan dengan pemilihan penolong persalinan di Puskesmas Mindiptana dan Puskesmas Tanah Merah Kabupaten Boven Digoel Propinsi Papua

KAMBAYONG, Agustustina, dr. Ova Emilia, M.Med.,Sp.OG.,Ph.D

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Perilaku dan Promosi

Latar Belakang: Angka kematian ibu bersalin di Propinsi Papua masih cukup tinggi (116/100.000 kelahiran hidup) dengan penyebab kematian ibu tertinggi yaitu perdarahan (25%), infeksi (13%), dan keracunan kehamilan (17%). Pemilihan penolong persalinan antara tenaga kesehatan dan tenaga non-kesehatan diduga memiliki kaitan dengan angka kematian ibu bersalin ini. Tujuan penelitian ini adalah untuk mengetahui hubungan dari predisposing factor (umur, paritas, sikap, pengetahuan, pendidikan), enabling factor (kemudahan pelayanan dan kepuasan pelayanan) dan dukungan keluarga terhadap pemilihan penolong persalinan (nakes dan non-nakes). Metode: Jenis penelitian ini adalah observasional dengan rancangan cross sectional (potong lintang) menggunakan pendekatan kuantitatif dan kualitatif. Penelitian dilakukan di Kabupaten Boven Digoel yang terdiri atas 6 Puskesmas. Responden penelitian berjumlah 151 dan 11 responden teridentifikasi sebagai missing cases sehingga tersisa 140 kasus valid untuk dianalisis. Data yang dikumpulkan berupa data primer dan data sekunder. Data kuantitatif diperoleh dengan menyebar kuesioner dan data sekunder diperoleh melalui laporan tahunan Puskesmas dan laporan tahunan Dinas Kesehatan Boven Digoel. Data kualitatif dikumpulkan dengan teknik in-depth interview. Validitas dan reliabilitas instrumen kuantitatif diuji dengan teknik korelasi butir-total (koefisien validitas ≥ 0,3) dan pencarian koefisien alpha (koefisien alpha > 0,6) dan butir-butir sahih (valid) disertakan dalam analisis. Data kemudian dianalisis dengan analisis statistik deskriptif, analisis bivariat (Tabulasi Silang dan Chi-Square) dan analisis multivariat (regresi logistik biner). Data kualitatif dianalisis untuk melengkapi hasil analisis kuantitatif. Hasil: Berdasarkan hasil analisis bivariat diketahui tiga variabel yang berhubungan dengan ibu bersalin dalam memilih penolong persalinan, yaitu pendidikan (χ2 = 6,364; p = 0,012), sikap (χ2 = 4,668; p = 0,031) dan dukungan keluarga (χ2 = 4,223; p = 0,040). Sementara itu variabel lainnya, umur, paritas, pengetahuan, kemudahan pelayanan, kepuasan pelayanan, tidak memiliki hubungan signifikan terhadap pemilihan penolong persalinan. Hasil analisis multivariat menunjukkan bahwa terdapat dua variabel yang memiliki hubungan signifikan, yaitu pendidikan (p = 0,030) dan dukungan keluarga (p = 0,024). Nilai OR (odds ratio), diurutkan dari yang paling besar, adalah dukungan keluarga (5,238), pendidikan (3,871), kemudahan (3,523), sikap (2,842). Sedangkan variabel lain, umur, paritas, pengetahuan, kepuasan memiliki OR mendekati 1.

Background: The maternal mortality during giving birth in Papua Province has been fairly high (116/100.000 living birth) with the highest mortality causes namely blooding (25%), infection (13%) and pregnancy toxicity ((17%). The choice of delivery helpers among medical and non-medical workers has been predicted to have relationship with the maternal mortality during giving birth. This research aimed at studying the relations of predisposing factor (age, parity, attitude, knowledge, education), enabling factor (accessibility and satisfaction), and family support to the choice of delivery helpers (medical and non-medical workers). Method: This is an observational study with the cross-sectional design using quantitative and qualitative approaches. The study has been conducted in Boven Digoel District consisting of 6 Puskesmas (Community Health Centers). The number of respondents was 151 and 11 of them identified as missing cases, and the remaining 140 cases considered as valid for analysis. The primary and secondary data were collected. The quantitative data were collected using questionnaires and the secondary data were collected from the annual reports of Puskesmas and Health Offices of Boven Digoel. The qualitative data were collected using in-depth interview. The quantitative instruments were tested for validity and reliability using item-total correlation technique (validity coefficient ≥ 0.3) and alpha coefficient (alpha coefficient > 0,6) and then the valid items were taken for analysis. The data were analyzed using descriptive analysis, bivariate analysis (cross-tab and Chi-Square) and multivariate analysis (binary logistic regression). The qualitative data were analyzed to complete the quantitative results of analysis. Results: The bivariate analysis results showed that there were three variables having significant relations to the maternal choices on delivery helpers, namely education (χ2 = 6.364; p = 0.012), attitude (χ2 = 4.668; p = 0.031), and family support (χ2 = 4.223; p = 0.040). Whereas, the variables of age, parity, knowledge, service accessibility and service satisfaction did not have significant relations to choices of delivery helpers. The results of multivariate analysis showed that there were two variables having significant relations, namely education (p = 0.030) and family support (p = 0.024). The Odds ratios, from the largest values, were family support (5.238), education (3.871), accessibility (3.523), attitude (2.842). Meanwhile, the variables of age, parity, knowledge, and satisfaction had OR values near to 1.

Kata Kunci : Perilaku Sehat,Pertolongan Persalinan,Puskesmas,Delivery helper choice, medical and non-medical workers, factors related to the choice of delivery helpers