Evaluasi program suplemen besi pada ibu hamil terhadap berat badan lahir rendah di Kota Palu Sulawesi Tengah

TEMPALI, Sri Restu, Prof. dr. Djaswadi Dasuki, MPH., Ph.D., Sp.OG(K)

2009 | Tesis | S2 Ilmu Kedokteran Klinik

Bayi berat lahir rendah masih merupakan masalah diseluruh dunia, karena merupakan penyebab kesakitan dan kematian pada masa neonatal. Kejadian bayi berat lahir rendah diperkirakan 16% terjadi diseluruh dunia, 19 % terjadi dinegara berkembang dan 7% terjadi dinegara maju. Salah satu upaya menurunkan risiko kelahiran bayi berat lahir rendah, diantaranya dengan pemberian suplemen besi sesuai program yaitu ≥ 90 tablet pada waktu hamil. Untuk mengetahui hubungan program pemberian suplementasi besi dengan kejadian bayi berat lahir rendah di Kota Palu. Jenis penelitian adalah observasional dengan rancangan case control study. Subyek penelitian semua bayi lahir dengan berat lahir rendah, dari ibu yang mengkonsumsi suplemen besi pada waktu hamil di Kota Palu (memenuhi kriteria inklusi dan eksklusi). Besar sampel dalam penelitian ini terdiri dari kelompok kasus sebanyak 87 dan kontrol sebanyak 87, dengan perbandingan 1:1. Pengambilan sampel secara Consecutive Sampling. Analisis data menggunakan analisis univariabel, analisis bivariabel dan analisis multivariabel menggunakan permodelan logistic regression. Analisis bivariabel menunjukkan suplementasi besi tidak sesuai program (< 90 tablet) pada waktu hamil, mempunyai hubungan signifikan dengan kejadian BBLR (p=0,01). Hasil analisis multivariabel, faktor risiko terkuat penyebab kejadian BBLR adalah suplemen besi tidak sesuai program mempengaruhi sebesar 3,82 kali risiko kejadian BBLR (OR 3,82; 95% CI: 1,77- 8,22). Faktor lain yang berperan terhadap risiko kejadian BBLR adalah kadar hemoglobin (OR 3,45; CI:1,59-7,49), IMT (OR 2,27; CI:1,05-4,91), umur kehamilan (OR 3,11; 95% CI:1,45-6,67), Paritas (OR 2,98,95 %CI: 1,36-6,51), Tingkat Pendidikan (OR 2,38, 95 %CI:1,12-5,03). Pemberian suplementasi besi tidak sesuai program (< 90 tablet) pada waktu hamil merupakan faktor risiko terkuat penyebab kejadian bayi berat lahir rendah di Kota Palu. Kejadian bayi berat lahir rendah dapat diturunkan, apabila dilakukan pengontrolan yang lebih ketat terhadap pemberian suplemen besi, kadar hemoglobin, indeks massa tubuh, umur kehamilan, paritas dan tingkat pendidikan pada setiap kunjungan ibu hamil.

Low birth weight (LBW) still poses a serious problem worldwide, because it is considered a leading cause of neonatal mortality and morbidity. The prevalence of LBW is estimated to be 16% worldwide, comprising 19% in developing countries and 7% in developed countries. One effort to reduce the risk of LBW is iron supplementation that is in accordance with the program, that is, > 90 tablets during pregnancy. To study the relationship between iron supplementation program and low birth weight in Palu Municipality. This was an observational study with case control study design. Subjects were all low birth weight babies from mothers that consumed iron supplementation during pregnancy in Palu Municipality (fulfilling inclusion and exclusion criteria). Sample size in this study was 87 for case and 87 for control with comparison of 1:1. Samples were selected with consecutive sampling. The data analyses employed univariable analysis, bivariable analysis and multivariable analysis using logistic regression model. Bivariable analysis showed that iron supplementation during pregnancy that was not in accordance with the program (< 90 tablet) had a significant relationship with LBW (p=0.01), Other significant factors were abnormal hemoglobin level (p=0.01), BMI (p=0.02), low educational level (p=0.02), risk parity >2 (p=0.03), and insufficient gestational age (p=0.03). In addition, from multivariable analysis the strongest risk factor of LBW was iron supplementation that was not in accordance with the program that it affected 3.82 times greater toward the prevalence of LBW ( OR 3.82; 95%CI: 1.77- 8.22). Other factors that had a role toward the prevalence of LBW were hemoglobin level (OR 3.45; CI: 1.59-7.49), BMI (OR 2.27; CI:1.05-4.91), gestational age (OR 3.11; 95%CI: 1.45-6.67), parity (OR 2.98, 95%CI: 1.36-6.51), and educational level (OR 2.38, 95%CI: 1.12-5.03). Based on the analysis, the strongest relationship that affected the prevalence of LBW, by considering the contribution of all variables included in logistic regression analysis, which could be seen from the change of the highest OR value was iron supplementation, followed by hemoglobin level and gestational age, parity and education. Iron supplementation during pregnancy that was not in accordance with the program (< 90 tablet) was the strongest risk factor of LBW in Palu Municipality. The prevalence of LBW could be reduced if strict controlling toward iron supplementation, hemoglobin level, body mass index, gestational age, parity and education in each pregnant woman was done.

Kata Kunci : Suplemen besi,Ibu hamil,BBLR,Kota Palu,iron supplementation, pregnant women, LBW, Palu Manucipality