EVALUASI PELAKSANAAN RUJUKAN BIDAN PADA KASUS PRE-EKLAMSIABERAT DI RUMAH SAKIT UMUMPROPINSI NUSA TENGGARA BARAT

Sri Murniati, Prof. dr. Mohammad Hakimi, Sp.OG(K), Ph.D

2014 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Angka Kematian Ibu (AKI) Indonesia menempati peringkat teratas di Asia Tenggara. AKI Propinsi Nusa Tenggara Barat (NTB) masih di atas AKI nasional.Pre-eklamsia berat (PEB) merupakan salah satu penyebab kematian ibu dan kasus kasus obstetri terbanyak yang dirujuk ke Rumah Sakit Umum Propinsi Nusa Tenggara Barat (RSUP NTB).Sistem rujukan merupakan kebijakan yang ditekankan dalam konteks pelayanan kesehatan.Evaluasi terhadap sistem rujukan bidan pada kasus PEB diharapkan dapat menurunkan AKI di Propinsi NTB. Tujuan penelitian:Untuk mendapatkan gambaran pelaksanaan rujukan bidan yang dilatih PPGDON pada kasus pre-eklamsia berat di RSU Propinsi NTB. Metode penelitian:Jenis penelitian observasional, rancangan cross sectional. Pengumpulan data menggunakankuesioner. Sampel seluruh bidan yang merujuk kasus PEB keRSUP NTB dari 10Juni hingga 15 Agustus 2013. Analisis dengan uji Chi Square danRegresi Logistik untuk mengetahui pengaruh antar variabel Hasil:Analisis bivariabel menunjukkan terdapat hubungan yang bermakna antara pelatihan PPGDON dengan pelaksanaan rujukan bidan (RP = 2,94; 95% CI = 1,86-4,65), pendidikan (RP = 1,83; 95% CI = 0,56-6,00), masa kerja (RP = 1,64; 95% CI=1,05-2,56) dan analisis multivariabel menunjukkan terdapat hubungan yang bermakna antara pelatihan PPGDON dengan pelaksanaan rujukan bidan (OR=9,57;95% CI = 3,99-22,89), dengan mengontrol variabel pendidikan dan variabel masa kerja dapat memberikan kontribusi sebesar 22% untuk ketepatan pelaksanaan rujukan bidan. Kesimpulan: Pelatihan PPGDON dan masa kerja bidan memiliki pengaruh yang bermakna terhadap pelaksanaan rujukan bidan kasus PEB di RSUP NTB sedangkan pendidikan bidan tidak memiliki pengaruh yang bermakna terhadap proses tersebut.

Background: The Maternal Mortality Rate (MMR) in Indonesia is Southeast Asia's top ranking. MMR in West Nusa Tenggara (NTB) was still on the top of the national MMR. Severe pre-eclampsia (SPE) was one of the most of maternal mortality causes and obstetric cases that were refer to the General Hospital of West Nusa Tenggara. The referral system was a policy that was emphasized in the context of health care. Evaluation to the midwife referral system in the case of SPE was expected to reduce maternal mortality in the Province of West Nusa Tenggara. Objective: To get an overview of the implementation of the midwife referral which was trained by Basic Emergency Obstetric and Newborn Care Training (BEmONC) in the case of severe pre-eclampsia in general hospital of NTB Province. Research methods: The study was observational research, using cross-sectional design. Data collection was using questionnaire. Entire midwives sample referred to the SPE case to the department of NTB General Hospital from June 10th until August 15th, 2013. The analysis of data was using Chi Square test and logistic regression to determine the influence of variables. Result : The results of bivariable analysis showed a significant association between BEmONC training with the midwife referral implementation (RP = 2,94; 95% CI = 1,86-4,65), the midfive education (RP = 1,83; 95% CI = 0,56-6,00), the period of working (RP = 1,64; 95% CI=1,05-2,56). While multivariable analysis showed a significant association between BEmONC training with the midwife referral implementation (OR= 9,57; 95% CI = 3,99-22,89). By controlling the midwife education variable and the period of working variable will give the contribution of 22% on accuracy of SPE referral. Conclusion: Basic Emergency Obstetric and Newborn Care Training (BEmONC) and the midwife long period of working had significant effect on the process of midwife referral implementation in the case of SPE in NTB General Hospital Medical Center. While the midwife education had not significant effect on the process of midwife referral implementation.

Kata Kunci : Evaluasi, rujukan, bidan, pelatihan pertolongan pertama gawat darurat obstetri neonatal.