MATERNAL CARE QUALITY IN NEAR MISS AND MATERNAL MORTALITY IN YOGYAKARTA

Yuli Mawarti, Prof. dr. Mohammad Hakimi, SpOg., PhD.

2014 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Indonesia tidak berhasil menurunkan angka kematian ibu seperti yang menjadi target MDG5. Kematian ibu diketahui dengan baik terutama terjadi pada sebelum, selama dan beberapa saat setelah masa persalinan. Meningkatkan kualitas pelayanan maternal khususnya terhadap kasus-kasus maternal yang mengancam nyawa atau dengan komplikasi perlu dilakukan untuk menurunkan angka kematian ibu di Indonesia. Mengevaluasi kasus-kasus near-miss dan kematian ibu yang telah terjadi sangat berguna untuk mengetahui kualitas pelayanan maternal dan dapat digunakan sebagai cermin untuk meningkatakan kualitas pelayanan maternal. Metode: Penelitian case control dilakukan di RSUP Dr Sardjito Yogyakarta untuk subyek dari periode Januari 2011 sampai September 2012. Data diperoleh dari rekam medis dari periode tersebut dan interview terhadap petugas kesehatan terkait dilakukan untuk melengkapi data yang diperlukan. Sampel dari kelopok case (28 subyek meninggal) dan control (86 subyek near miss) dinilai dari aspek timeliness dan kepatuhan terhadap standar pelayanan. Beberapa variable luar yang mungkin berpengaruh terhadap outcome pelayanan maternal disajikan sebagai karakteristik sampel. Data Penelitian digolongkan menjadi 3 kelompok yaitu proses indikator pelayanan terhadap kematian ibu sebagai data nominal(1), timeliness terhadap kematian ibu sebagai data kontinyu (2) dan variable luar terhadap kematian ibu sebagai data nominal(3). Data dianalisis dengan logistic regression dengan Stata SE 12.1 dan disajikan sebagai OR, 95% Confidence Interval dan p. Hasil: (1) indikator proses terhadap kematian ibu: oxytocine membuat perbedaan besar pada kelompok case dan control yang diteliti dan secara statistik signifikan lebih tinggi pada kelompok control (OR=0.13 95% CI=0.02- 0.77 dan p=0.025). Magnesium sulfat sebagai terapi pada Preeklampsia/ Eklampsia tidak membuat perbedaan pada kedua kelompok yang diteliti ( OR =0.19, 95% CI= 0.03-1.47 dan p=0.113). Pemberian antibiotik sebagai profilaksis tidak memberi perbedaan yang bermakna pada kedua kelompok tersebut ( OR =0.19, 95% CI= 0.03-1.47 dan p=0.113). (2) Timeliness terhadap kematian ibu: mean response time dari semua komponen timeliness terlalu panjang dari yang diharapkan dalam setting kegawatdaruratan. Triage response time memberi perbedaan pada kedua kelompok yang diteliti dg OR=1.88, 95% CI=1.35-2.62 dan p=0.000. (3) Variabel luar: beberapa variable luar yang secara statistik signifikan memberi perbedaan pada kedua kelompok yang diteliti adalah referral status, operasi Caesar dan persalinan per vaginal. Kesimpulan: Kualitas pelayanan maternal pada kelompok control (near miss) lebih baik dari pelayanan maternal pada kelompok case (maternal mortality).

Background: Indonesia is likely fail achieving MDG5 to decrease maternal mortality to 102/100,000 live birth by 2015. Maternal death well known clustered around labour and immediate post partum period. Improving quality of maternal care is important in diminishing the third delay of maternal care and reduce maternal mortality. Quality of maternal care is consisted of structures, process and outcome of maternal care. Maternal cases with life threatening conditions will have outcome as near miss cases or maternal death. Evaluating maternal near miss and mortality cases is to identify the quality of maternal care and conduct initiatives to improve it. Methods: A case control design was conducted to identify the quality of care in maternal near miss and mortality. Data obtained from medical records and interview conducted to the respective health workers to confirm the data. Medical records used from period of 1 February 2011- 30 September 2012. Sample from each group were evaluated in term of timeliness and adherence to standard of process indicators. Some extraneous variables were also evaluated. The results of study are categorized into 3 groups; the process indicators of care toward outcome of maternal care in nominal scale (1), the timeliness toward outcome of maternal care in continuous scale (2) and extraneous variables toward outcome of maternal care in nominal scale (3). Result: (1) Process indicators: oxytocin as treatment give big difference in those groups and significantly higher in the control group (OR= 0.13, 95% CI=0.02- 0.77 and p = 0.025). Magnesium sulfate as treatment in Preeclampsia or Eclampsia give no statistically difference in both groups with (OR =0.19, 95% CI= 0.03-1.47 dan p=0.113). Antibiotic as treatment and prophylactic were not show statistically difference in both near miss and maternal death groups with p > 0.05. (2) Timeliness: The mean of all timeliness components were longer than expected. Triage response time indicated significant difference with OR=1.88, 95% CI=1.35-2.62 and p=0.000. (3) Extraneous variables: some extraneous variables statistically have significant difference between the death and near miss group, which include of referral status, caesarean section and vaginal delivery as final mode of delivery. Conclusion: The quality of care in near miss group is better than in maternal mortality group. The near miss group received better response time, especially in response time from triage. Some process indicators of quality of care were not showing any difference between those two groups and the extraneous variables may made the difference of those groups. Overall, the mother with life threatening conditions who survived accepted better quality of care compare to those who dead.

Kata Kunci : Kualitas pelayanan maternal, indikator proses, response time, timeliness, maternal near miss, maternal mortality