DETERMINAN AKSES PADA KEMATIAN MATERNAL DI KABUPATEN MOROWALI PROVINSI SULAWESI TENGAH

Nirmawati, dr. Ova Emilia, M.M.Ed, SpOG(K), Ph.D,

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Badan Kesehatan Dunia memperkirakan kematian maternal sebesar 529.000 setiap tahun di dunia. Di Indonesia angka kematian maternal 228/100.000 kelahiran hidup. Jumlah kematian maternal di Kabupaten Morowali rata-rata 12 pertahun. Upaya penurunan kematian ibu belum menunjukkan hasil memuaskan. Oleh karena itu perlu diketahui faktor risiko penyebabnya untuk memudahkan mengatasi masalah ini. Tujuan Penelitian: Mengetahui faktor risiko penyebab kematian maternal di Kabupaten Morowali Tahun 2007-2010 Metode: Jenis penelitian observasional dengan rancangan matched case-control study menggunakan pendekatan kuantitatif dan kualitatif. Data diperoleh dari rekam medik rumah sakit atau hasil audit maternal dan perinatal Puskesmas dan laporan kematian maternal Dinas Kesehatan Kabupaten periode 1 Januari 2007 s/d 31 Desember 2010 serta melalui indepth interview. Subjek penelitian adalah maternal meninggal sejumlah 47 kasus: 141 orang maternal yang masih hidup sebagai kontrol (1:3). Data dikumpulkan melalui wawancara dengan menggunakan kuesioner dan dianalisis dengan komputer menggunakan uji regresi logistik. Hasil : Hasil analisis bivariabel menunjukkan bahwa hanya komplikasi yang mempunyai hubungan bermakna secara statistik dengan kematian ibu di Kabupaten Morowali (p 0,00001; OR 19,8 dan CI 5,99-65,02) . Hasil analisis multivariabel menunjukkan bahwa OR pada akses pelayanan kesehatan menjadi berubah dari 1,6 menjadi (OR 2,4; CI 95% 0,93-6,15) setelah dikontrol dengan status kesehatan, status reproduksi dan komplikasi. Simpulan : Ibu yang sulit mengakses pelayanan kesehatan akan lebih besar mengalami kematian jika disertai dengan komplikasi dibandingkan dengan ibu yang tidak mengalami kematian.

Background: World Health Organization (WHO) has estimated that 529,000 maternal deaths occur each year in the world. The rate of maternal deaths or so called Maternal Mortality Ratio in Indonesia has reached 228/100,000 live births. Particularly in Morowali District is an average 12 per year. Various programs have been implemented; however, they have not shown satisfactory results. It is therefore necessary to know the risk factors to facilitate this problem. Objective: To determine the risk factors associated with the cause of maternal mortality in Morowali District in 2007-2010. Methods: This was an observational study with a matched case-control study design using quantitative and qualitative approaches. Data were obtained from medical records in hospital or the results of maternal and perinatal audit from health centers and District Health Office’s maternal death reports in the period of January 1, 2007 to December 31, 2010, and through in-depth interview to the case respondents and health workers that handled maternal mortality cases. Subjects were mothers who died totaling to 47 cases compared to 141 mothers with live birth as the control (1:3). Data were collected through interviews using a questionnaire and analyzed by computer using a logistic regression test. Results: The bivariable analysis showed that complication was the only variable that had a statistically significant relationship with maternal mortality in Morowali District. The results of multivariable analysis showed that the OR to health service access changed from 1.6 to (OR = 2.4, CI 95% = 0.93 to 6.15) after being controlled by the variable of health status, reproduction status and complication. Conclusion: Mothers who had difficulty in accessing health services would more be likely to increase mortality when accompanied by complications compared to those without complications.

Kata Kunci : Kematian maternal, Determinan, Kabupaten Morowali