Evaluasi pelayanan MTBS terhadap kesembuhan Pneumonia pada anak Balita di Puskesmas Kabupaten Bungo Propinsi Jambi

NURHAYATI, Prof.dr. Djaswadi Dasuki, MPH.,SpOG(K).,Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kes. Ibu dan Anak-Ke

Latar Belakang: Kematian bayi dan halita merupakan mesalah di Indonesia, terutama disebabkan penyakit infeksi antara lain pneumonia. Dari data SUivei Demografi dan Kesehatan Indonesia (SDKI) tahun 2002~ 2003 angka kematian bayi 35 per 1000 kelahiran hidup dan angka kematian balita (AKBA) 46 per 1000 kelahilran.Sejak tahun 1997 Depkes melaksanakan MTBS di puskesmas dalam usaha meningkatkan cakupan penemuan dan tatalaksana pneumonia pada anak balita. Di Propinsi Jambi angka kematian bayi masih tinggi 41 per kelahiran hidup dan di Kabupaten Bungo kematian bayi ada 93 dari 6108 kelahiran hidup (15.2%) tahun 2005. Ada 9 orang bayi dan anak balita meninggal setiap tahun, rata-rata setiap bulan ada 1 orang anak balita (10%), disebabkan pneumonia. Dengan kata lain ada 3 kematian anak balita setiap tatum di puskesmas di sebabkan pneumonia. Untuk mengatasi kematian tersebut salah satu upaya puskesmas melaksanakan pelayanan MTBS standar namun pelaksanaan program MTBS masih menemui kendala dan hambatan di lapangan. Tujuan: Mengetahui hasil pelayanan MTBS yang standar temadap kesembuhan pneumonia anak balita di Puskesmas Kabupaten Bungo Propinsi Jambi tahun 2007. Metode: Penelitian ini menggunakan desain analitik oIbservasional rancangan Prospedive Cohort dengan pengambj.lan sampel teknik purposive sampling. Kelompok terpapar pelaysnan MTBS standar dan kelornpok yang terpapar pelayanan MTBS yang tidak standar. Subjek penelitian anak balita yang menderita pneumonia umur 2 bulan sampai dengan 5 tahun berjumlah 124 orang, a = 0,05 dan ~ = 20 %. Data di analisis univariabel, bivariabel dan multivariabel. Uji hipotesis yang digunakan chi-square, tingkat kemaknaan p<0,05 confidence interval 95% dan regression logistic. Hasil: Terdapat hubungan bermakna antara pelayanan MTBS standar dengan jarak ke puskesmas dan pendidikan ibu terhadap kesembuhan pneumonia anak balita (OR=3,14 CI95%=1,59-6,21 p=O,OO),(OR=1,68 CI95%=1,09-2,52 p=O,OO) dan (OR=0,57 CI95%=0,35-0,92 p=0,(2). Penghasilan keluarga tidak menunjukkan hubungan yang bermakna dengan kesembuhan pneumonia pada anak balita. Kesimpulan: Pelayanan MTBS yang standar memberikan peluang labih tinggi dalam kesembuhan pneumonia pada anak balita dibandingkan dangan pelayanan MTBS yang tidak standar.

Background: Infant and under-five children mortality remains a major problem in Indonesia, especially caused by infectious diseases such as pneumonia. Based on the 2002-2003 Indonesia’s Demographic and Health Survey, infant and underfive mortality rates are 35 per 1000 live births and 46 per 1000 live births, respectively. Nationally, Health Office has implemented IMCI (Integrated Management of Childhood Illness) in primary health centers (PHCs) since 1997 to improve the coverage of pneumonia finding in under-five children. In 2005, infant mortality rate in Jambi Province was still high, that is, 41 per 1000 live births while infant mortality rate in Bungo District was 93 per 6108 live births (15.2%). Each year, there are 9 babies and 1 under five child that die and for the average there is one under five child (10%) who die because of pneumonia. In other words, there are three under five children who die every year in primary health center due to pneumonia. To avoid the death of infant and under five children, primary health center should implement standard IMCI program, yet in field it has still been facing obstacles and constraints. Objective: To investigate the results of standard IMCI service toward the recovery of under-five pneumonia in primary health centers of Bungo District in 2007. Method: This was an analytical and observational study with a prospective cohort study design. Sampling technique employed was purposive sampling. There were two groups in this study, namely case group which was exposed with the standard IMCI service and group which was exposed with non standard IMCI service. One hundred and twenty-four subjects were under-five children 2 months-5 years of age presenting pneumonia with α = 0.05 and β = 20%. Data were analyzed with univariable, bivariable, and multivariable analyses and hypothesis test used was chi-square with p<0.05, CI 95% and logistic regression. Results: There was a significant relationship between the standard IMCI service, the distance to the PHC and the mothers’ education and the recovery of underfive pneumonia (OR=3.14 CI 95%=1.59-6.21 p=0.00; OR=1.68 CI 95%=1.09- 2.57 p=0.00; OR=0.57 CI 95%=0.35-0.92 p=0.02, respectively). However, family income had an insignificant relationship with under-five pneumonia. Conclusion: The standard IMCI services have a greater chance toward the recovery of under-five pneumonia compared to non standard IMCI services.

Kata Kunci : Pneumonia Balita,Layanan MTBS, Standard, IMCI, recovery, pneumonia, under-five children