Professional Documents
Culture Documents
Indonesia?
http://www.geographylwc.org.uk/A/AS/ASpopulation/DTM.htm
Turunnya Angka Kematian
Revolusi Pertanian yang meningkatkan
produksi Pertanian, sehingga suplai Makanan
meningkat
Perbaikan Kesehatan Masyarakat yang
“beyond” Pelayanan kesehatan:
– Suplai air bersih dan aman, pengelolaan air limbah,
penata-laksanaan pangan, dan pola hidup bersih
dan sehat
– Pemberdayaan perempuan: melek huruf yang
dikaitkan dengan pendidikan kesehatatan
masyarakat – pola hidup bersih dan sehat
Source: Keith Montgomery THE DEMOGRAPHIC TRANSITION
http://www.uwmc.uwc.edu/geography/demotrans/demtran.htm diakses 3 September 2013
CBR DAN CDR INDONESIA
Total Pop Trend
Region
100.0
100.0 100.0 100.0 100.0 100.0
Total (N=888
(N=1738) (N=3333) (N=587) (N=979) (N=7524)
)
Uncorrected
Maternal Mortality
114 99 148 200 189 121
Ratio per 100.000
live births
Maternal Mortality
Ratio per 100.000 262 227 340 459 434 278
live births*
*after correction with completeness - divided by 0,4352
Determinan Kematian Maternal_kajian Litbangkes
AGE
CHARACTERISTIC
Legend : 1. Pregnancy with abortive outcome, 2. Edema, proteinuria, and hypertensive disorder (HDK), 3. Placenta previa,
premature separation of placenta and Antepartum hemorrhage, 4. Other maternal care related to fetus and amniotic cavity and
possible delivery problems, 5. Obstructed Labor, 6. Postpartum hemorrhage (PPP), 7. Other complications of pregnant and
delivery, 8. Complication predominantly related puerperium and other conditions
Saat Meninggal
No Saat meninggal n %
1 Hamil ≤ 20 minggu 543 7.22
2 Hamil > 20 minggu 1372 18.24
3 Persalinan 974 12.95
4 Nifas 4634 61.59
Total 7524 100.00
Kematian Ibu paling sering terjadi dalam tempo 2x24 jam setelah
persalinan, pemantauan pasca persalinan adalah suatu keniscayaan
Determinan Kematian Maternal_kajian Litbangkes
12
Tempat Meninggal
Catatan:
•NTT menerapkan revolusi KIA dan menargetkan pada tahun 2012 melahirkan di
rumah menjadi 30 %, namun SDKI 2012 menunjukkan masih 59% ibu melahirkan di
rumah!
20 Highest Medical Causes
of Maternal Death
Code
NO Rank Causes of death N %
ICD 10
1 O72 Post partum hemorrhage 1533 20.4
2 O15 Eclampsia 1222 16.2
Hypertension and Edema disorders
O10-
3 694 9.2
O13,O16
4 O14 Pre-eclampsia 535 7.1
5 O99.4 Diseases of circulatory system 480 6.4
6 O00-O08 311 4.1
Abortion outcome (abortion, KET, Mola Hidatidosa)
7 O98.0 Tuberculosis 307 4.1
8 O85 Puerperal sepsis 222 2.9
9 O99.5 Diseases of Respiratory System 196 2.6
10 O46 Antepartum Haemorrhage 174 2.3
11 O99.8 Other specific diseases & condition 167 2.2
12 O90.3 Cardio-myopathy in puerperium 126 1.7
13 O32 Mal-presentation of fetus 108 1.4
14 O88 Obstetric embolism 82 1.1
15 O36 Suspect fetal problems 80 1.1
16 O63 Long Labour 77 1
17 O42 Premature ruptur membran 74 1
18 O44 Placenta previa 72 1
19 O45 75 1
Premature separation of placenta(abruptio placenta)
20 O21 Excessive vomiting in pregnancy 66 0.9
Kinerja Yankes
(RISKESDAS 2010)
Region
Kalimanta Indonesia
Sumatera Jawa-Bali Sulawesi IBT
n
MMR 262 227 340 459 434 278
Services Performance (Data Riskesdas 2010)
Who provided ANC
~ Heath Workers (Nakes) 83.2 86.9 79.9 69.6 73.6 83.8
(N=3945334 (N=112935 (N=411173 (N=5674491
(N=883320) (N=321729)
) ) ) )
No of ANC visits (K4)
~ K4 (4 visits) 65.3 77.5 62.0 41.8 63.1 71.5
(N=3388520 (N=222236 (N=4563693
(N=634543) (N=76389) (N=242005)
) ) )
Who attended delivery (Linakes)
~ Health Workers 86.1 80.1 68.5 63.6 67.9 78.6
(N=3587247 (N=363598 (N=5239801
(N=903425) (N=96134) (N=289397)
) ) )
PNC visits (KF1)
~ Visit on day 1-3 71.8 60.6 79.4 85.3 68.9 65.1
(N=530903) (N=2142836) (N=80601) (N=351555) (N=197513) (N=3303408)
(87%)
(60.5%)
Region
Indonesia
Sumatera Jawa-Bali Kalimantan Sulawesi IBT
9 KRITERIA PONEK
Ketersedian kamar operasi yang siap 24 jam untuk
kepentingan gawat darurat obstetrik & neonatal
(PONEK)
Ketersediaan kamar bersalin yang terhubung dengan
kamar operasi dalam 30 menit
Tersedia tim medis yang siap untuk melaksankan
tindakan gawat darurat obstetrik
Ketersediaan layanan transfusi darah selama 24 jam
dalam sehari
Dukungan staf umum pada PONEK
Laboratorium siap selama 24 jam dalam sehari
Radiologi siap selama 24 dalam sehari
Ruang pemulihan siap selama 24 jam dalam sehari
Ketersediaan obat dan
Determinan Kematian alat kesehatan
Maternal_kajian Litbangkes
24
No of children
100.0
1-2 4.4 31.2 3.4 1.6 0.8 18 7.3 33.2 (N=4138)
100.0
3-4 3.8 35.1 2.8 1.4 0.5 23 6.6 26.8 (N=2136)
100.0
>4 4 30.5 3.6 2.2 1.3 25.2 7.3 26 (N=1103)
Legend : 1. Pregnancy with abortive outcome, 2. Oedema, proteinuria, and hypertensive disorder
(HDK), 3. Placenta previa, premature separation of placenta and Antepartum haemorrhage, 4. Other
maternal care related to fetus and amniotic cavity and possible delivery problems, 5. Obstructed
Labour, 6. Postpartum haemorrhage (PPP), 7. Other complications of pregnanct and delivery, 8.
Complication predominantly related puerperium and other conditions
Determinan Kematian Maternal_kajian Litbangkes
30
PENDIDIKAN IBU
Mothers
Underlying cause of maternal death
Total
characteristics 1* 2* 3* 4* 5* 6* 7* 8*
Educational level
No
schooling/P 100.0
3.4 29.4 3.5 1.3 1 25.4 6.9 29.1
rimary (N=3604)
compl
Secondary / 100.0
4.9 34.9 3.4 1.9 0.5 15.9 7.3 31.1
high school (N=500)
100.0
Tertiary 3.4 34.1 0.8 1 1.6 17.4 8 33.7 (N=2740
)
Legend : 1. Pregnancy with abortive outcome, 2. Oedema, proteinuria, and hypertensive disorder
(HDK), 3. Placenta previa, premature separation of placenta and Antepartum haemorrhage, 4. Other
maternal care related to fetus and amniotic cavity and possible delivery problems, 5. Obstructed
Labour, 6. Postpartum haemorrhage (PPP), 7. Other complications of pregnanct and delivery, 8.
Complication predominantly related puerperium and other conditions
Determinan Kematian Maternal_kajian Litbangkes
31
Penyebab Kematian
(Perkotaan vs Perdesaan)
Underlying cause of maternal death
Mother
characteristics Total
1* 2* 3* 4* 5* 6* 7* 8*
100.0
Urban 4.6 36.2 3.6 1.5 0.8 14.3 6.6 32.5 (N=2740)
100.0
Rural 3.9 30.2 3.1 1.7 0.8 23.8 7.4 29.1 (N=4784)
Legend : 1. Pregnancy with abortive outcome, 2. Oedema, proteinuria, and hypertensive disorder
(HDK), 3. Placenta previa, premature separation of placenta and Antepartum haemorrhage, 4.
Other maternal care related to fetus and amniotic cavity and possible delivery problems, 5.
Obstructed Labour, 6. Postpartum haemorrhage (PPP), 7. Other complications of pregnanct and
delivery, 8. Complication predominantly related puerperium and other conditions
KESIMPULAN
Penyebab AKI langsung adalah 77,2% dan
tidak langsung adalah 22,8%
Penyebab tidak langsung di Jawa Bali dan
IBT lebih tinggi dari daerah lain. Penyakit
kardiovaskuler dan TB di Jawa Bali, dan TB
+ Malaria di IBT
Penyebab langsung yang tertinggi adalah:
eklampsia (32,4%) dan perdarahan pasca
persalinan atau PPP (20,3%)
36
KESIMPULAN
Agenda Aksi
Turunkan kesenjangan aksesibilitas dan
kualitas fasyankes KIA
Pada kondisi fasilitas yang minimal, maka
diperlukan improving collaboration
Cegah kehamilan risiko tinggi: < 20 tahun
(kehamilan remaja) dan usia di atas 35
tahun
Pemberdayaan perempuan yang dikaitkan
dengan PHBS dan intervensi kesehatan
masyarakat adalah keniscayaan.
38
Agenda Aksi
Dwiana Ocviyanti MD1,2, Sabarinah Prasetyo PhD 3, Asri Adisasmita PhD 3, Prof. Endy Moegni MD 1,2, Imran
Pambudi MD 4, Laurensia Lawintono MSc 5, Lhuri Dwianti Rahmartani MD 1,2, Allan Taufiq Rivai MD 1,2,
Samuel Josafat Olam MD 1,2, Noviyanti Rosmaniar 3 , Fitra Yelda M. Epid 3, RUSTINI FLORANITA 6, MARTIN W.
WEBER Dr. med. habil. 6 and the Indonesian Maternal and Neonatal Quality of Care Assessment Group
Affiliations
Country Caucus Meeting @Women Deliver Conference, 29 May 2013 Kuala Lumpur
Background
From 1992 to 2010, percentage of skilled birth
attendance increased from 41% to 82% in
Indonesia
Maternal and infant mortality remain high in
Indonesia:
– Maternal mortality ratio = 228/100,000 live births,
– Infant mortality ratio = 31/1,000 live births
– Neonatal mortality ratio = 19/1,000 live births
Observations, anecdotes and small scale
studies indicated that the quality of care is
often low.
Methods Assessors:
•20 obstetricians
Data collection Sampled health •20 physicians
period: facilities: •20 midwives
19 Feb – 3 Mar •20 hospitals •20 MoH staffs
2012 •40 health centers •20 UN agency
•40 midwifery clinics staffs
How to assess quality of
care for mothers and
newborn in Indonesia?
Based on international
standards (e.g. WHO IMPAC
guidelines) and national
standards (e.g. Maternal
health pocket book, CEONC,
BEONC, and Baby friendly
hospital standards)
Problem oriented: all main
areas assessed
Action oriented : identification
of areas most in need for
improvement and of action
plan
Participatory: involvement of
health professionals (and
users) in the assessment
Assessment tools on quality of care for mothers and
newborns in Indonesia
Antenatal care
Normal care
delivery
Postnatal care
Main weakness in quality of
antenatal care
/ r r o r n
m ge ia v e c y bo b a
u
rt ha ps f e in an l a la r e
a
tp orr m m n g n ed s a
s a
l ia rtu d i e g r m g e on
Po aem c
e ps pa e p r t e o n C a t i
H -
e m st e
l ly r e ol e c
r
P cla B r P P r s
o a
Main weakness in
management of
complications at hospital
level (1)
Weakness:
PPH Incomplete medical record
Lack of competencies of
health provider in shock
management
Incomplete lab test
Eclampsia-preeclampsia Irrational use of antibiotics
Poor diagnosis and
management of shock cases
Poor counseling on post
Ministry of Health RI
Indonesian Midwives
Association
Medical Doctor,
University of Indonesia