Upload
silvestri-purba
View
102
Download
2
Tags:
Embed Size (px)
DESCRIPTION
Maternal & Child Healthcare
Citation preview
Dr. dr. SHIRLEY I. MONINGKEY MkesFamily and community departmentFoM Pelita Harapan University
>200 million women become pregnant each year585,000 women die each year20 million women develop chronic debilitating illnesses as a result of pregnancy-related complication75 million unwanted pregnancies50 million induced abortions20 million unsafe abortions (same as above)600,000 maternal deaths (1 per minute)1 maternal death = 30 maternal morbidities*
3 million neonatal deaths (first week of life)3 million stillbirths
*
Annually, 585,000 women die of pregnancy related complications 99% in developing world~ 1% in developed countries*
380 women become pregnant190 women face unplanned or unwanted pregnancy110 women experience a pregnancy related complication40 women have an unsafe abortion1 woman dies from a pregnancy-related complication*Every Minute...
50% (5.767) kematian ibu25% (2.884) kematian ibu25% (2.883) kematian ibuSumber: Laporan rutin KIA, 2010 & koreksi jumlah kematian ibu dg AKI menurut SDKI 2007
Chart1
837
668
627
250
208
168
156
152
150
130
121
120
120
116
113
105
97
94
83
78
77
77
73
71
60
56
55
53
50
42
40
39
32
2011
Sheet1
2011
JAWA BARAT837
JAWA TENGAH668
JAWA TIMUR627
BANTEN250259050.61
NUSA TENGGARA TIMUR208123324.09
SUMATERA UTARA168129525.30
ACEH1565118100.00
LAMPUNG152
RIAU150
NUSA TENGGARA BARAT130
SUMATERA SELATAN121
SUMATERA BARAT120
KALIMANTAN SELATAN120
SULAWESI SELATAN116
KALIMANTAN BARAT113
SULAWESI TENGAH105
SULAWESI TENGGARA97
KALIMANTAN TIMUR94
MALUKU83
DKI JAKARTA78
JAMBI77
MALUKU UTARA77
KALIMANTAN TENGAH73
SULAWESI UTARA71
KEPULAUAN RIAU60
D I YOGYAKARTA56
BALI55
PAPUA53
GORONTALO50
SULAWESI BARAT42
KEPULAUAN BANGKA BELITUNG40
BENGKULU39
PAPUA BARAT32
$5,118
JUMLAH KEMATIAN IBU DAN PENYEBABNYA2012 - NOVEMBER 2013Sumber Data : Data Rutin Kesehatan Ibu 2013Sumber : Data rutin direktorat Bina kesehatan Ibu
Chart1
781514
675419
582290
237142
178118
17288
170125
15873
15174
143107
14060
137195
10667
10360
10131
10079
10075
8686
8451
8139
7717
6931
6520
6326
5923
5623
5540
4950
4726
4627
4026
3838
3711
50% kematian (2.453 kasus 2012) (1.483 Kasus 2013)
25% kematian (1.280 kasus - 2012) ( 849 kasus 2013)
25% kematian (1.253 kasus - 2012) ( 719 kasus 2013)
2012
2013
Sheet1
20122013
JAWA BARAT781514
JAWA TENGAH675419
JAWA TIMUR582290
BANTEN237142
LAMPUNG178118
NUSA TENGGARA TIMUR17288
ACEH170125
RIAU15873
KALIMANTAN BARAT15174
SUMATERA SELATAN143107
SULAWESI SELATAN14060
SUMATERA UTARA137195
KALIMANTAN TIMUR10667
KALIMANTAN SELATAN10360
DKI JAKARTA10131
SUMATERA BARAT10079
NUSA TENGGARA BARAT10075
SULAWESI TENGAH8686
SULAWESI TENGGARA8451
MALUKU UTARA8139
JAMBI7717
MALUKU6931
PAPUA6520
BALI6326
SULAWESI BARAT5923
KEPULAUAN RIAU5623
KALIMANTAN TENGAH5540
SULAWESI UTARA4950
PAPUA BARAT4726
GORONTALO4627
D I YOGYAKARTA4026
BENGKULU3838
KEPULAUAN BANGKA BELITUNG3711
Sumber : Data rutin direktorat Bina kesehatan Ibu
KECENDERUNGAN ANGKA KEMATIAN BALITA, BAYI DAN NEONATAL, 1991 -201533%43%48%37%Proporsi kematian neonatal dibanding kematian balita meningkat
Chart1
326897
305781
264658
203546
193444
193240
2014242014
142332
Neonatal Mortality Rate
Infant Mortality Rate
Underfive Mortality Rate
Sheet1
Neonatal Mortality RateInfant Mortality RateUnderfive Mortality Rate
1991326897
1995305781
1999264658
2003203546
2007193444
2012193240
201424
2015142332
2020
2025
2035
Sheet2
50% kematian (86.111)25% kematian (42.845)25% kematian (41.313)
Sources; Basic Health Survey 2007Pneumonia, 12.7 %Diarrhea 15 %NeonatalProblems 46,2 %Meningtis, 4.5 %Kongenital Anomaliies 5.7 %Unknown 3.7 % Tetanus, 1.7 %NeonatalProblems 36 %Diarrhea 17.2 %Pneumonia, 13.2 %Kongenital Anomalies4.9 %Unknown 5.5 % Meningtis, 5.1 %Tetanus, 1.5 %
JUMLAH KEMATIAN IBU DAN PENYEBABNYA2012 - NOVEMBER 2013Sumber Data : Data Rutin Kesehatan Ibu 2013Sumber : Data rutin direktorat Bina kesehatan Ibu
Chart1
781514
675419
582290
237142
178118
17288
170125
15873
15174
143107
14060
137195
10667
10360
10131
10079
10075
8686
8451
8139
7717
6931
6520
6326
5923
5623
5540
4950
4726
4627
4026
3838
3711
50% kematian (2.453 kasus 2012) (1.483 Kasus 2013)
25% kematian (1.280 kasus - 2012) ( 849 kasus 2013)
25% kematian (1.253 kasus - 2012) ( 719 kasus 2013)
2012
2013
Sheet1
20122013
JAWA BARAT781514
JAWA TENGAH675419
JAWA TIMUR582290
BANTEN237142
LAMPUNG178118
NUSA TENGGARA TIMUR17288
ACEH170125
RIAU15873
KALIMANTAN BARAT15174
SUMATERA SELATAN143107
SULAWESI SELATAN14060
SUMATERA UTARA137195
KALIMANTAN TIMUR10667
KALIMANTAN SELATAN10360
DKI JAKARTA10131
SUMATERA BARAT10079
NUSA TENGGARA BARAT10075
SULAWESI TENGAH8686
SULAWESI TENGGARA8451
MALUKU UTARA8139
JAMBI7717
MALUKU6931
PAPUA6520
BALI6326
SULAWESI BARAT5923
KEPULAUAN RIAU5623
KALIMANTAN TENGAH5540
SULAWESI UTARA4950
PAPUA BARAT4726
GORONTALO4627
D I YOGYAKARTA4026
BENGKULU3838
KEPULAUAN BANGKA BELITUNG3711
Sumber : Data rutin direktorat Bina kesehatan Ibu
KECENDERUNGAN ANGKA KEMATIAN BALITA, BAYI DAN NEONATAL, 1991 -201533%43%48%37%Proporsi kematian neonatal dibanding kematian balita meningkat
Chart1
326897
305781
264658
203546
193444
193240
2014242014
142332
Neonatal Mortality Rate
Infant Mortality Rate
Underfive Mortality Rate
Sheet1
Neonatal Mortality RateInfant Mortality RateUnderfive Mortality Rate
1991326897
1995305781
1999264658
2003203546
2007193444
2012193240
201424
2015142332
2020
2025
2035
Sheet2
*Current Approach to Reduction of Maternal Mortality
Delay in decision to seek careLack of understanding of complicationsAcceptance of maternal deathLow status of womenSocio-cultural barriers to seeking careDelay in reaching careMountains, islands, rivers poor organizationDelay in receiving careSupplies, personnelPoorly trained personnel with punitive attitudeFinances *Three Delays Model
Good quality maternal health services are not universally available and accessible> 35% receive no antenatal care ~ 50% of deliveries unattended by skilled provider ~ 70% receive no postpartum care during 1st 6 weeks following delivery*
Historical ReviewTraditional birth attendantsAntenatal care Risk screening Current ApproachSkilled attendant at delivery*
The flawed assumption: Most life-threatening obstetric complications can be predicted or prevented*
AdvantagesCommunity-basedSought out by womenLow techTeaches clean deliveryDisadvantagesTechnical skills limitedMay keep women away from life-saving interventions due to false reassuranceCurrent Approach to Reduction of Maternal Mortality*
Current Approach to Reduction of Maternal Mortality
Health system improvements:Introduction of system of health facilitiesExpansion of midwifery skillsDecreased use of home delivery and delivery by untrained birth attendantsSpread of family planningCurrent Approach to Reduction of Maternal Mortality*
Current Approach to Reduction of Maternal Mortality
*Current Approach to Reduction of Maternal Mortality85% births attended by trained personnel
Conclusion: TBAs are useful in the maternal health network, but there will not be a substantial reduction in maternal mortality by TBAs delivering clinical services aloneCurrent Approach to Reduction of Maternal Mortality*
Current Approach to Reduction of Maternal Mortality
Antenatal care clinics started in US, Australia, Scotland between 19101915New concept - screening healthy women for signs of diseaseBy 1930s large number (1200) ANC clinics opened in UKNo reduction in maternal mortalityHowever, widely used as a maternal mortality reduction strategy in 1980s and early 1990s
Is ANC important? YES!!Early detection of problems and birth preparation*
*Improvements in nutrition, sanitationAntibiotics, banked blood, surgical improvementsAntenatal careMaine 1999.
Proper training, range of skillsAssess risk factorsRecognize onset of complicationsObserve woman, monitor fetus/infantPerform essential basic interventionsRefer mother/baby to higher level of care if complications arise requiring interventions outside realm of competenceHave patience and empathy*WHO 1999.
DisadvantagesVery-poorly predictiveCostly: Removes woman to maternity waiting homesIf risk-negative, gives false security
Conclusion: Cannot identify those at risk of maternal mortality every pregnancy is at risk*
KELEMAHANPrediksi sangat burukMahal memberikan keamanan palsuSEBAGIAN BESAR WANITA YG DIMASUKKAN KELOMPOK RISIKO TINGGI TIDAK PERNAH MENGALAMI KOMPLIKASI
Pregnancy is a period of riskAny pregnant woman can have complication and dieAccurately predicting which woman will develop complication is not possibleEarly detection and management of complications is vital
Proven effectiveMalaysia: basic maternity services 320 157 Cuba: national priority 118 31China: facility based childbirth 1500 50Malaysia vs. Indonesia:Trained community midwives (2 year) vs. untrained midwives (4 years)*
komplikasiPengaruh pada ibuPengaruh pada bayiInfeksi saat hamil, STDPremature onset of labour, Kehamilan ektopik, PID, infertilitasPrematur, infeksi mata, kebutaan, pneumonia, stillbirth, sifilis congenitalhepatitisHPP, gagal liverHepatitisMalariaAnemia berat, trombosis serebralPrematur, IUGRUnwanted pregnacy,Unsafe abortion, PID, perdarahan,infertilityPeningkatan risiko mrbidits dan mortlitas, child abuse,neglectPersalinan tidak bersihInfeksi, tetanus Neonatal tetanus, sepsis
KomplikiasiPengaruh pada ibuPengaruh pada bayiAnemia beratCardiac failure B BLR, asfiksia, stillbirthPerdarahanShock, c.failure, infeksiAsfiksia, stillbirthHipertensiEklampsia, CVABBLR. Asfiksi, stillbirth Sepsis puerpuralisSeptikemia, shockSepsis pada neonatusPartus lamaFistula, ruptura uterin,prolaps, amnionitis, sepsis Stillbirth, asfiksia, sepsis, trauma lahir, cacat
Causes of maternal deathsProven interventionPostpartum HaemorrhageTreat anemiaSkilled attendant at birtPrevent/treat bleeding with correct drugsReplace fluid loss/tranfusionInfection after deliverySkilled attendantClean practiseAntibiotics if infection arises
Causes of maternal deathsProven interventionHypertension during pregnancyDetect in pregnancyRefer to hospitalTreat eclampsia with appropriate anticonvulsiveReferunconscious womanObstructed labourDetection in time and referral for operative surgeryOther direct obstetric causesRefer ectopic pregnancy for operationIndirect causesDisease-specific intervention (malaria, HIV)
Causes of neonatal deathsProven interventionInfection (septic meningitis, pneumonia, NT, congenital syphillisTT immunization, syphillis screening and treatment, clean delivery, early and exclusive breastfeeding, early recognition and management
Causes of neonatal deathsProven interventionBirth asphyxia and traumaSkilled attendant at birthEffective management of maternal obstetric complicationPreterm birth and/or low birth weightAnti-malarials at risk during pregnancyBreastfeeding counselling and supportInfection controlEarly detection and m,anagement of complicationSTD treatmentSmoking cessation
**For each woman who dies during pregnancy, 30 women suffer complications.Initiatives should include:Family planningManagement of complications of abortionManagement of complications of pregnancy and childbirth****Maternal mortality is a global tragedy, but if affects the developing world. Almost all of the deaths from pregnancy-related complications occur in the developing world.** 50% kematian ibu terjadi di 5 propinsi: Jabar, Jateng, NTT, Banten, Jatim 25% lagi terjadi 9 propinsi: Sumut, Kalbar, Sulsel, Sulteng, Lampung, NTB, Kalsel, Aceh, Sumsel Sisanya 19 propinsi menyumbang 25% kematian ibu Propinsi penyumbang kematian ibu terbesar bukan propinsi yg memiliki angka kematian ibu tertinggi maupun cakupan persalinan yg terendah Hubungan antara cakupan persalinan dengan angka kematian ibu antar propinsi di Indonesia lemah
Dengan demikian, untuk mencapai MDG, kematian ibu di propinsi2 dengan penyumbang kematian terbesar harus diturunkan secara signifikan. Penurunan jumlah kematian ini tidak selalu terkait dengan peningkatan cakupan linakes karena pada beberapa propinsi penyumbang kematian ibu terbesar, cakupan linkaes sudah tinggi. Harus ada usaha lebih dari sekedar peningkatan cakupan linakes (beyond skilled birth attendant).
***Assalamualaikum Warahmatullahi WabarakatuhSelamat siang dan salam damai sejahtera,
Yth. Ketua, Wakil Ketua dan Anggota Panja MDGs Badan Kerjasama Antar Parlemen DPR RIYth Menteri Luar NegeriYth Kepala BappenasYth Kepala Unit Kerja Presiden Bidang Pengawasan & Pengendalian Pembangunan (UKP-PPP)Hadirin sekalian yang berbahagia
Pertama-tama marilah kita panjatkan puji dan syukur kehadirat Allah SWT, Tuhan Yang Maha Esa karena berkat rahmat dan hidayah-Nya, kita dapat bersama-sama berkumpul dalam forum yang terhormat ini untuk melaksanakan Rapat Kerja pada hari ini.
*****Assalamualaikum Warahmatullahi WabarakatuhSelamat siang dan salam damai sejahtera,
Yth. Ketua, Wakil Ketua dan Anggota Panja MDGs Badan Kerjasama Antar Parlemen DPR RIYth Menteri Luar NegeriYth Kepala BappenasYth Kepala Unit Kerja Presiden Bidang Pengawasan & Pengendalian Pembangunan (UKP-PPP)Hadirin sekalian yang berbahagia
Pertama-tama marilah kita panjatkan puji dan syukur kehadirat Allah SWT, Tuhan Yang Maha Esa karena berkat rahmat dan hidayah-Nya, kita dapat bersama-sama berkumpul dalam forum yang terhormat ini untuk melaksanakan Rapat Kerja pada hari ini.
*Masih banyak tantangan yang dilaporkan dari hasil Risfaskes 2011 dan laporan rutin program KIA antara lain:70.15% Bidan tinggal di desa64.86% Bidan di Desa yang mempunyai KitBdD mampu GDON: 10.80%,BdD telah dilatih APN: 45.63%.47,4% puskesmas perawatan mampu PONED 42,6% puskesmas PONED tersedia MgSO4
Studi Banten, sebab keterlambatan 474 kematian ibu thn 2006: 45% terlambat krn pengambilan keputusan
Data SP 2010-Litbangkes 2012SP 2010 Litbangkes 2012: 49.7%-75.3% meninggal di RS pemerintah dan swasta (tgt jenis komplikasi); 17.1-37.8% di rumah sendiriStudi di Banten: 66% terlambat mencapai fasilitas rujukan
Pelayanan Rujukan (Risfaskes 2011) Risfaskes 201121% RS Pemerintah Memenuhi Kriteria Umum PONEK 52.7% RSU pemerintah dengan Dr telah terlatih PONEK 50.4 % RSU pemerintah dengan Bidan telah terlatih PONEK
Studi di Banten: 44% terlambat mendapatkan pelayanan di RS
***The most common cause of maternal mortality is hemorrhage (24.8%), followed by infection (14.9%), obstructed labor (6.9%) and unsafe abortion (12.9%). Indirect causes account for 19.8%.**Multiple factors affect WHY a woman dies during pregnancy.The three delays model:Delay in decision to see care: lack of information about problems/warning signs, social factorsDelay in reaching care: having transportation, road conditionsDelay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel****There have been many interventions implemented to try to improve maternal mortality. We will review the ones used to date.TBAs and antenatal care still play a role, but the role needs clarification.**Certain interventions can help prevent problems: active management of third stage of labor and clean delivery. Should be routine, however, pre-eclampsia and uterine atony cannot be prevented.**Traditional birth attendants: use has many advantages and disadvantages. The biggest disadvantage is that their skills are limited and may delay a woman getting to an appropriate level of care.**Midwifery skills: provision of emergency obstetric care. Untrained birth attendants are unable to provide emergency obstetric care.**Even with TBAs and other interventions, maternal mortality decreased in Sri Lanka. The reduction, however, was the greatest (maternal mortality was the lowest) after having births attended by skilled providers The governments commitment to this intervention was crucial.**TBAs are useful, but more skilled attendants are needed to substantially reduce maternal mortality.**Wide use of antenatal care in UK, US and Australia. Still maternal mortality in US 700/100.000 in 1940s.**Other interventions can make a difference, but not as substantial as skilled attendants. For example, in this graph, the implementation of antenatal care did not reduce maternal mortality in the UK. Improvements came only with skilled attendants who could provide surgical intervention if needed, and who had access to and could use appropriate antibiotics and blood products.Nevertheless, antenatal care remains an important intervention in maternal care because it provides an opportunity to detect problems and be prepared to handle them.**A skilled attendant should have a good range of skills, be able to identify problems, recognize complications early, be able to perform essential basic interventions and make referrals to appropriate levels of care when necessary.**Risk screening is another intervention that has been used. It is problematic because only about 10-15% of women who are thought to be at risk for a complication actually go on to have a problem. And most women who do develop complications have no risk factors. If risk factors are ruled out, the patient and provider develop a false sense of security, and are then not prepared when complications arise. All women, therefore, should be considered at risk.**