Efektivitas biaya program makanan pendamping air susu ibu (MP-ASI) pada bayi usia 6-11 bulan da anak usia 12-24 bulan di empat kabupaten/kota di Indonesia
PRAMBUDI, Herman, Prof. dr. Hamam Hadi, MS., Sc
2008 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar belakang : Akar permasalahan masalah gizi di Indonesia terletak pada krisis ekonomi yang melanda Indonesia sejak pertengahan tahun 1997. Keadaan tersebut menyebabkan makin meningkatkan jumlah keluarga miskin yang diikuti pula dengan peningkatan prevaleensi gizi kurang dan gizi buruk. Di propinsi Nusa Tenggara Barat (NTB) tahun 2005 prevalensi balita yang mengalami gizi buruk sebesar 8,4% dan gizi kurang sebesar 24,9%. Di Propinsi Bengkulu prevalensi balita mengalami gizi buruk sebesar 7,0% dan gizi kurang sebesar 19,6%. Upaya yang dilakukan pemerintah dalam menurunkan prevalensi gizi kurang/buruk adalah dengan pemberian MP-ASI (blendeed food). Pada tahun 2007 ini, kembali pemerintah secara nasional memberikan bantuan pada keluarga miskin berupa MP-ASI bubuk instan untuk bayi 6-11 bulan serta MP-ASI biskuit untuk anak 12-24 bulan. Tujuan penelitian ini adalah mengetahui efektivitas biaya (cost effectiveness) program Makanan Pendamping Air Susu Ibu (MP-ASI) pada bayi usia 6-11 bulan dan anak usia 12-24 bulan dalam meningkatkan status gizi serta membandingkan efektivitas biaya di antara empat kabupaten/kota di Indonesia Metode : Penelitian ini merupakan jenis penelitian observasional dengan pendekatan longitudinal. Lokasi penelitian di Kota Mataram, Kabupaten Lombok Barat, Kabupaten Lombok Timur dan Kabupaten Bengkulu Utara dengan waktu penelitian dilaksanakan mulai bulan Juli 2007 sampai dengan bulan Pebruari 2008. Populasi penelitian yaitu keluarga miskin yang mempunyai bayi usia 6-11 bulan dan anak usia 12-24 bulan dengan status gizi kurang yang mendapat MP-ASI, sampel pada penelitian ini berjumlah 336 bayi dan anak, yang diambil dengan cara sistematic random sampling. Variabel dalam penelitian ini : Biaya MP-ASI bubuk instan dan biskuit dan Variabel status gizi. Teknik pengumpulan data dengan wawancara dan pengukuran berat badan menggunakan alat bantu kuesioner dan alat timbang dacin, cara pengolahan dan analisis data dengan cara deskriptif dan analitik Hasil dan Kesimpulan : Terdapat perbedaan Nilai Efektivitas Biaya pemberian MP-ASI di antara 4 kabupaten/kota. Pemberian MP-ASI di Kabupaten Bengkulu Utara lebih efektif dibanding 3 kabupaten/kota lainnya jika menggunakan perubahan berat badan. Jika menggunakan perubahan Z-skor BB/U, pemberian MP-ASI bubuk instan di Kabupaten Lombok Timur lebih efektif dibanding 3 kabupaten/kota lainnya dan pada pemberian MP-ASI biskuit, kabupaten Bengkulu Utara lebih efektif dibandingkan dengan kabupaten lainnya. Jumlah rata-rata biaya yang dikeluarkan untuk pemberian MP-ASI bubuk instan selama 3 bulan Rp. 176.000,- - Rp. 198.000,- dan MP-ASI biskuit Rp. 170.815,- - Rp. 270.000,- dengan rata-rata jumlah MP-ASI yang diterima bayi sebanyak 8–9 kg dan balita 6,63 – 10,8 kg. Bayi usia 6-11 bulan yang diberikan MP-ASI bubuk instan selama 3 bulan naik berat badannya 1,01–1,45 kg dan untuk Z-skor 0,003-0,331. Sedangkan pada anak usia 12-24 bulan yang diberikan MP-ASI biskuit naik berat badannya rata-rata 0,36–0,82 kg dan Z-skor naik di Kabupaten Lombok Timur dan Bengkulu Utara masing-masing 0,227 dan 0,281 sedangkan di Kota Mataram dan Lombok Barat turun masing-masing -0,095 dan -0,152.
Background: Economic crisis which has occurred since 1997 causes increasing number of poor families and lead to increasing prevalence of malnourishment and malnutrition. In the Province of Bengkulu, the prevalence of malnutrition among children under five is 7.0% and malnourishment is 19.6%. In the Province of Nusa Tenggara Barat 2005 the prevalence of malnutrition among children under five was 8.4% and malnourishment was 24.9%. An effort that has been made by the government to minimize the prevalence of malnourishment/malnutrition is distributing industrial complementary breastfeeding for free to poor families in the form of instant powder to infants of 6-11 months and biscuits to children of 12-24 months. Objective: The study aimed to identify cost effectiveness of complementary breastfeeding program for infants of 6-11 months and children of 12-24 months in improving weight growth and compare cost effectiveness among four districts/municipality in Indonesia. Method: The study was observational with case study design. Location of the study were District of Bengkulu Utara, Mataram Municipality, District of Lombok Barat and District of Lombok Timur. The study was carried out from August 2007 to February 2008. Population of the study were poor families having malnourished infants of 6- 11 months and malnourished children of 12-24 months based on weight/age that got complementary breastfeeding. There were as many as 336 samples of infants and children taken using systematic random sampling technique. Variables of the study were cost of complementary breastfeeding and weight changes. Data collection used interview and weighing using forms of weight gain, scale and forms of cost description of complementary breastfeeding. Data processing and analysis used cost effectiveness formula. Result and Conclusion: There was difference of cost effectiveness in the supply of the complementary breastfeeding in the four districts/municipalities with as much as 0.0046 – 0.0079 for instant powder and 0.0012 – 0.0048 for biscuits. If viewed from weight changes, the supply of complementary breastfeeding at District of Bengkulu Utara was more effective than at 3 other districts/municipalities. If viewed from changes of Z-score weight/age, the supply of instant powder complementary breastfeeding at District of Lombok Timur was more effective than at three other districts/municipalities. The supply of biscuit complementary breastfeeding at District of Bengkulu Utara was more effective than at three other districts. The average amount of cost spent for the supply of instant powder complementary breastfeeding within 3 months was Rp 176,000 – Rp 198,000 and biscuit complementary breastfeeding was Rp 170,815 – Rp 270,000 with average amount of complementary breastfeeding received by infants were 8 – 9 kgs and children under five were 6.63 – 10.8kgs. Infants of 6 – 11 months supplied with instant powder complementary breastfeeding gained weight 1.01 – 1.45kgs and Z-score 0.003 – 0.331. Children of 12 – 24 months supplied with biscuit complementary breastfeeding gained weight in average as much as 0.36 – 0.82 kg and Z-score increased 0.227 at District of Lombok Timur and 0.0281 at District of Bengkulu Utara, whereas at Mataram Municipality and District of Lombok Barat Z-score decreased -0.095 and 0.152 subsequently.
Kata Kunci : MP,ASI,Makanan tambahan,Kekurangan gizi,Biaya,efektivitas,cost effectiveness, complementary breastfeeding, under-weight
