Analisis spasial aksesibilitas dan kinerja bidan di desa dalam program perbaikan kurang gizi pada balita di Kecamatan Kembang Tanjong Kabupaten Pidie NAD

MAHDINUR, Prof. dr. Hari Kusnanto, DrPH

2010 | Tesis | S2 IKM-Sistem Informasi Manajemen Kesehatan

Latar Belakang : Prevalensi KEP total di Kembang Tanjong 19,82% dan 2,73% diantaranya gizi buruk masih diatas prevalensi nasional yakni 18,4%. Keadaan geografis yang sulit dengan 51,11% tidak ditempati bidan di desa dan banyak balita kurang gizi ditemukan di desa-desa terpencil. Kemudahan akses dari atau ke pusat layanan kesehatan dimana faktor jarak, waktu dan biaya akan sangat menentukan pemerataan dan keterjangkauan pelayanan kesehatan terutama bidan di desa dalam melakukan kunjungan rumah balita kurang gizi. Aksesibilitas bidan di desa melalui kunjungan rumah akan menghasilkan kinerja bidan di desa dalam program perbaikan kurang gizi pada balita. Dengan menggunakan sistem informasi geografis (SIG) akan tersedia informasi data secara spasial yang akan menggambarkan aksesibilitas dan kinerja bidan di desa dalam program perbaikan kurang gizi pada balita yang dapat digunakan sebagai sarana pendukung keputusan dalam penanganan balita kurang gizi dan penempatan bidan di desa di Kabupaten Pidie, sehingga keputusan yang diambil lebih terarah, efisien dan efektif. Tujuan Penelitian : untuk mengetahui aksesibilitas dan kinerja bidan di desa dalam program perbaikan kurang gizi pada balita secara spasial serta mengetahui hubungan aksesibilitas dan karakteristik bidan di desa dengan kinerja bidan di desa yang dinilai berdasarkan lamanya pemulihan balita kurang gizi di Kecamatan Kembang Tanjong Kabupaten Pidie. Metode Penelitian : Jenis penelitian survey deskriptif analitik dengan rancangan crossectional menggunakan total sampling yang berjumlah 182 balita kurang gizi di wilayah kerja bidan di desa dan 22 bidan di desa di Kec Kembang Tanjong. Variabel dependen adalah kinerja bidan di desa berdasarkan lamanya pemulihan balita kurang gizi dan independen adalah aksesibilitas dan karakteristik bidan di desa. Pemetaan lokasi subjek penelitian ditentukan dengan peralatan GPS dan analisis data spasial dengan clustering menggunakan satscan, selanjutnya untuk mengetahui hubungan karakteristik dan aksesibilitas bidan di desa dengan lamanya pemulihan balita kurang gizi menggunakan Geoda. Hasil : Aksesibilitas dengan kinerja bidan di desa, hanya faktor biaya ibu balita yang berhubungan secara bermakna dengan kinerja bidan di desa berdasarkan lamanya pemulihan balita kurang gizi (p=0.0011), sedangkan faktor jarak tempuh dan waktu tempuh tidak berhubungan secara bermakna. Karakteristik dengan kinerja bidan di desa, hanya faktor pendidikan yang berhubungan secara bermakna dengan kinerja bidan di desa berdasarkan lamanya pemulihan kurang gizi (p=0,035), sedangkan status gizi kurang dan gizi buruk terdapat perbedaan yang bermakna terhadap lamanya pemulihan balita kurang gizi (p=0,004). Kesimpulan : Kinerja bidan di desa dalam program perbaikan kurang gizi berdasarkan lamanya pemulihan balita kurang gizi sebagian besar berkinerja kurang baik. Kemudian terdapat clustering balita kurang gizi menurut lamanya pemulihan gizi dan juga bidan di desa menurut wilayah kerjanya dan prevalensi gizi buruk. Aksesibilitas menurut jarak tempuh lebih banyak berjarak dekat, sebagian besar dengan waktu tempuh tidak lama, dan balita status gizi buruk hampir semua mengeluhkan biaya mahal untuk mengakses pelayanan gizi

Background: The total prevalence of KEP in Kembang Tanjong Subdistrict, i.e. 19.82% and 2.73%, including malnutrition, is still above the national prevalence of 18.4%. The difficult geographical fields of 51.11% are not occupied by village midwife and many infants with malnutrition are found in remote villages. The accessibility from or to public health centers is low, where factors of distance, time, and cost will highly determine the distribution and accessibility of health service mainly for village midwife in visiting houses where infants with malnutrition live. The accessibility of village midwife based on house visit will increase village midwife performance in malnutrition improvement program for infants. Using the Geographic Information System (GIS), information on spatial data will be available, describing the village midwife accessibility and performance in malnutrition improvement program for infants, which can be used as a supportive media of handling the problem of infants with malnutrition, and placing village midwives in Pidie District. It can be expected that by the program, decisions made will be more oriented, effective, and efficient. Objectives: The study is to find out the village midwife accessibility and performance in malnutrition improvement program for infants with a spatial approach and to find out the relationship between both accessibility and characteristics of village midwives and their performance that can be assessed on the base of the duration of malnutrition recovery in Kembang Tanjong Subdistrict Pidie District. Method: A descriptive analytical method was used with cross-sectional design. The total sample was 182 infants with malnutrition in the work areas of village midwives and 22 village midwives in Kembang Tanjong Subdistrict. A dependent variable was the village midwife performance based on the duration of malnutrition recovery, while independent variables were the accessibility and characteristics of village midwives. The mapping of location among the subjects of study was determined by using the GPS equipment and the analysis of spatial data by using the clustering with satscan. To find out relationship between the accessibility and characteristics of village midwife according to the duration of malnutrition recovery, Geoda was used. Result : Related to village midwife accessibility and performance, only the cost factor of mother’s infant has a significant correlation with village midwife performance on the base of the duration of malnutrition recovery (p=0.0011), while factor of distance and time did not have a significant correlation. Related to the characteristics and the village midwife performance, only the factor of education has a significant correlation with the village midwife performance on the base of the duration of malnutrition recovery (p=0.035), while the status of malnutrition has a significant difference on the base of the duration of malnutrition recovery (p=0.004). Conclusion: Village midwife performance in malnutrition improvement program on the base of the duration of malnutrition recovery was largely less good. There occurred the clustering of malnutrition according to the duration of malnutrition recovery and village midwife on the base of work areas and the prevalence of malnutrition. Related to the accessibility, the distance was shorter, most areas did not take much time, and almost all the mothers’ infants with malnutrition complained on the expensive costs for nutrition service access.

Kata Kunci : Aksesibilitas,Kinerja bidan di desa,Analisis spasial,Balita kurang gizi, accessibility, village midwife performance, spatial analysis, malnutrition