HUBUNGAN DURASI INTERVAL PENANGANAN DAN KEMATIAN IBU DI RUMAH SAKIT RUJUKAN KABUPATEN BANDUNG BARAT TAHUN 2008-2012
Zumrotul Chomariyah, Prof. dr. H. M.Hakimi, SpOG.(K), Ph.D
2013 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang. Jumlah kematian ibu di Kabupaten Bandung Barat meningkat dari tahun 2009 hingga 2011, yaitu 91,67 per 100.000 kelahiran hidup (KH), 99,63 per 100.000 KH dan 117,76 per 100.000 KH. Tahun 2009, didominasi kematian ibu di rumah (60%), berubah tahun 2010 dan 2011 yang didominasi kematian di rumah sakit (51,6% dan 58,3%). Tujuan penelitian untuk mengetahui hubungan durasi interval penanganan dengan kematian ibu di rumah sakit. Metode Penelitian. Metode penelitian mixed method dengan rancangan triangulasi bersamaan. Desain penelitian matched case control. Kasus adalah ibu yang meninggal saat hamil, bersalin atau nifas. Kontrol adalah ibu yang nyaris meninggal saat hamil, bersalin atau nifas. Instrumen penelitian adalah form ekstraksi rekam medis, panduan observasi dan wawancara mendalam. Analisis menggunakan Mc Nemar, uji stratifikasi dan kondisional regresi logistik ganda. Hasil. Sampel penelitian 98 kasus dan 98 kontrol, 60,83% durasi interval evaluasi cepat, 55,10% durasi interval perawatan lambat. Risiko kematian ibu pada durasi interval evaluasi lambat meningkat 2 kali lebih dibanding ibu yang mendapat durasi interval evaluasi cepat (p=0,043; OR=2,85; 95%CI=1,033-7,853). Risiko kematian ibu pada durasi interval perawatan lambat meningkat 10 kali lebih dibanding ibu yang mendapat durasi interval perawatan cepat (p<0,01; OR=10,557; 95%CI=2,872-38,804). Keadaan saat tiba di RS merupakan variabel perancu pada hubungan durasi interval perawatan dengan kematian ibu (p=0,011; OR=4,989; 95%CI=1,438-17,31). Faktor keterlambatan pertama adalah biaya, terlambat mengenali tanda bahaya, dan motivasi dari orang sekitar. Faktor keterlambatan kedua adalah ketersediaan sarana transportasi, dan kondisi jalan. Aspek organisasi yang mempengaruhi kualitas pelayanan adalah keberadaan 24 jam di RS dari tenaga kebidanan, dan anestesi yang ditunjang pelayanan 24 jam apotik, laboratorium, kamar operasi dan bank darah lokal. Kesimpulan. Durasi interval evaluasi, durasi interval perawatan dan keadaan saat tiba di RS berhubungan dengan kematian ibu di RS. Perlu upaya meminimalkan durasi waktu menunggu dengan mendekatkan akses pelayanan penunjang menyatu IGD Kebidanan dan tenaga kebidanan dan anestesi yang on site 24 jam di RS.
Background: The maternal mortality in West Bandung Regency increased from 2009 to 2011 that was 91.67 per 100,000 life birth, 99.63 per 100,000 life birth and 117.76 per 100,000 life births. In 2009, this was dominated by maternal mortality in their home (60%), and in 2010 and 2011 was changed be dominated by mortality in the hospital (51.6% and 58.3%). The objective of this study was to knowing the correlation between the duration of treatment interval with maternal mortality in the hospital. Methods: The method of the study was mixed method by simultaneous triangulation design and matched case control design. The case group was the mother who died in their pregnancy, labor or postpartum. Control group was the mother who almost experienced near death experience in their pregnancy, labor or postpartum. The instrument of the study was form of medical record extraction, observation guideline and in depth interview. The data was analyzed used Mc Nemar test, stratification test and conditional multiple logistic regression. Results: The sample consist of 98 respondents respectively in case group and control group, 60.83% of the mother was with quick evaluation interval duration, 55.10% was with slow treatment interval duration. The maternal mortality risk in slow evaluation interval duration increased 2 times compared to the mother who get quick evaluation interval duration (p=0.043; OR=2.85; 95%CI=1.033-7.853). The mortality risk in slow treatment interval duration increased 10 times greater compared to the mother who get quick treatment interval duration (p<0.01; OR=10.557; 95%CI=2.872-38.804). The condition when hospital admission was the confounding variable to the correlation between treatment interval duration with maternal mortality (p=0.011; OR=4.989; 95%CI=1.438-17.31). The first delays factor was cost, late in recognizing the danger signs, and lack of motivation from the surrounding people. The second delays factors were transportation availability, and the condition of the road. The organizational aspect which was influencing the service quality was the readiness of midwifery worker for 24 hours in the hospital, and antesthetic which was supported by 24 hours pharmaceutical service, laboratory, surgery room, and local blood bank. Conclusion: Evaluation interval duration, treatment interval duration and the condition when hospital admission had significant correlation to the maternal mortality in the hospital. It was need an effort to minimize the waiting time duration by bring nearer the access to integrated supporting service of Midwifery Emergency Installation and midwifery workers and anesthetic that on site in 24 hours in the hospital.
Kata Kunci : Durasi interval evaluasi, durasi interval perawatan, kematian ibu.
